title: Evaluation of reduced-dose CT for acute non-traumatic abdominal pain: evaluation of diagnostic accuracy in comparison to standard-dose CT.
abstract: Background Patients with acute non-traumatic abdominal pain often undergo abdominal computed tomography (CT). However, abdominal CT is associated with high radiation exposure. Purpose To evaluate diagnostic performance of a reduced-dose 100 kVp CT protocol with advanced modeled iterative reconstruction as compared to a linearly blended 120 kVp protocol for assessment of acute, non-traumatic abdominal pain. Material and Methods Two radiologists assessed 100 kVp and linearly blended 120 kVp series of 112 consecutive patients with acute non-traumatic pain (onset < 48 h) regarding image quality, noise, and artifacts on a five-point Likert scale. Both radiologists assessed both series for abdominal pathologies and for diagnostic confidence. Both 100 kVp and linearly blended 120 kVp series were quantitatively evaluated regarding radiation dose and image noise. Comparative statistics and diagnostic accuracy was calculated using receiver operating curve (ROC) statistics, with final clinical diagnosis/clinical follow-up as reference standard. Results Image quality was high for both series without detectable significant differences ( P = 0.157). Image noise and artifacts were rated low for both series but significantly higher for 100 kVp ( P ≤ 0.021). Diagnostic accuracy was high for both series (120 kVp: area under the curve [AUC] = 0.950, sensitivity = 0.958, specificity = 0.941; 100 kVp: AUC ≥ 0.910, sensitivity ≥ 0.937, specificity = 0.882; P ≥ 0.516) with almost perfect inter-rater agreement (Kappa = 0.939). Diagnostic confidence was high for both dose levels without significant differences (100 kVp 5, range 4-5; 120 kVp 5, range 3-5; P = 0.134). The 100 kVp series yielded 26.1% lower radiation dose compared with the 120 kVp series (5.72 ± 2.23 mSv versus 7.75 ± 3.02 mSv, P < 0.001). Image noise was significantly higher in reduced-dose CT (13.3 ± 2.4 HU versus 10.6 ± 2.1 HU; P < 0.001). Conclusion Reduced-dose abdominal CT using 100 kVp yields excellent image quality and high diagnostic accuracy for the assessment of acute non-traumatic abdominal pain.
authors.affiliation: 1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Othman
authors.affiliation: 1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Malte Niklas
authors.initials: MN
authors.lastname: Bongers
authors.affiliation: 1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Zinsser
authors.affiliation: 1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schabel
authors.affiliation: 2 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
authors.affiliation: 3 Department of General, Visceral and Transplantation Surgery, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Rami
authors.initials: R
authors.lastname: Arshid
authors.affiliation: 1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Mike
authors.initials: M
authors.lastname: Notohamiprodjo
authors.affiliation: 1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: 1 Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000000981:diagnostic imaging*; D000208:Acute Disease; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011860:Radiography, Abdominal / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Low-dose CT; acute abdominal pain; computed tomography (CT); diagnostic accuracy; radiation dose