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Detection of pulmonary nodules with scoutless fixed-dose ultra-low-dose CT: a prospective study

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

Abstract

Objectives

To determine the accuracy of scoutless, fixed-dose ultra-low-dose (ULD) CT compared to standard-dose (SD) CT for pulmonary nodule detection and semi-automated nodule measurement, across different patient sizes.

Methods

Sixty-three patients underwent ULD and SD CT. Two readers examined all studies visually and with computer-aided detection (CAD). Nodules detected on SD CT were included in the reference standard by consensus and stratified into 4 categories (nodule category, NODCAT) from the Dutch-Belgian Lung Cancer Screening trial (NELSON). Effects of NODCAT and patient size on nodule detection were determined. For each nodule, volume and diameter were compared between both scans.

Results

The reference standard comprised 173 nodules. For both readers, detection rates on ULD versus SD CT were not significantly different for NODCAT 3 and 4 nodules > 50 mm3 (reader 1: 93% versus 89% (p = 0.257); reader 2: 96% versus 98% (p = 0.317)). For NODCAT 1 and 2 nodules < 50 mm3, detection rates on ULD versus SD CT dropped significantly (reader 1: 66% versus 80% (p = 0.023); reader 2: 77% versus 87% (p = 0.039)). Body mass index and chest circumference did not influence nodule detectability (p = 0.229 and p = 0.362, respectively). Calculated volumes and diameters were smaller on ULD CT (p < 0.0001), without altering NODCAT (84% agreement).

Conclusions

Scoutless ULD CT reliably detects solid lung nodules with a clinically relevant volume (> 50 mm3) in lung cancer screening, irrespective of patient size. Since detection rates were lower compared to SD CT for nodules < 50 mm3, its use for lung metastasis detection should be considered on a case-by-case basis.

Key Points

• Detection rates of pulmonary nodules > 50 mm3are not significantly different between scoutless ULD and SD CT (i.e. volumes clinically relevant in lung cancer screening based on the NELSON trial), but were different for the detection of nodules < 50 mm3(i.e. volumes still potentially relevant in lung metastasis screening).

• Calculated nodule volumes were on average 0.03 mL or 9% smaller on ULD CT, which is below the 20–25% interscan variability previously reported with software-based volumetry.

• Even though a scoutless, fixed-dose ULD CT protocol was used (CTDI vol 0.15 mGy), pulmonary nodule detection was not influenced by patient size.

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Abbreviations

ADMIRE:

Advanced modelled iterative reconstruction

BMI:

Body mass index

CAD:

Computer-aided detection

CTDIvol :

Volume computed tomography dose index

DLP:

Dose length product

ED:

Effective dose

kV:

Kilovolt

LD:

Low dose

mAs:

Milliampere * seconds

MBIR:

Model-based iterative reconstruction

mGy:

Milligray

mSv:

Millisievert

NELSON:

Dutch-Belgian Lung Cancer Screening Trial

NODCAT:

Nodule category (adopted from the NELSON trial)

SD:

Standard dose

ULD:

Ultra-low dose

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium

    Gerald Gheysens, Walter De Wever, Lesley Cockmartin, Hilde Bosmans & Walter Coudyzer

  2. Medical Physics and Quality Assessment, Department of Imaging and Pathology, KULeuven, Leuven, Belgium

    Hilde Bosmans

  3. Department of Radiology, Imelda Hospital, Bonheiden, Belgium

    Sofie De Vuysere & Mathieu Lefere

Authors
  1. Gerald Gheysens
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  2. Walter De Wever
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  3. Lesley Cockmartin
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  4. Hilde Bosmans
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  5. Walter Coudyzer
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  6. Sofie De Vuysere
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  7. Mathieu Lefere
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Correspondence to Gerald Gheysens.

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The scientific guarantor of this publication is Mathieu Lefere.

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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

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

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Gheysens, G., De Wever, W., Cockmartin, L. et al. Detection of pulmonary nodules with scoutless fixed-dose ultra-low-dose CT: a prospective study. Eur Radiol 32, 4437–4445 (2022). https://doi.org/10.1007/s00330-022-08584-y

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  • DOI: https://doi.org/10.1007/s00330-022-08584-y

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