Low-tube-voltage CT urography using low-concentration-iodine contrast media and iterative reconstruction: A multi-institutional randomized controlled trial for comparison with conventional CT urography

Sang Youn Kim, Jeong Yeon Cho, Joongyub Lee, Sung Il Hwang, Min Hoan Moon, Eun Ju Lee, Seong Sook Hong, Chan Kyo Kim, Kyeong Ah Kim, Sung Bin Park, Deuk Jae Sung, Yongsoo Kim, You Me Kim, Sung Il Jung, Sung Eun Rha, Dong Won Kim, Hyun Lee, Youngsup Shim, Inpyeong Hwang, Sungmin WooHyuck Jae Choi

    Research output: Contribution to journalArticlepeer-review

    18 Citations (Scopus)

    Abstract

    Objective: To compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU. Materials and Methods: This prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated. Results: The study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose (5.73 ± 4.04 vs. 8.43 ± 4.38 mSv) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ≥ 3), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group. Conclusion: The diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.

    Original languageEnglish
    Pages (from-to)1119-1129
    Number of pages11
    JournalKorean journal of radiology
    Volume19
    Issue number6
    DOIs
    Publication statusPublished - 2018 Nov 1

    Bibliographical note

    Funding Information:
    Received December 26, 2017; accepted after revision June 7, 2018. This study was supported by a grant from TAEJOON PHARM Co. Ltd., South Korea (TJC-IOB-401). Corresponding author: Jeong Yeon Cho, MD, Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. • Tel: (822) 2072-3074 • Fax: (822) 743-6385 • E-mail: radjycho@snu.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Publisher Copyright:
    © 2018 The Korean Society of Radiology.

    Keywords

    • Computed tomography
    • Contrast media
    • Double dose reduction
    • Low dose
    • Urography

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging

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