Ultra-low dose chest CT for the diagnosis of pulmonary arteriovenous malformation in patients with hereditary hemorrhagic telangiectasia

IF 4.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Diagnostic and Interventional Imaging Pub Date : 2024-04-10 DOI:10.1016/j.diii.2024.03.006

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引用次数: 0

Abstract

Purpose

The purpose of this study was to compare ultra-low dose (ULD) and standard low-dose (SLD) chest computed tomography (CT) in terms of radiation exposure, image quality and diagnostic value for diagnosing pulmonary arteriovenous malformation (AVM) in patients with hereditary hemorrhagic telangiectasia (HHT).

Materials and methods

In this prospective board-approved study consecutive patients with HHT referred to a reference center for screening and/or follow-up chest CT examination were prospectively included from December 2020 to January 2022. Patients underwent two consecutive non-contrast chest CTs without dose modulation (i.e., one ULD protocol [80 kVp or 100 kVp, CTDIvol of 0.3 mGy or 0.6 mGy] and one SLD protocol [140 kVp, CTDIvol of 1.3 mGy]). Objective image noises measured at the level of tracheal carina were compared between the two protocols. Overall image quality and diagnostic confidence were scored on a 4-point Likert scale (1 = insufficient to 4 = excellent). Sensitivity, specificity, positive predictive value and negative predictive value of ULD CT for diagnosing pulmonary AVM with a feeding artery of over 2 mm in diameter were calculated along with their 95% confidence intervals (CI) using SLD images as the standard of reference.

Results

A total of 44 consecutive patients with HHT (31 women; mean age, 42 ± 16 [standard deviation (SD)] years; body mass index, 23.2 ± 4.5 [SD] kg/m²) were included. Thirty-four pulmonary AVMs with a feeding artery of over 2 mm in diameter were found with SLD images versus 35 with ULD images. Sensitivity, specificity, predictive positive value, and predictive negative value of ULD CT for the diagnosis of PAVM were 100% (34/34; 95% CI: 90–100), 96% (18/19; 95% CI: 74–100), 97% (34/35; 95% CI: 85–100) and 100% (18/18; 95% CI: 81–100), respectively. A significant difference in diagnostic confidence scores was found between ULD (3.8 ± 0.4 [SD]) and SLD (3.9 ± 0.1 [SD]) CT images (P = 0.03). No differences in overall image quality scores were found between ULD CT examinations (3.9 ± 0.2 [SD]) and SLD (4 ± 0 [SD]) CT examinations (P = 0.77). Effective radiation dose decreased significantly by 78.8% with ULD protocol, with no significant differences in noise values between ULD CT images (16.7 ± 5.0 [SD] HU) and SLD images (17.7 ± 6.6 [SD] HU) (P = 0.07).

Conclusion

ULD chest CT provides 100% sensitivity and 96% specificity for the diagnosis of treatable pulmonary AVM with a feeding artery of over 2 mm in diameter, leading to a 78.8% dose-saving compared with a standard low-dose protocol.

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超低剂量胸部 CT 诊断遗传性出血性毛细血管扩张症患者的肺动静脉畸形。

本研究旨在比较超低剂量（ULD）和标准低剂量（SLD）胸部计算机断层扫描（CT）在诊断遗传性出血性毛细血管扩张症（HHT）患者肺动静脉畸形（AVM）方面的辐射暴露、图像质量和诊断价值。材料和方法在这项经委员会批准的前瞻性研究中，从 2020 年 12 月到 2022 年 1 月，前瞻性地纳入了转诊到参考中心进行筛查和/或随访胸部 CT 检查的连续 HHT 患者。患者连续接受了两次无剂量调节的非对比胸部 CT 检查（即一个 ULD 方案 [80 kVp 或 100 kVp，CTDIvol 为 0.3 mGy 或 0.6 mGy] 和一个 SLD 方案 [140 kVp，CTDIvol 为 1.3 mGy]）。比较了两种方案在气管心尖水平测量到的客观图像噪音。整体图像质量和诊断可信度采用李克特四分法评分（1 = 不足，4 = 优秀）。以 SLD 图像为参考标准，计算了 ULD CT 诊断直径超过 2 mm 的供血动脉肺动静脉畸形的敏感性、特异性、阳性预测值和阴性预测值及其 95% 置信区间 (CI)。在 SLD 图像中发现了 34 个直径超过 2 毫米的肺动静脉畸形，而在 ULD 图像中发现了 35 个。ULD CT 诊断 PAVM 的敏感性、特异性、预测阳性值和预测阴性值分别为 100%（34/34；95% CI：90-100）、96%（18/19；95% CI：74-100）、97%（34/35；95% CI：85-100）和 100%（18/18；95% CI：81-100）。ULD（3.8 ± 0.4 [标码]）和 SLD（3.9 ± 0.1 [标码]）CT 图像的诊断置信度得分存在明显差异（P = 0.03）。ULD CT 检查（3.9 ± 0.2 [SD] ）和 SLD CT 检查（4 ± 0 [SD] ）的总体图像质量评分没有差异（P = 0.77）。ULD方案的有效辐射剂量大幅降低了78.8%，ULD CT图像（16.7 ± 5.0 [SD] HU）和SLD图像（17.7 ± 6.6 [SD] HU）之间的噪声值无明显差异（P = 0.07）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic and Interventional Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

8.50

自引率

29.10%

发文量

126

审稿时长

11 days

期刊介绍： Diagnostic and Interventional Imaging accepts publications originating from any part of the world based only on their scientific merit. The Journal focuses on illustrated articles with great iconographic topics and aims at aiding sharpening clinical decision-making skills as well as following high research topics. All articles are published in English. Diagnostic and Interventional Imaging publishes editorials, technical notes, letters, original and review articles on abdominal, breast, cancer, cardiac, emergency, forensic medicine, head and neck, musculoskeletal, gastrointestinal, genitourinary, interventional, obstetric, pediatric, thoracic and vascular imaging, neuroradiology, nuclear medicine, as well as contrast material, computer developments, health policies and practice, and medical physics relevant to imaging.