Skeletal Radiology

, Volume 47, Issue 4, pp 491–504 | Cite as

Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation

  • Sun Hwa Lee
  • Seong Jong YunEmail author
  • Hyeon Hwan Jo
  • Dong Hyeon Kim
  • Jae Gwang Song
  • Yong Sung Park
Scientific Article



To compare the image quality, radiation dose, and diagnostic performance between low-dose (LD) and ultra-low-dose (ULD) lumbar-spine (L-spine) CT with iterative reconstruction (IR) for patients with chronic low back pain (LBP).


In total, 260 patients with chronic LBP who underwent L-spine CT between November 2015 and September 2016 were prospectively enrolled. Of these, 143 underwent LD-CT with IR and 117 underwent ULD-CT with IR. The patients were divided according to their body mass index (BMI) into BMI1 (<22.9 kg/m2), BMI2 (23.0–24.9 kg/m2), and BMI3 (≥25 kg/m2) groups. Two blinded radiologists independently evaluated the signal-to-noise ratio (SNR), qualitative image quality, and final diagnoses (lumbar disc disease and facet joint osteoarthritis). L-spine MRIs interpreted by consensus were used as the reference standard. All data were statistically analyzed.


ULD protocol showed significantly lower SNR for all patients (p < 0.001) except the vertebral bodies and lower qualitative image quality for BMI3 patients (p ≤ 0.033). There was no statistically significant difference between ULD (sensitivity, 95.1–98.1%; specificity, 92.5–98.7%; accuracy, 94.6–98.0%) and LD protocols (sensitivity, 95.6–100%; specificity, 95.5–98.9%; accuracy, 97.4–98.1%), (all p≥0.1) in the BMI1 and BMI2; while dose was 60–68% lower with the ULD protocol. Interobserver agreements were excellent or good with regard to image quality and final diagnoses.


For the BM1 and BMI2 groups, ULD-CT provided an acceptable image quality and exhibited a diagnostic accuracy similar to that of LD-CT. These findings suggest that it is a useful diagnostic tool for patients with chronic LBP who exhibit a BMI of <25 kg/m2.


Lumbar disc herniation Facet joint osteoarthritis Image quality Diagnostic performance Computed tomography 



This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human. Participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consents from each patient were obtained.


  1. 1.
    Patel ND, Broderick DF, Burns J, et al. ACR Appropriateness Criteria. Low Back Pain. J Am Coll Radiol. 2016;13:1069–78.CrossRefPubMedGoogle Scholar
  2. 2.
    Van Rijn RM1, Wassenaar M, Verhagen AP, et al. Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012;21:228–39.CrossRefPubMedGoogle Scholar
  3. 3.
    Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.CrossRefPubMedGoogle Scholar
  4. 4.
    Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol. 2008;81:362–78.CrossRefPubMedGoogle Scholar
  5. 5.
    Omoumi P, Verdun FR, Becce F. Optimization of radiation dose and image quality in musculoskeletal CT: emphasis on iterative reconstruction techniques (Part 2). Semin Musculoskelet Radiol. 2015;19:422–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Omoumi P, Becce F, Ott JG, Racine D, Verdun FR. Optimization of radiation dose and image quality in musculoskeletal CT: emphasis on iterative reconstruction techniques (Part 1). Semin Musculoskelet Radiol. 2015;19:415–21.CrossRefPubMedGoogle Scholar
  7. 7.
    McCollough CH, Chen GH, KalenderW, et al. Achieving routine ultra-low dose CT scanning: report from the summit on management of radiation dose in CT. Radiology. 2012;264:567–80.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Boone JM, Hendee WR, McNitt-Gray MF, et al. Radiation exposure from CT scans: how to close our knowledge gaps, monitor and safeguard exposure—proceedings and recommendations of the Radiation Dose Summit, sponsored by NIBIB, February 24–25, 2011. Radiology. 2012;265:544–54.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Shin CI, Kim SH, Im JP, et al. One-mSv CT colonography: effect of different iterative reconstruction algorithms on radiologists’ performance. Eur J Radiol. 2016;85:641–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Kalra MK, Quick P, Singh S, et al. Whole spine CT for evaluation of scoliosis in children: feasibility of sub-milliSievert scanning protocol. Acta Radiol. 2013;54:226–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Cademartiri F, Maffei E, Arcadi T, Catalano O, Midiri M. CT coronary angiography at an ultra-low radiation dose (<0.1 mSv): feasible and viable in times of constraint on healthcare costs. Eur Radiol. 2013;23:607–13.CrossRefPubMedGoogle Scholar
  12. 12.
    Kim Y, Kim YK, Lee BE, et al. Ultra-low-dose CT of the thorax using iterative reconstruction: evaluation of image quality and radiation dose reduction. AJR Am J Roentgenol. 2015;204:1197–202.CrossRefPubMedGoogle Scholar
  13. 13.
    Rob S, Bryant T, Wilson I, Somani BK. Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature. Clin Radiol. 2017;72:11–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Willemink MJ, de Jong PA, Leiner T, et al. Iterative reconstruction techniques for computed tomography Part 1: technical principles. Eur Radiol. 2013;23:1623–1631.Google Scholar
  15. 15.
    Geyer LL, Schoepf UJ, Meinel FG, et al. State of the art: iterative CT reconstruction techniques. Radiology. 2015;276:339–57.CrossRefPubMedGoogle Scholar
  16. 16.
    Gervaise A, Osemont B, Lecocq S, et al. CT image quality improvement using adaptive iterative dose reduction with wide-volume acquisition on 320-detector CT. Eur Radiol. 2012;22:295–301.CrossRefPubMedGoogle Scholar
  17. 17.
    Bohy P, De Maertelaer V, Roquigny A, Keyzer C, Tack D, Gevenois PA. Multidetector CT in patients suspected of having lumbar disk herniation: comparison of standard-dose and simulated low-dose techniques. Radiology. 2007;244:524–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Alshamari M, Geijer M, Norrman E, et al. Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice. Acta Radiol. 2016;57:602–11.CrossRefPubMedGoogle Scholar
  19. 19.
    Alshamari M, Geijer M, Norrman E, Geijer H. Low-dose computed tomography of the lumbar spine: a phantom study on imaging parameters and image quality. Acta Radiol. 2014;55:824–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Yang CH, Wu TH, Chiou YY, et al. Imaging quality and diagnostic reliability of low-dose computed tomography lumbar spine for evaluating patients with spinal disorders. Spine J. 2014;14:2682–90.CrossRefPubMedGoogle Scholar
  21. 21.
    Yang CH, Wu TH, Lin CJ, et al. Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain. Eur J Radiol. 2016;85:1757–64.CrossRefPubMedGoogle Scholar
  22. 22.
    World Health Organization. Obesity: preventing and managing the global epidemic— report of a WHO consultation of obesity. Geneva, Switzerland: World Health Organization; 1997.Google Scholar
  23. 23.
    Kilic K, Erbas G, Guryildirim M, Arac M, Ilgit E, Coskun B. Lowering the dose in head CT using adaptive statistical iterative reconstruction. AJNR Am J Neuroradiol. 2011;32:1578–82.CrossRefPubMedGoogle Scholar
  24. 24.
    Patro SN, Chakraborty S, Sheikh A. The use of adaptive statistical iterative reconstruction (ASiR) technique in evaluation of patients with cervical spine trauma: impact on radiation dose reduction and image quality. Br J Radiol. 2016;89:20150082.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Bongartz G, Golding SJ, Jurik AJ, et al. European guidelines for multislice computed tomography: report EUR 16262 EN 2004. European Commission: Luxembourg; 2004.Google Scholar
  26. 26.
    Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol. 1999;28:215–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Deak PD, Smal Y, Kalender WA. Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product. Radiology. 2010;257:158–66.CrossRefPubMedGoogle Scholar
  28. 28.
    Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361:849–57.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Martin CJ. Effective dose: how should it be applied to medical exposures? Br J Radiol. 2007;80:639–47.CrossRefPubMedGoogle Scholar
  30. 30.
    von Falck C, Galanski M, Shin HO. Informatics in radiology: sliding-thin-slab averaging for improved depiction of low-contrast lesions with radiation dose savings at thin-section CT. Radiographics. 2010;30:317–326.Google Scholar
  31. 31.
    Omoumi P, Verdun FR, Ben Salah Y, et al. Low-dose multidetector computed tomography of the cervical spine: optimization of iterative reconstruction strength levels. Acta Radiol. 2014;55:335–44.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2017

Authors and Affiliations

  • Sun Hwa Lee
    • 1
  • Seong Jong Yun
    • 2
    Email author
  • Hyeon Hwan Jo
    • 2
  • Dong Hyeon Kim
    • 2
  • Jae Gwang Song
    • 3
  • Yong Sung Park
    • 4
  1. 1.Department of Emergency Medicine, Sanggye Paik HospitalInje University College of MedicineNowon-guRepublic of Korea
  2. 2.Department of Radiology, Aerospace Medical CenterRepublic of Korea Air ForceCheongwon-gunRepublic of Korea
  3. 3.Department of Orthopedic Surgery, Aerospace Medical CenterRepublic of Korea Air ForceCheongwon-gunRepublic of Korea
  4. 4.Department of RadiologyKyung Hee University Hospital at Gangdong, Kyung Hee University School of MedicineSeoulRepublic of Korea

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