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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, SY | Cho, JY | Lee, J | Hwang, SI | Moon, MH | Lee, EJ  | Hong, SS | Kim, CK | Kim, KA | Park, SB | Sung, DJ | Kim, Y | Kim, YM | Jung, SI | Rha, SE | Kim, DW | Lee, H | Shim, Y | Hwang, I | Woo, S | Choi, HJ
Korean journal of radiology, 19(6). : 1119-1129, 2018
Journal Title
Korean journal of radiology
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.


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