title: A prospective comparison of standard-dose CT enterography and 50% reduced-dose CT enterography with and without noise reduction for evaluating Crohn disease.
abstract: OBJECTIVE
  The purpose of this study was to prospectively compare standard-dose CT enterography (CTE) and 50% reduced-dose CTE, obtained with and without an image noise reduction method, in the evaluation of Crohn disease.
  
  
  METHODS
  Ninety-two patients (69 men and 23 women; mean age [± SD], 31.2 ± 9.5 years) with Crohn disease underwent CTE. Using a dual-source scanner equipped with a proprietary noise reduction method (iterative reconstruction in image space [IRIS]), three sets of CTE images were obtained: standard-dose filtered back projection (FBP) (i.e., weighted FBP), low-dose (i.e., 50% reduction) FBP, and low-dose IRIS CTE. Image noise was measured. Two independent radiologists evaluated subjective image quality (1 [worst] to 4 [best]) and findings of active Crohn disease in the terminal small-bowel segment, including mural hyperenhancement, thickening and stratification, comb sign, and increased perienteric fat attenuation (1 [definitely absent] to 5 [definitely present]).
  
  
  RESULTS
  The mean (± SD) volume CT dose index (CTDI(vol)) was 7.0 ± 0.9 mGy and 3.5 ± 0.5 mGy for standard-dose and low-dose CTE examinations, respectively. The mean (± SD) image noise for standard-dose FBP, low-dose FBP, and low-dose IRIS CTE was 10.6 ± 1.7 HU, 13.9 ± 2.1 HU, and 9.7 ± 1.7 HU, respectively (p < 0.001 for all comparisons). Both assessors found that image quality was poorer with low-dose (mean grade (± SD), 2.3 ± 0.4-2.7 ± 0.5) than in standard-dose (3 ± 0) CTE (p < 0.01), and one found that image quality was poorer with low-dose IRIS (2.3 ± 0.4) than with low-dose FBP (2.7 ± 0.5) CTE (p < 0.01). Low-dose (with or without IRIS) and standard-dose CTE showed ≥ 85% agreement (one-sided 95% CI ≥ 77%) in interpretation of bowel findings.
  
  
  CONCLUSIONS
  Low-dose CTE using 50% reduced-dose performed similarly to standard-dose CTE in identifying findings of enteric inflammation of Crohn disease. Although a noise reduction method markedly reduced image noise in half-dose examinations, its effect on image quality was not as great and was reader dependent.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
authors.forename: So Jung
authors.initials: SJ
authors.lastname: Lee
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Ah Young
authors.initials: AY
authors.lastname: Kim
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Gyoo Sik
authors.initials: GS
authors.lastname: Jung
authors.forename: Hyun Kwon
authors.initials: HK
authors.lastname: Ha
mesh_terms: D000328:Adult; D016477:Artifacts; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*