Detection and characterization of focal liver lesions with ultra-low dose computed tomography in neoplastic patients

The purpose of this study was to evaluate and compare the diagnostic accuracy of ultra-low dose (ULD) computed tomography (CT) with that of standard dose (STD) CT in the detection and characterization of focal liver lesions in neoplastic patients.

A total of 177 neoplastic patients who underwent two abdominopelvic CT examinations (one with STD and one with ULD protocol) for suspected focal liver lesions were included. There were 103 men and 74 women with a mean age of 64.6±14.4 (SD) (range: 19-93 years). Raw data images were reconstructed with iterative reconstruction. Dose length product (DLP) and effective dose for both protocols were compared. Images were independently evaluated by two radiologists for image-quality, diagnostic quality, and confidence level.

DLP for STD and ULD were respectively 215.4±92.0 (SD) mGy·cm (range: 76-599mGy·cm) and 90.7±37.2 (SD) mGy·cm (range: 32-254mGy·cm). Effective dose for STD and ULD CT were 3.2±1.4 (SD) mSv (range: 1.1-9.0mSv) and 1.4±0.6 (SD) mSv (range: 0.5 to 3.8mSv). A significant 58% dose reduction was found between the two protocols (P<0.05). Noise, signal-to-noise ratio and contrast-to-noise ratio were higher with the ULD protocol compared to the STD protocol. No differences in subjective image quality were found between the two protocols. STD CT revealed focal liver lesions in 80 patients and ULD CT in 70 patients (P<0.05). ULD protocol resulted in a sensitivity of 83.8% and a specificity of 96.9% for the diagnosis of focal liver lesions although it was not able to characterize them properly (Se 62.5%).

STD CT helps detect and characterize focal liver lesions. ULD CT offers good performance to detect focal liver lesions but with lower performances for lesion characterization.