Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography

  • Kim, Sang Youn (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Cho, Jeong Yeon (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Joongyub (Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hwang, Sung Il (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Moon, Min Hoan (Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Lee, Eun Ju (Department of Radiology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Hong, Seong Sook (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Kim, Chan Kyo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kyeong Ah (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Park, Sung Bin (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Sung, Deuk Jae (Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Kim, Yongsoo (Department of Radiology, Hanyang University Guri Hospital) ;
  • Kim, You Me (Department of Radiology, Dankook University Hospital, Dankook University College of Medicine) ;
  • Jung, Sung Il (Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • Rha, Sung Eun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Dong Won (Department of Radiology, Dong-A University College of Medicine) ;
  • Lee, Hyun (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Shim, Youngsup (Department of Radiology, Gachon University, Gil Medical Center) ;
  • Hwang, Inpyeong (Department of Radiology, Cheongyang-gun Health Center and County Hospital) ;
  • Woo, Sungmin (Department of Radiology, Armed Forces Daejeon Hospital) ;
  • Choi, Hyuck Jae (Department of Radiology, Sheikh Khalifa Specialty Hospital)
  • Received : 2017.12.26
  • Accepted : 2018.06.07
  • Published : 2018.12.01
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Abstract

Objective: To compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU. Materials and Methods: This prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated. Results: The study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose ($5.73{\pm}4.04$ vs. $8.43{\pm}4.38mSv$) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ${\geq}3$), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group. Conclusion: The diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.

Keywords

Acknowledgement

Supported by : TAEJOON PHARM Co. Ltd.

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