Diagnostic performance of ultra-low dose versus standard dose CT for non-traumatic abdominal emergencies - 26/05/21
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Highlights |
• | Ultra-low dose abdominopelvic CT, with more than 50% of effective dose reduction, has sensitivity and specificity equivalent to those of standard CT for the diagnosis of bowel obstruction, acute colitis and diverticulitis. |
• | Sensitivities of ultra-low dose CT are lower than those of standard CT for the diagnosis of other conditions including appendicitis and pyelonephritis. |
• | Diagnostic confidence is poorer with ultra-low dose CT compared to standard CT and requires a learning period. |
Abstract |
Purpose |
The purpose of this study was to compare the diagnostic performance of ultra-low dose (ULD) to that of standard (STD) computed tomography (CT) for the diagnosis of non-traumatic abdominal emergencies using clinical follow-up as reference standard.
Materials and methods |
All consecutive patients requiring emergency abdomen-pelvic CT examination from March 2017 to September 2017 were prospectively included. ULD and STD CTs were acquired after intravenous administration iodinated contrast medium (portal phase). CT acquisitions were performed at 125mAs for STD and 55mAs for ULD. Diagnostic performance was retrospectively evaluated on ULD and STD CTs using clinical follow-up as a reference diagnosis.
Results |
A total of 308 CT examinations from 308 patients (145 men; mean age 59.1±20.7 (SD) years; age range: 18–96 years) were included; among which 241/308 (78.2%) showed abnormal findings. The effective dose was significantly lower with the ULD protocol (1.55±1.03 [SD] mSv) than with the STD (3.67±2.56 [SD] mSv) (P<0.001). Sensitivity was significantly lower for the ULD protocol (85.5% [95%CI: 80.4–89.4]) than for the STD (93.4% [95%CI: 89.4–95.9], P<0.001) whereas specificities were similar (94.0% [95%CI: 85.1–98.0] vs. 95.5% [95%CI: 87.0–98.9], respectively). ULD sensitivity was equivalent to STD for bowel obstruction and colitis/diverticulitis (96.4% [95%CI: 87.0–99.6] and 86.5% [95%CI: 74.3–93.5] for ULD vs. 96.4% [95%CI: 87.0–99.6] and 88.5% [95%CI: 76.5–94.9] for STD, respectively) but lower for appendicitis, pyelonephritis, abscesses and renal colic (75.0% [95%CI: 57.6–86.9]; 77.3% [95%CI: 56.0–90.1]; 90.5% [95%CI: 69.6–98.4] and 85% [95%CI: 62.9–95.4] for ULD vs. 93.8% [95%CI: 78.6–99.2]; 95.5% [95%CI: 76.2–100.0]; 100.0% [95%CI: 81.4–100.0] and 100.0% [95%CI: 80.6–100.0] for STD, respectively). Sensitivities were significantly different between the two protocols only for appendicitis (P=0.041).
Conclusion |
In an emergency context, for patients with non-traumatic abdominal emergencies, ULD-CT showed inferior diagnostic performance compared to STD-CT for most abdominal conditions except for bowel obstruction and colitis/diverticulitis detection.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Abdomen, Emergencies, Pelvis, Tomography, , X-ray computed, Ultra-low dose CT
Abbreviations : AAPM, Am, AP, BMI, CT, CTDI, DLP, ED, HU, IR, kVp, LAT, NPV, Pm, PPV, ROI, SD, SSDE, STD, ULD
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Vol 102 - N° 6
P. 379-387 - giugno 2021 Ritorno al numero
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Benvenuto su EM|consulte, il riferimento dei professionisti della salute.