Diagnostic usefulness  of low-dose lumbar multi-detector CT with iterative reconstruction in trauma patients: acomparison with standard-dose CT

Lee, Sun Hwa; Yun, Seong Jong; Kim, Dong Hyeon; Jo, Hyeon Hwan; Song, Jae Gwang; Park, Yong Sung

doi:10.1259/bjr.20170181

Cited by 16 publications

(28 citation statements)

References 22 publications

(41 reference statements)

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“…To the authors’ knowledge, only few recent studies investigated CT with reduced doses specifically for diagnostics of vertebral fractures. The diagnostic performance of lumbar low-dose CT (47–69% radiation dose reduction) combined with IR was comparable to that of standard-dose CT with IR [ 13 ]. Higher levels of IR for low-dose CT (50% radiation dose reduction) still provided high image quality and diagnostic confidence [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, iterative reconstruction (IR) algorithms have been applied together with low-dose CT, but led to worse image quality for soft tissue and cervical vertebrae when compared to standard-dose CT using filtered back projection (FBP) [ 12 ]. To date, only few studies investigated CT with reduced doses specifically for diagnostics of vertebral fractures, showing that low-dose CT with IR may maintain a high diagnostic performance compared to standard-dose CT with IR in trauma patients [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Multi-detector CT imaging: impact of virtual tube current reduction and sparse sampling on detection of vertebral fractures

et al. 2019

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Purpose To systematically evaluate the effects of virtual tube current reduction and sparse sampling on image quality and vertebral fracture diagnostics in multi-detector computed tomography (MDCT). Materials and methods In routine MDCT scans of 35 patients (80.0% females, 70.6 ± 14.2 years, 65.7% showing vertebral fractures), reduced radiation doses were retrospectively simulated by virtually lowering tube currents and applying sparse sampling, considering 50%, 25%, and 10% of the original tube current and projections, respectively. Two readers evaluated items of image quality and presence of vertebral fractures. Readout between the evaluations in the original images and those with virtually lowered tube currents or sparse sampling were compared. Results A significant difference was revealed between the evaluations of image quality between MDCT with virtually lowered tube current and sparse-sampled MDCT ( p < 0.001). Sparse-sampled data with only 25% of original projections still showed good to very good overall image quality and contrast of vertebrae as well as minimal artifacts. There were no missed fractures in sparse-sampled MDCT with 50% reduction of projections, and clinically acceptable determination of fracture age was possible in MDCT with 75% reduction of projections, in contrast to MDCT with 50% or 75% virtual tube current reduction, respectively. Conclusion Sparse-sampled MDCT provides adequate image quality and diagnostic accuracy for vertebral fracture detection with 50% of original projections in contrast to corresponding MDCT with lowered tube current. Thus, sparse sampling is a promising technique for dose reductions in MDCT that could be introduced in future generations of scanners. Key Points • MDCT with a reduction of projection numbers of 50% still showed high diagnostic accuracy without any missed vertebral fractures. • Clinically acceptable determination of vertebral fracture age was possible in MDCT with a reduction of projection numbers of 75%. • With sparse sampling, higher reductions in radiation exposure can be achieved without compromised image or diagnostic quality in routine MDCT of the spine as compared to MDCT with reduced tube currents. Electronic supplementary material The online version of this article (10.1007/s00330-019-06090-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multi-detector CT imaging: impact of virtual tube current reduction and sparse sampling on detection of vertebral fractures

et al. 2019

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“…To our knowledge, this is the first prospective study in nuclear medicine in which a double set of images of the same patient was used to directly compare the diagnostic results of standard-dose and low-dose CT in bone scintigraphy. This approach allows more direct comparison than what was previously provided by other studies using a retrospective design and a different cohort of patients (6)(7)(8)13). The design of the present study is aimed to test whether the low-dose CT provides sufficient image information to make the same decision as the standard CT in those areas with increased tracer uptake and not just to assess image quality as in previously published studies (10,13,17).…”

Section: Discussionmentioning

confidence: 99%

“…There are several studies available in diagnostic radiology evaluating whether the reduction of radiation doses can provide similar image quality in skeletal studies (6)(7)(8)(9) and in other organs (10,11). To our knowledge, there are two studies that evaluated the utility of low-dose CT in association with bone scintigraphy, though none of these studies consisted of strictly oncological patients (12,13).…”

Section: Introductionmentioning

confidence: 99%

Is sub-mSv CT for evaluation of non-specific findings in bone scintigraphy of oncological patients feasible?

et al. 2019

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Computed tomography (CT) was introduced to medicine in the early 1970s, which brought slice imaging into wide use for the first time. Today, CT is an essential part of radiological diagnostics, and is used for a wide range of clinical applications. One downside of CT imaging is the health risks related to the ionizing radiation. In the 80s it was believed that CT would soon be replaced completely by MRI due, in part, to the ionizing radiation required in CT. A further downside are the health risks related to the use of iodine-based contrast media. Both radiation-and contrast media dose have a trade-off with image quality. However, many technical advances have been made, and progress is still ongoing, to improve and broaden the applications of CT. Such advances necessitate a re-evaluation of imaging protocols and continued optimization of radiation dose, contrast media dose and imaging quality. This is the subject of this PhD project.Study I: The aim of this study was to evaluate the potential of low-kV dual-source (DS) and dual-energy (DE) to reduce CM-doses while maintaining soft-tissue and iodine CNR in phantoms of varying size, and to quantify the corresponding radiation dose increases. It was found that low-kV dual-source imaging could be used to reduce CM doses by 44-53% with maintained iodine-, soft tissue-and other materials CNR in a wide range of abdominal sizes, to the cost of about 20-100% increased radiation dose, depending on size. The dual-energy technique allowed a reduction of CM dose by 20% at similar radiation dose as the standard 120 kV protocol.Study II: The aim of this study was to implement and evaluate a scanning regimen, based on the results from Study I, to reduce CM-doses for patients believed to be at risk of CIN. It was concluded that the protocols from Study I could be used to reduce CM doses by 40-50%, depending on patient size, with maintained CNR in patients with a BMI-range of 15-36 kg/m 2 . The size-specific dose estimates increased by 70%.Study III: The aim of this study was to compare the outcome in image noise and radiation dose in the subsequent CT scan following a single anterior-posterior (AP) vs a combined lateral plus AP (LAT+AP) localizer when using automatic tube-current modulation (ATCM). The results suggested that using LAT+AP localizer yields more consistent noise and radiation dose than a single AP. The effect was small, except for a subgroup of females with laterally protruding breast tissue, which may have been overexposed by about 57% in the thorax region.Study IV: The aim of this study was to evaluate if standard-dose CT can be replaced with low-dose CT for characterization of non-specific findings bone in scintigraphy. Based on these results, sub-mSv CT seems feasible for morphological characterization of skeletal changes in areas with increased tracer uptake on bone scintigraphy, although a larger study is needed.

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“…In case a vertebral fracture was detected or could not be reliably ruled out, an additional computed tomography (CT) scan of the suspicious segment should be obtained (20)(21)(22). In fractures of the spine, the diagnostic performance of low-dose CT was found to be comparable to that of standarddose CT, with a considerable reduction in radiation dose (23).…”

Section: Aospine Thoracolumbar Vertebral Fracture Classification Systemmentioning

confidence: 99%

The Conservative Treatment of Traumatic Thoracolumbar Vertebral Fractures

Spiegl¹,

Fischer²,

Schmidt³

et al. 2018

Deutsches Ärzteblatt International

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very year, an estimated 8000 severe fractures of the thoracic and the lumbar spine occur in Germany (1). In more than two-thirds of these cases, the thoracolumbar junction, i.e. the thoracic vertebral bodies T11/T12 or the lumbar vertebral bodies L1/L2 are affected (2). For the classification of the various types of fracture, the AOSpine classification of the AO Foundation (Arbeitsgemeinschaft Osteosynthese) has become the established standard (3). It differentiates between compression fractures (Type A), flexion-distraction fractures (Type B), and the highly unstable displaced fractures (Type C) (Table 1). Complete paraplegia was observed in 2% and incomplete neurological deficits in 11% of patients with type-A fractures (2). The indications for conservative and surgical management remain the subject of international controversy (4, 5). Box 1 provides a summary of the treatment recommendations of the Spine Working Group of the German Society for Orthopedics and Trauma (DGOU, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie) (4). Overall, a conservative treatment strategy can be applied in many cases with promising long-term outcomes (6, 7). However, the type of conservative treatment is usually poorly defined. This applies to both the intensity and type of the therapeutic measures and the timing of the clinical and radiographic follow-ups (5, 8). The aim of this review, which was initiated by the committee for conservative spine treatment of the German Spine Society (DWG, Deutsche Wirbelsäulengesellschaft), is to systematically screen the literature for content related to conservative management. From this, the current state of evidence shall be described for a standardized conservative treatment of traumatic vertebral fractures of the thoracic and lumbar spine. Based on these results, prospective studies could be created to increase the evidence in this field and to produce data that can be used to further scientifically support the therapeutic strategy. Materials and methods The literature search included recent vertebral fractures (<4 weeks) of the thoracic and lumbar spine of adults with adequate trauma history and without neurological deficits. Children and adolescents (age <18 years) and Summary Background: The conservative treatment of traumatic thoracolumbar vertebral fractures is often not clearly defined. Methods: This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for publications up to February 2018 dealing with the conservative treatment of traumatic thoracolumbar vertebral fractures. The search initially yielded 3345 hits, of which 35 were suitable for use in this review. Results: It can be concluded from the available original clinical research on the subject, including three randomized controlled trials (RCTs), that the primary diagnostic evaluation should be with plain x-rays, in the standing position if possible. If a fracture is suspected on the plain films, computed tomography (CT) is indicated. Magnetic resonance imaging (MRI) ...

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Diagnostic usefulness of low-dose lumbar multi-detector CT with iterative reconstruction in trauma patients: acomparison with standard-dose CT

Abstract: The diagnostic performance of LDCT with IR for L-spine fractures was comparable to that of SDCT with IR, with a 47-69% reduction in the radiation dose. Advances in knowledge: LDCT scan can be used as a diagnostic imaging tool for evaluating trauma patients with suspected L-spine fractures.

Cited by 16 publications

References 22 publications

Multi-detector CT imaging: impact of virtual tube current reduction and sparse sampling on detection of vertebral fractures

Multi-detector CT imaging: impact of virtual tube current reduction and sparse sampling on detection of vertebral fractures

Is sub-mSv CT for evaluation of non-specific findings in bone scintigraphy of oncological patients feasible?

The Conservative Treatment of Traumatic Thoracolumbar Vertebral Fractures

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