Utilizing photon-counting CT (PCCT) for stomach imaging to diagnose kidney stones reduces sufferers’ radiation publicity by 44% in contrast with standard CT, researchers have discovered.
PCCT additionally affords the next signal-to-noise ratio than standard CT with no proof of a distinction in reader confidence, reported a workforce led by Henner Huflage, MD, of College Hospital Würzburg in Germany. The findings had been revealed July 30 in Radiology.
Urolithiasis is a standard illness with rising prevalence amongst adults and even kids lately, and since it could actually recur, there’s usually frequent want for diagnostic imaging, the group defined. Noncontrast, low-dose CT of the stomach is the go-to examination for the analysis of kidney stones, with a sensitivity charge of 95% and a specificity charge of 98%. However complying with the American Faculty of Radiology (ACR) guideline of radiation publicity charges of not more than 3 mSv for low-dose CT will be difficult.
That is the place PCCT is available in. Earlier research have proven it could actually produce photographs with out digital noise, improved tissue characterization, and optimized spectral imaging whereas additionally utilizing much less iodine and radiation. However how does it evaluate with conventional CT for kidney stone analysis?
To handle the query, Huflage and colleagues in contrast radiation dose and picture high quality of energy-integrating detector (EID) CT with these of an experimental PCCT scan protocol in sufferers suspected of getting kidney stones. The research included 507 sufferers who underwent unenhanced stomach PCCT (229 sufferers) or EID CT (278 sufferers) for the indication between February 2022 and March 2023. The researchers evaluated signal-to-noise outcomes on the kidney, psoas, and obturator muscle; and three radiologists assessed the presence of kidney stones and registered their diagnostic confidence utilizing a five-point scale (1, little-to-no confidence; 5, full confidence).
The group reported an efficient radiation dose for EID CT of 1.39 mSv and for PCCT of 0.79 mSv, a discount of 44%. Quantity CT dose index was 1.99 mGy for EID CT and 1.17 mGy for PCCT, a discount of 41%. The researchers additionally discovered the next:
| Efficiency comparability of EID CT and PCCT for detecting kidney stones on stomach imaging | ||||
|---|---|---|---|---|
| Measure | EID CT | PCCT | P.c distinction | p-value |
| Picture noise (in Hounsfield items) | ||||
| Kidney | 21.24 | 15.88 | 25% | < 0.001 |
| Psoas muscle | 21.71 | 16.34 | 25% | < 0.001 |
| Inner obturator muscle | 19.61 | 15.61 | 20% | < 0.001 |
| Sign-to-noise ratio | ||||
| Kidney | 1.66 | 2.15 | 30% | < 0.001 |
| Psoas muscle | 153 | 114 | 23% | < 0.001 |
| Inner obturator muscle | 2.79 | 3.25 | 17% | < 0.001 |
The authors famous that settlement among the many three readers was “virtually excellent” (Krippendorff’s alpha coefficient, ≥ 0.99) and diagnostic confidence rankings had “good reliability” (with a correlation coefficient of 0.78 [1 as reference]).
Axial contrast-unenhanced stomach CT examinations in a 38-year-old feminine affected person with a physique mass index (calculated as weight in kilograms divided by top in meters squared) of 31.23 with recognized renal calculi for recurring occasions of flank ache. The affected person underwent (A) dose-optimized energy-integrating detector CT (1.49 mSv) and (B) submillisievert photon-counting detector CT (0.94 mSv). Photographs from each examinations confirmed a 3-mm calculus within the left kidney (arrows). Photographs and caption courtesy of the RSNA.
The research findings are promising, in keeping with the authors.
“[Our study showed that] the radiation burden may very well be decreased by an extra 44% in contrast with that of absolutely optimized EID CT with a longtime low-dose protocol whereas sustaining reader confidence and even rising picture high quality,” they wrote.
Nariman Nezami, MD, of Georgetown College Medical Heart in Washington, DC, and Ashkan A. Malayeri, MD, of the Nationwide Institutes of Well being in Bethesda, MD, agreed in an accompanying editorial.
“As radiologists, we try to boost the standard of affected person care and decrease danger,” they wrote. “[This study] exhibits the potential of [PCCT] in rising diagnostic confidence in renal stone depiction, enhancing picture high quality, and lowering radiation dose, marking an essential development towards this objective.”
The whole research will be discovered right here.
