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Published: . Dec 2014

Glazer DI, Maturen KE, Cohan RH, Davenport MS, Ellis JH, Knoepp US, Weadock WJ, Platt JF

Assessment of 1 mSv urinary tract stone CT with model-based iterative reconstruction.
(AJR Am J Roentgenol)

The purpose of this study was to evaluate stone detection, assessment of secondary signs of stone disease, and diagnostic confidence utilizing submillisievert CT with model-based iterative reconstruction (MBIR) in a North American population with diverse body habitus. Fifty-two adults underwent stone CT using a split-dose protocol; weight-based projected volume CT dose index (CTDIvol) and dose-length product (DLP) were divided into two separate acquisitions at 80% and 20% dose levels. Images were reconstructed with MBIR. Five blinded readers counted stones in three size categories and rated "overall diagnostic confidence" and "detectability of secondary signs of stone disease" on a 0-4 scale at both dose levels. Effective dose (ED) in mSv was calculated as DLP multiplied by conversion coefficient, k, equal to 0.017. Mean ED (80%, 3.90┬▒1.44 mSv; vs 20%, 0.97┬▒0.34 mSv [p<0.001]) and number of stones detected (80%, 193.6┬▒25.0; vs 20%, 154.4┬▒15.4 [p=0.03]) were higher in scans at 80% dose level. Intrareader correlation between scans at 80% and 20% dose levels was excellent (0.83-0.97). With 80% scans as reference standard, mean sensitivity and specificity at 20% varied with stone size (<3 mm, 74% and 77%; Ôëą3 mm, 92% and 82%). The 20% scans scored lower than 80% scans in diagnostic confidence (2.46┬▒0.50; vs 3.21┬▒0.36 [p<0.005]) and detectability of secondary signs (2.41┬▒0.39; vs 3.19┬▒0.29 [p<0.005]). Aggressively dose-reduced (~1 mSv) MBIR scans detected most urinary tract stones of 3 mm or larger but underperformed the low-dose reference standard (3-4 mSv) scans in small (<3 mm) stone detection and diagnostic confidence.

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Read more articles from the authors:
1. Glazer DI
2. Maturen KE
3. Cohan RH
4. Davenport MS
5. Ellis JH
6. Knoepp US
7. Weadock WJ
8. Platt JF

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