Can iterative reconstruction algorithms replace tube loading compensation in low kVp hepatic CT? Subjective versus objective image quality.

BACKGROUND: Hepatic computed tomography (CT) with decreased peak kilovoltage (kVp) may be used to reduce contrast medium doses in patients at risk of contrast-induced acute kidney injury (CI-AKI); however, it increases image noise. To preserve image quality, noise has been controlled by X-ray tube loading (mAs) compensation (TLC), i.e. increased mAs. Another option to control image noise would be to use iterative reconstructions (IR) algorithms without TLC (No-TLC). It is unclear whether this may preserve image quality or only reduce image noise. PURPOSE: To evaluate image quality of 80 kVp hepatic CT with TLC and filtered back projection (FBP) compared with 80 kVp with No-TLC and IR algorithms (SAFIRE 3 and 5) in patients with eGFR <45 mL/min. MATERIAL AND METHODS: Forty patients (BMI 18-32 kg/m2) were examined with both protocols following injection of 300 mg I/kg. Hepatic attenuation, image noise, enhancement, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality were evaluated for each patient. RESULTS: Comparing TLC/FBP with No-TLC/IR-S5, there were no significant differences regarding hepatic attenuation, image noise, enhancement, SNR and CNR: 114 vs. 115 HU, 14 vs. 14 HU, 55 vs. 57 HU, 8.0 vs. 8.4, and 3.8 vs. 4.0 in median, respectively. No-TLC/IR-S3 resulted in higher image noise and lower SNR and CNR than TLC/FBP. Subjective image quality scoring with visual grading showed statistically significantly inferior scores for IR-S5 images. CONCLUSION: CT of 80 kVp to reduce contrast medium dose in patients at risk of CI-AKI combined with IR algorithms with unchanged tube loading to control image noise does not provide sufficient diagnostic quality.

Simulated Dose Reduction for Abdominal CT With Filtered Back Projection Technique: Effect on Liver Lesion Detection and Characterization.

OBJECTIVE: Previous studies have shown the possibility to reduce radiation dose in abdominal CT by 25-50% without negatively affecting detection of liver lesions. How radiation dose reduction affects characterization of liver metastases is not as well known. The objective of this study was to investigate how different levels of simulated dose reduction affect the detection and characterization of liver lesions, primarily hypovascular metastases. A secondary objective was to analyze the relationship between the lesion size and contrast-to-noise ratio (CNR) and the detection rate. MATERIALS AND METHODS: Thirty-nine patients (19 with metastases and 20 without) were retrospectively selected. The following radiation dose levels (DLs) were simulated: 100% (reference level), 75%, 50%, and 25%. Five readers were asked to mark liver lesions and rate the probability of malignancy on a 5-grade Likert scale. Noninferiority analysis using the jackknife free-response ROC (JAFROC) method was performed as well as direct comparison of detection rates and grades. RESULTS: JAFROC analysis showed noninferior detection and characterization of metastases at DL75 as compared with DL100. However, the number of benign lesions and false-positive localizations rated as "suspected malignancy" was significantly higher at DL75. CONCLUSION: Radiation dose can be reduced by 25% without negatively affecting diagnosis of hypovascular liver metastases. Characterization of benign lesions, however, is impaired at DL75, which may lead to unnecessary follow-up examinations. Finally, increased image noise seems to affect the detection of small lesions to a degree that cannot be explained solely by the reduction in CNR.

Material Decomposition in Dual-Energy Computed Tomography Separates High-Z Elements From Iodine, Identifying Potential Contrast Media Tailored for Dual Contrast Medium Examinations.

OBJECTIVE: The aim of this study was to determine the potential of different high-Z elements to act as contrast media (CMs) alongside iodine (I) in dual-CM, dual-energy (DE) computed tomography examinations. METHODS: Gadolinium (Gd), tantalum (Ta), wolfram (W), gold (Au), and bismuth (Bi) in addition to I were examined at all available kilovolt settings in a DE computed tomography scanner. Dual-energy ratios were calculated by dividing attenuation at low kilovolt by attenuation at high kilovolt. Dual-energy data sets were loaded into material decomposition software to evaluate separation of the elements from I. RESULTS: The DE ratios of Ta, W, and Au ranged between 0.9 and 1.2, being considerably lower than I at 1.9 to 2.6. These elements were completely separated from I using material decomposition. Gadolinium and Bi were more similar to I at 1.4 to 1.9. However, separation was nearly complete for Bi and suboptimal for Gd. CONCLUSIONS: Tantalum, W, and Au are ideal candidates for dual-CM examinations, whereas Bi is a slightly weaker candidate.

Seesaw balancing radiation dose and i.v. contrast dose: evaluation of a new abdominal CT protocol for reducing age-specific risk.

OBJECTIVE: The purpose of this study was to evaluate an abdominal CT protocol in which radiation dose was reduced and i.v. contrast dose increased for young patients and radiation dose was increased and i.v. medium dose decreased for elderly patients. The hypothesis was that these adjustments would result in constant image quality and a reduction in age-specific risk. MATERIALS AND METHODS: Patients were divided into four age groups of 25 patients each: group 1, 16-25 years; group 2, 26-50 years; group 3, 51-75 years; and group 4, older than 75 years. The quality reference tube load ranged from 100 to 300 mAs, and the i.v. contrast dose ranged from 600 to 350 mg I/kg. Group 3 was the reference group. Signal-to-noise and contrast-to-noise ratios for a hypothetical hypovascular liver metastatic lesion were calculated. Subjective image quality was evaluated by visual grading characteristic analysis in which four readers assessed the reproduction of seven image-quality criteria. RESULTS: Radiation dose was reduced 57% in the youngest group, and the i.v. contrast dose was reduced 18% in elderly patients. There were no statistically significant differences between the groups with respect to signal-to-noise and contrast-to-noise ratios. Subjective image quality was graded significantly lower for four criteria in group 1 compared with group 3. No significant difference was found in comparisons of groups 2 (except for one criterion) and 4 with group 3. CONCLUSION: It is possible to balance radiation dose and contrast dose against each other and maintain signal-to-noise and contrast-to-noise ratios. Subjective image quality was affected by increased noise level on the images but was judged acceptable in all groups except the one with the lowest radiation dose.

Post-processing image filtration enabling dose reduction in standard abdominal CT.

The collective effective radiation dose to the population is increasing due to a higher use of computerised tomography. SharpView AB, Linköping, Sweden, has developed an adaptive non-linear post-processing image filtration that may enable the use of lower radiation doses. The present study assessed if a lower dose with image filtration had the same image quality as a higher dose without the filter applied. All imaging was performed on a Siemens Somatom Sensation 16 CT. The parameters used were 120 kV and 200 mAs (40 patients) and 130 mAs without and with image filtering (40 patients), respectively. All studies were quantitatively evaluated for noise and image quality was assessed by visual grading characteristics (VGC) analysis. After image filtration, the noise in the processed images was lowered and the image quality was improved as shown by the VGC analysis. However, images using the higher dose were still ranked as the best in five out of eight criteria as shown by the VGC analysis. Image filtration enhances CT images significantly and further studies will show if 130 mAs with image filtration may be sufficient for clinically general abdominal CT.

PCR-denaturing gradient gel electrophoresis and two feces antigen tests for detection of Helicobacter pylori in mice.

PCR-denaturing Gradient Gel Electrophoresis (PCR-DGGE), a method suitable for the detection of microbial species in complex ecosystems, was evaluated for the detection and identification of Helicobacter spp. in feces and stomach tissue of mice. Two commercially available stool antigen tests for clinical diagnostics in humans were also evaluated in the C57Bl/6 mouse model of H. pylori infection. PCR-DGGE detected only Helicobacter ganmani in feces from H. pylori-infected as well as control animals, whereas in stomach specimens it demonstrated the presence of H. pylori in challenged and H. ganmani in control animals. Hence, the method detected DNA only of the predominant Helicobacter spp., which was also shown in cell dilution experiments. The Amplified IDEIA Hp StAR feces antigen test detected H. pylori in feces from all infected animals and generated no false-positive results, whereas the Premier Platinum HpSA-test also detected H. pylori in all infected animals but generated false-positive or equivocal results in 50% of the control animals. Premier Platinum HpSA, as opposed to Hp StAR, cross-reacted with non-pylori Helicobacter spp. in vitro.

The rapid detection of low molecular mass proteins differentially expressed under biological stress for four Helicobacter spp. using ProteinChip technology.

Helicobacter pylori is one of the most prevalent human pathogens in the world and is the aetiological agent of gastritis, peptic ulcer disease and gastric malignancies. In addition H. pylori and other novel members of the genus are capable of successfully colonising the bile-rich niche of the upper intestine and are associated with a diverse range of intestinal pathologies. Surface-enhanced laser desorption/ionisation-time of flight mass spectrometry was used to analyse surface extracts from H. pylori, Helicobacter bilis, Helicobacter pullorum and "Helicobacter sp. flexispira" to characterise cell surface changes following bile stress. The system detected two distinct response patterns to bile stress on the cell surface of Helicobacter spp. in vitro. The first involved the increase under bile stress of peaks at 7.6 and 7.9 kDa for H. billis and H. pullorum, respectively. In contrast both "Helicobacter sp. flexispira" and a clinical isolate of H. pylori had similar response profiles to bile stress. Both strains had at least three low mass peaks decreased under bile stress and a single peak induced by bile stress. The present study has established the use of ProteinChip(R) technology to analyse helicobacter-related proteomics. Specifically this study has established that different patterns are generated in response to bile stress among various pathogenic Helicobacter spp. which may give insights into the ability of these strains to colonise different niches.