J Am Coll Radiol 2010;7:754-773
Sarabjeet Singh, MBBS, MMST Mannudeep K. Kalra, MD Jiang Hsieh, PhD Paul E. Licato, MS Synho Do, PhD Homer H. Pien, PhD Michael A. Blake, MD
Purpose: To compare image quality and lesion conspicuity on abdominal computed tomographic (CT) images acquired with different x-ray tube current-time products (50-200 mAs) and reconstructed with adaptive statistical iterative reconstruction (ASIR) and filtered back projection (FBP) techniques.
Materials and methods: Twenty-two patients (mean age, 60.1 years ± 7.3 [standard deviation]; age range, 52.8-67.4 years; mean weight, 78.9 kg ±18.3; 12 men, 10 women) gave informed consent for this prospective institutional review board-approved and HIPAA-compliant study, which involved the acquisition of four additional image series at multidetector CT. Images were acquired at different tube current-time products (200, 150, 100, and 50 mAs) and encompassed an abdominal lesion over a 10-cm scan length. Images were reconstructed separately with FBP and with three levels of ASIR-FBP blending. Two radiologists reviewed FBP and ASIR images for image quality in a blinded and randomized manner. Volume CT dose index (CTDIvol), dose-length product, patient weight, objective noise, and CT numbers were recorded. Data were analyzed by using analysis of variance and the Wilcoxon signed rank test.
Results: CTDIvol values were 16.8, 12.6, 8.4, and 4.2 mGy for 200, 150, 100, and 50 mAs, respectively (P < .001). Subjective noise was graded as below average at 150 mAs and average at 100 and 50 mAs for ASIR images, as compared with FBP images, on which noise was graded as average at 150 mAs, above average at 100 mAs, and unacceptable at 50 mAs. A substantial blotchy image appearance was noted in four of 22 image series acquired at 4.2 mGy with 70% ASIR. Lesion conspicuity was significantly better at 4.2 mGy on ASIR than on FBP images (observed P < .044), and overall diagnostic confidence changed from unacceptable on FBP to acceptable on ASIR images.
Conclusion: ASIR lowers noise and improves diagnostic confidence in and conspicuity of subtle abdominal lesions at 8.4 mGy when images are reconstructed with 30% ASIR blending and at 4.2 mGy in patients weighing 90 kg or less when images are reconstructed with 50% or 70% ASIR blending.