Skip to main content

Advertisement

SpringerLink
Log in

Sub-millisievert CT colonography: effect of knowledge-based iterative reconstruction on the detection of colonic polyps

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the feasibility of ultra-low dose computed tomography colonography (CTC) using knowledge-based iterative reconstruction (IR) and to determine its effect on polyp detection.

Methods

Forty-nine prospectively-enrolled patients underwent ultra-low dose CTC in the supine (100 kVp/20 mAs) and prone positions (80 kVp/20 mAs), followed by same-day colonoscopy. Thereafter, images were reconstructed using filtered back projection (FBP) and knowledge-based IR (IMR; Philips Healthcare, Best, Netherlands) algorithms. Effective radiation dose of CTC was recorded. Pooled per-polyp sensitivity and positive predictive value of three radiologists was analysed and compared between FBP and IMR. Image quality was assessed on a five-point scale and image noise was recorded using standard deviations.

Results

Mean effective radiation dose of ultra-low dose CTC was 0.90 ± 0.06 mSv. Eighty-nine polyps were detected on colonoscopy (mean, 8.5 ± 4.7 mm). The pooled per-polyp sensitivity for polyps 6.0-9.9 mm (n = 22) on CTC reconstructed with IMR (36/66, 54.5%) was not significantly different with that using FBP algorithm (34/66, 51.5%) (p = 0.414). For polyps ≥10 mm (n = 35), however, the pooled per-polyp sensitivity on CTC with IMR (73/105, 69.5%) was significantly higher than that with FBP (55/105, 52.4%) (p < 0.001). In particular, the difference of per-polyp sensitivity was statistically significant in intermediate (p = 0.014) and novice (p = 0.003) reviewers. Furthermore, mean image noise of IMR (8.4 ± 6.2 HU) was significantly lower than that of FBP (37.5 ± 13.9 HU) (p < 0.001) and image quality with IMR was significantly better than with FBP in all evaluated segments in all reviewers (all ps < 0.001).

Conclusions

Sub-mSv CTC reconstructed with IMR was feasible for the detection of clinically significant polyps, demonstrating 70% per-polyp sensitivity of polyps ≥10 mm, while allowing significant noise reduction and improvement in image quality compared with FBP reconstruction.

Key Points

• Sub-mSv CTC using IMR demonstrated 70% per-polyp sensitivity for polyps ≥10 mm.

• CTC using IMR significantly outperformed CTC reconstructed with FBP.

• IMR allows significantly more noise reduction and improvement in image quality than FBP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

CTC :

Computed tomography colonography

FBP :

Filtered back projection

IMR :

Iterative model reconstruction

IR :

Iterative reconstruction

References

  1. Johnson CD, Chen M-H, Toledano AY et al (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359:1207–1217

    Article  CAS  Google Scholar 

  2. Levin B, Lieberman DA, McFarland B et al (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 58:130–160

    Article  Google Scholar 

  3. Park SH, Yee J, Kim SH et al (2007) Fundamental elements for successful performance of CT colonography (virtual colonoscopy). Korean J Radiol 8:264–275

    Article  Google Scholar 

  4. Chung SY, Park SH, Lee SS et al (2012) Comparison between CT colonography and double-contrast barium enema for colonic evaluation in patients with renal insufficiency. Korean J Radiol 13:290–299

    Article  Google Scholar 

  5. Angtuaco TL, Banaad-Omiotek GD, Howden CW (2001) Differing attitudes toward virtual and conventional colonoscopy for colorectal cancer screening: surveys among primary care physicians and potential patients. Am J Gastroenterol 96:887–893

    Article  CAS  Google Scholar 

  6. Gluecker TM, Johnson CD, Harmsen WS et al (2003) Colorectal cancer screening with CT colonography, colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences. Radiology 227:378–384

    Article  Google Scholar 

  7. Iannaccone R, Catalano C, Mangiapane F et al (2005) Colorectal polyps: detection with low-dose multi-detector row helical CT colonography versus two sequential colonoscopies. Radiology 237:927–937

    Article  Google Scholar 

  8. Cohnen M, Vogt C, Beck A et al (2004) Feasibility of MDCT Colonography in ultra-low-dose technique in the detection of colorectal lesions: comparison with high-resolution video colonoscopy. AJR Am J Roentgenol 183:1355–1359

    Article  Google Scholar 

  9. Shin C-I, Kim SH, Lee ES et al (2014) Ultra-low peak voltage CT colonography: effect of iterative reconstruction algorithms on performance of radiologists who use anthropomorphic colonic phantoms. Radiology 273:759–771

    Article  Google Scholar 

  10. Flicek KT, Hara AK, Silva AC et al (2010) Reducing the radiation dose for CT colonography using adaptive statistical iterative reconstruction: a pilot study. AJR Am J Roentgenol 195:126–131

    Article  Google Scholar 

  11. Fletcher JG, Grant KL, Fidler JL et al (2012) Validation of dual-source single-tube reconstruction as a method to obtain half-dose images to evaluate radiation dose and noise reduction: phantom and human assessment using CT colonography and sinogram-affirmed iterative reconstruction (SAFIRE). J Comput Assist Tomogr 36:560–569

    Article  Google Scholar 

  12. Nagata K, Fujiwara M, Kanazawa H et al (2015) Evaluation of dose reduction and image quality in CT colonography: comparison of low-dose CT with iterative reconstruction and routine-dose CT with filtered back projection. Eur Radiol 25:221–229

    Article  Google Scholar 

  13. Willemink MJ, de Jong PA, Leiner T et al (2013) Iterative reconstruction techniques for computed tomography Part 1: technical principles. Eur Radiol 23:1623–1631

    Article  Google Scholar 

  14. Yoon MA, Kim SH, Lee JM et al (2012) Adaptive statistical iterative reconstruction and Veo: assessment of image quality and diagnostic performance in CT colonography at various radiation doses. J Comput Assist Tomogr 36:596–601

    Article  Google Scholar 

  15. Mehta D, Thompson R, Morton T, Dhanantwari A, Shefer E (2013) Iterative model reconstruction: simultaneously lowered computed tomography radiation dose and improved image quality. Med Phys Int J 2:147–155

    Google Scholar 

  16. Bongartz G, Golding S, Jurik A et al (2004) European guidelines for multislice computed tomography. European Commission, Luxembourg

    Google Scholar 

  17. Kim SH, Lee JM, Shin CI et al (2008) Effects of spatial resolution and tube current on computer-aided detection of polyps on CT colonographic images: phantom study. Radiology 248:492–503

    Article  Google Scholar 

  18. Shin CI, Kim SH, Im JP et al (2016) One-mSv CT colonography: Effect of different iterative reconstruction algorithms on radiologists' performance. Eur J Radiol 85:641–648

    Article  Google Scholar 

  19. Lambert L, Ourednicek P, Briza J et al (2016) Sub-milliSievert ultralow-dose CT colonography with iterative model reconstruction technique. Peer J 4:e1883

    Article  Google Scholar 

  20. Lambert L, Ourednicek P, Jahoda J et al (2015) Model-based vs hybrid iterative reconstruction technique in ultralow-dose submillisievert CT colonography. Br J Radiol 88:20140667

    Article  CAS  Google Scholar 

  21. Lubner MG, Pooler BD, Kitchin DR et al (2015) Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging. Eur Radiol 25:2089–2102

    Article  Google Scholar 

  22. Yamamura S, Oda S, Imuta M et al (2016) Reducing the radiation dose for CT colonography: effect of low tube voltage and iterative reconstruction. Acad Radiol 23:155–162

    Article  Google Scholar 

  23. Taguchi N, Oda S, Imuta M et al (2017) Model-based iterative reconstruction in low-radiation-dose computed tomography colonography: preoperative assessment in patients with colorectal cancer. Acad Radiol. https://doi.org/10.1016/j.acra.2017.10.008

    Article  Google Scholar 

  24. de Haan MC, van Gelder RE, Graser A et al (2011) Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis. Eur Radiol 21:1747–1763

    Article  Google Scholar 

  25. Lin JS, Piper MA, Perdue LA et al (2016) Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 315:2576–2594

    Article  CAS  Google Scholar 

  26. Sosna J, Sella T, Sy O et al (2008) Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol 190:374–385

    Article  Google Scholar 

  27. Chang W, Lee JM, Lee K et al (2013) Assessment of a model-based, iterative reconstruction algorithm (MBIR) regarding image quality and dose reduction in liver computed tomography. Invest Radiol 48:598–606

    Article  CAS  Google Scholar 

  28. Lv P, Liu J, Zhang R et al (2015) Combined use of automatic tube voltage selection and current modulation with iterative reconstruction for CT evaluation of small hypervascular hepatocellular carcinomas: effect on lesion conspicuity and image quality. Korean J Radiol 16:531–540

    Article  Google Scholar 

  29. Song JS, Choi EJ, Kim EY et al (2015) Attenuation-based automatic kilovoltage selection and sinogram-affirmed iterative reconstruction: effects on radiation exposure and image quality of portal-phase liver CT. Korean J Radiol 16:69–79

    Article  Google Scholar 

Download references

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea [NRF] funded by the Ministry of Science, ICT & Future Planning (2016R1A2B4007762).

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea

    Hyo-Jin Kang, Se Hyung Kim, Cheong-Il Shin, Ijin Joo & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea

    Hyo-Jin Kang, Se Hyung Kim, Cheong-Il Shin, Ijin Joo & Joon Koo Han

  3. Pusan National University Yangsan Hospital, Yangsan, Korea

    Hwaseong Ryu

  4. Department of Internal medicine, Seoul National University Hospital, Seoul, Korea

    Sang Gyun Kim & Jong Pil Im

  5. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Joon Koo Han

Authors
  1. Hyo-Jin Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Se Hyung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheong-Il Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ijin Joo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hwaseong Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sang Gyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jong Pil Im
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joon Koo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Se Hyung Kim.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Se Hyung Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• cross-sectional study

• performed at one institution

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kang, HJ., Kim, S.H., Shin, CI. et al. Sub-millisievert CT colonography: effect of knowledge-based iterative reconstruction on the detection of colonic polyps. Eur Radiol 28, 5258–5266 (2018). https://doi.org/10.1007/s00330-018-5545-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5545-5

Keywords

Search

Navigation