Low-dose versus conventional CT urography using dual-source CT with different time-current product values and the same tube voltage: image quality and diagnostic performance in various diagnoses

Abstract

Abstract Objectives To compare the image quality and diagnostic performance of low-dose CT urography to that of concurrently acquired conventional CT using dual-source CT. Methods This retrospective study included 357 consecutive CT urograms performed by third-generation dual-source CT in a single institution between April 2020 and August 2021. Two-phase CT images (unenhanced phase, excretory phase with split bolus) were obtained with two different tube current-time products (280 mAs for the conventional-dose protocol and 70 mAs for the low-dose protocol) and the same tube voltage (90 kVp) for the two X-ray tubes. Iterative reconstruction was applied for both protocols. Two radiologists independently performed quantitative and qualitative image quality analysis and made diagnoses. The correlation between the noise level or the effective radiation dose and the patients’ body weight was evaluated. Results Significantly higher noise levels resulting in a significantly lower liver signal-to-noise ratio and contrast-to-noise ratio were noted in low-dose images compared to conventional images (P < .001). Qualitative analysis by both radiologists showed significantly lower image quality in low-dose CT than in conventional CT images (P < .001). Patient’s body weight was positively correlated with noise and effective radiation dose (P < .001). Diagnostic performance for various diseases, including urolithiasis, inflammation, and mass, was not different between the two protocols. Conclusions Despite inferior image quality, low-dose CT urography with 70 mAs and 90 kVp and iterative reconstruction demonstrated diagnostic performance equivalent to that of conventional CT for identifying various diseases of the urinary tract. Advances in knowledge Low-dose CT (25% radiation dose) with low tube current demonstrated diagnostic performance comparable to that of conventional CT for a variety of urinary tract diseases.