Korean Journal of Radiology

  • 제19권6호
  • /
  • Pages.1119-1129
  • /
  • 2018
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

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

  • Kim, Sang Youn (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Cho, Jeong Yeon (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Joongyub (Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hwang, Sung Il (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Moon, Min Hoan (Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Lee, Eun Ju (Department of Radiology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Hong, Seong Sook (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Kim, Chan Kyo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kyeong Ah (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Park, Sung Bin (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Sung, Deuk Jae (Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Kim, Yongsoo (Department of Radiology, Hanyang University Guri Hospital) ;
  • Kim, You Me (Department of Radiology, Dankook University Hospital, Dankook University College of Medicine) ;
  • Jung, Sung Il (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Rha, Sung Eun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Dong Won (Department of Radiology, Dong-A University College of Medicine) ;
  • Lee, Hyun (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Shim, Youngsup (Department of Radiology, Gachon University, Gil Medical Center) ;
  • Hwang, Inpyeong (Department of Radiology, Cheongyang-gun Health Center and County Hospital) ;
  • Woo, Sungmin (Department of Radiology, Armed Forces Daejeon Hospital) ;
  • Choi, Hyuck Jae (Department of Radiology, Sheikh Khalifa Specialty Hospital)
  • 투고 : 2017.12.26
  • 심사 : 2018.06.07
  • 발행 : 2018.12.01
⟨ 이전 논문 다음 논문 ⟩

초록

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 ($5.73{\pm}4.04$ vs. $8.43{\pm}4.38mSv$) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ${\geq}3$), 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.

키워드

과제정보

연구 과제 주관 기관 : TAEJOON PHARM Co. Ltd.

참고문헌

  1. Silverman SG, Leyendecker JR, Amis ES Jr. What is the current role of CT urography and MR urography in the evaluation of the urinary tract? Radiology 2009;250:309-323 https://doi.org/10.1148/radiol.2502080534
  2. Nawfel RD, Judy PF, Schleipman AR, Silverman SG. Patient radiation dose at CT urography and conventional urography. Radiology 2004;232:126-132 https://doi.org/10.1148/radiol.2321030222
  3. Yanaga Y, Awai K, Funama Y, Nakaura T, Hirai T, Roux S, et al. Low-dose MDCT urography: feasibility study of low-tubevoltage technique and adaptive noise reduction filter. AJR Am J Roentgenol 2009;193:W220-W229 https://doi.org/10.2214/AJR.08.1710
  4. Juri H, Matsuki M, Inada Y, Tsuboyama T, Kumano S, Azuma H, et al. Low-dose computed tomographic urography using adaptive iterative dose reduction 3-dimensional: comparison with routine-dose computed tomography with filtered back projection. J Comput Assist Tomogr 2013;37:426-431 https://doi.org/10.1097/RCT.0b013e3182830aa9
  5. Kekelidze M, Dwarkasing RS, Dijkshoorn ML, Sikorska K, Verhagen PC, Krestin GP. Kidney and urinary tract imaging: triple-bolus multidetector CT urography as a one-stop shop--protocol design, opacification, and image quality analysis. Radiology 2010;255:508-516 https://doi.org/10.1148/radiol.09082074
  6. Seyal AR, Arslanoglu A, Abboud SF, Sahin A, Horowitz JM, Yaghmai V. CT of the abdomen with reduced tube voltage in adults: a practical approach. Radiographics 2015;35:1922-1939 https://doi.org/10.1148/rg.2015150048
  7. Nakaura T, Nakamura S, Maruyama N, Funama Y, Awai K, Harada K, et al. Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256-detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality. Radiology 2012;264:445-454 https://doi.org/10.1148/radiol.12111082
  8. Namimoto T, Oda S, Utsunomiya D, Shimonobo T, Morita S, Nakaura T, et al. Improvement of image quality at lowradiation dose and low-contrast material dose abdominal CT in patients with cirrhosis: intraindividual comparison of low tube voltage with iterative reconstruction algorithm and standard tube voltage. J Comput Assist Tomogr 2012;36:495-501 https://doi.org/10.1097/RCT.0b013e31825b821f
  9. Gonzalez-Guindalini FD, Ferreira Botelho MP, Tore HG, Ahn RW, Gordon LI, Yaghmai V. MDCT of chest, abdomen, and pelvis using attenuation-based automated tube voltage selection in combination with iterative reconstruction: an intrapatient study of radiation dose and image quality. AJR Am J Roentgenol 2013;201:1075-1082 https://doi.org/10.2214/AJR.12.10354
  10. Nakayama Y, Awai K, Funama Y, Hatemura M, Imuta M, Nakaura T, et al. Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 2005;237:945-951 https://doi.org/10.1148/radiol.2373041655
  11. Nakaura T, Awai K, Maruyama N, Takata N, Yoshinaka I, Harada K, et al. Abdominal dynamic CT in patients with renal dysfunction: contrast agent dose reduction with low tube voltage and high tube current-time product settings at 256-detector row CT. Radiology 2011;261:467-476 https://doi.org/10.1148/radiol.11110021
  12. Gruberg L, Mintz GS, Mehran R, Gangas G, Lansky AJ, Kent KM, et al. The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol 2000;36:1542-1548 https://doi.org/10.1016/S0735-1097(00)00917-7
  13. Thomsen HS, Webb JAW. Appendix A: ESUR guidelines on contrast media version 8.1. In: Thomsen HS, Webb JAW, eds. Contrast media, 3rd ed. Berlin: Springer Berlin Heidelberg, 2014:257-274
  14. Hwang I, Cho JY, Kim SY, Oh SJ, Ku JH, Lee J, et al. Low tube voltage computed tomography urography using lowconcentration contrast media: comparison of image quality in conventional computed tomography urography. Eur J Radiol 2015;84:2454-2463 https://doi.org/10.1016/j.ejrad.2015.09.010
  15. Samei E, Dobbins JT 3rd, Lo JY, Tornai MP. A framework for optimising the radiographic technique in digital X-ray imaging. Radiat Prot Dosimetry 2005;114:220-229 https://doi.org/10.1093/rpd/nch562
  16. Goo HW. CT radiation dose optimization and estimation: an update for radiologists. Korean J Radiol 2012;13:1-11 https://doi.org/10.3348/kjr.2012.13.1.1
  17. Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester RJ, Burger M, et al. European Association of Urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur Urol 2015;68:868-879 https://doi.org/10.1016/j.eururo.2015.06.044
  18. Kapoor A, Allard CB, Black P, Kassouf W, Morash C, Rendon R. Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma. Can Urol Assoc J 2013;7:306-311
  19. Kawamoto S, Fishman EK. Role of CT in postoperative evaluation of patients undergoing urinary diversion. AJR Am J Roentgenol 2010;194:690-696 https://doi.org/10.2214/AJR.09.3197
  20. Mayo-Smith WW, Hara AK, Mahesh M, Sahani DV, Pavlicek W. How I do it: managing radiation dose in CT. Radiology 2014;273:657-672 https://doi.org/10.1148/radiol.14132328
  21. Desai GS, Fuentes Orrego JM, Kambadakone AR, Sahani DV. Performance of iterative reconstruction and automated tube voltage selection on the image quality and radiation dose in abdominal CT scans. J Comput Assist Tomogr 2013;37:897-903 https://doi.org/10.1097/RCT.0b013e3182a73fa6
  22. Kim M, Lee JM, Yoon JH, Son H, Choi JW, Han JK, et al. Adaptive iterative dose reduction algorithm in CT: effect on image quality compared with filtered back projection in body phantoms of different sizes. Korean J Radiol 2014;15:195-204 https://doi.org/10.3348/kjr.2014.15.2.195
  23. Desai GS, Uppot RN, Yu EW, Kambadakone AR, Sahani DV. Impact of iterative reconstruction on image quality and radiation dose in multidetector CT of large body size adults. Eur Radiol 2012;22:1631-1640 https://doi.org/10.1007/s00330-012-2424-3
  24. Yu L, Li H, Fletcher JG, McCollough CH. Automatic selection of tube potential for radiation dose reduction in CT: a general strategy. Med Phys 2010;37:234-243
  25. Wang X, He W, Chen J, Hu Z, Zhao L. Feasibility study of radiation dose reduction in adult female pelvic CT scan with low tube-voltage and adaptive statistical iterative reconstruction. Korean J Radiol 2015;16:1047-1055 https://doi.org/10.3348/kjr.2015.16.5.1047
  26. Kalender WA, Deak P, Kellermeier M, van Straten M, Vollmar SV. Application- and patient size-dependent optimization of x-ray spectra for CT. Med Phys 2009;36:993-1007 https://doi.org/10.1118/1.3075901
  27. Kaza RK, Platt JF, Goodsitt MM, Al-Hawary MM, Maturen KE, Wasnik AP, et al. Emerging techniques for dose optimization in abdominal CT. Radiographics 2014;34:4-17 https://doi.org/10.1148/rg.341135038
  28. Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 2010;256:32-61 https://doi.org/10.1148/radiol.10090908
  29. Caoili EM, Inampudi P, Cohan RH, Ellis JH. Optimization of multi-detector row CT urography: effect of compression, saline administration, and prolongation of acquisition delay. Radiology 2005;235:116-123 https://doi.org/10.1148/radiol.2351031085
  30. Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology 2013;268:719-728 https://doi.org/10.1148/radiol.13122276
  31. Wang ZJ, Coakley FV, Fu Y, Joe BN, Prevrhal S, Landeras LA, et al. Renal cyst pseudoenhancement at multidetector CT: what are the effects of number of detectors and peak tube voltage? Radiology 2008;248:910-916 https://doi.org/10.1148/radiol.2482071583
  32. Cho ES, Yu JS, Ahn JH, Kim JH, Chung JJ, Lee HK, et al. CT angiography of the renal arteries: comparison of lowertube-voltage CTA with moderate-concentration iodinated contrast material and conventional CTA. AJR Am J Roentgenol 2012;199:96-102 https://doi.org/10.2214/AJR.11.7450
  33. Zhang CY, Cui YF, Guo C, Cai J, Weng YF, Wang LJ, et al. Low contrast medium and radiation dose for hepatic computed tomography perfusion of rabbit VX2 tumor. World J Gastroenterol 2015;21:5259-5270 https://doi.org/10.3748/wjg.v21.i17.5259
  34. Jensen K, Martinsen AC, Tingberg A, Aalokken TM, Fosse E. Comparing five different iterative reconstruction algorithms for computed tomography in an ROC study. Eur Radiol 2014;24:2989-3002 https://doi.org/10.1007/s00330-014-3333-4

피인용 문헌

  1. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology vol.20, pp.12, 2019, https://doi.org/10.3348/kjr.2019.0928