Wide-volume versus helical acquisition in unenhanced chest CT: prospective intra-patient comparison of diagnostic accuracy and radiation dose in an ultra-low-dose setting.

Abstract

Diagnostic performance and potential radiation dose reduction of wide-area detector CT sequential acquisition ("wide-volume" acquisition (WV)) in unenhanced chest examination are unknown. This study aims to assess the image quality, the diagnostic performance, and the radiation dose reduction of WV mode compared with the classical helical acquisition for lung parenchyma analysis in an ultra-low-dose (ULD) protocol. After Institutional Review Board Approval and written informed consent, 64 patients (72% men; 67.6 ± 9.7years old; BMI 26.1 ± 5.3kg/m2) referred for a clinically indicated unenhanced chest CT were prospectively included. All patients underwent, in addition to a standard helical acquisition (120kV, automatic tube current modulation), two ULD acquisitions (135kV, fixed tube current at 10mA): one in helical mode and one in WV mode. Image noise, subjective image quality (5-level Likert scale), and diagnostic performance for the detection of 9 predetermined parenchymal abnormalities were assessed by two radiologists and compared using the chi-square or Fisher non-parametric tests. Subjective image quality (4.2 ± 0.7 versus 4.2 ± 0.8, p = 0.56), image noise (41.7 ± 8 versus 40.9 ± 8.7, p = 0.3), and diagnostic performance were equivalent between ULD WV and ULD helical. Radiation dose was significantly lower for the ULD WV acquisition (mean dose-length product 14.1 ± 1.3mGycm versus 15.8 ± 1.3, p < 0.0001). An additional 11% dose reduction is achieved with the WV mode in ULD chest CT with fixed tube current, with equivalent image quality and diagnostic performance when compared with the helical acquisition. • Image quality and diagnostic performance of ultra-low-dose unenhanced chest CT are identical between wide-volume mode and the reference helical acquisition. • Wide-volume mode allows an additional radiation dose reduction of 11% (mean dose-length product 14.1 ± 1.3mGycm versus 15.8 ± 1.3, p < 0.0001).