Clinical value of a new generation adaptive statistical iterative reconstruction (ASIR-V) in the diagnosis of pulmonary nodule in low-dose chest CT.

Objective: To evaluate the clinical value of low-dose chest CT combined with the new generation adaptive statistical iterative reconstruction (ASIR-V) algorithm in the diagnosis of pulmonary nodule. Methods: 30 patients with pulmonary nodules underwent chest CT using Revolution CT. The patients were first scanned with standard-dose at a noise index (NI) of 14, and the images were reconstructed with filtered back projection (FBP) algorithm. If pulmonary nodules were found, a low-dose targeted scan, with NI of 24, was performed localized on the nodules, and the images were reconstructed with 60% ASIR-V. The detection rate of pulmonary nodules in the two scanning modes was recorded. The size of nodules, CT value and standard deviation of nodules were measured. The signal-to-noise ratio and contrast-to-noise ratio were also calculated. Two experienced radiologists used a 5-point method to score the image quality. The volumetric CT dose index, and dose-length product were recorded and the effective dose (ED) was calculated of the two scanning modes. Results: Volumetric CT dose index (ED) of the standard-dose scan covering the entire lungs was 7.29 +/- 2.38 mGy (3.52 +/- 1.09 mSv), and that of low-dose targeted scan was 2.56 +/- 1.87 mGy (0.51 +/- 0.32 mSv). However, the ED of the virtual low-dose scan for the entire lungs was 1.44 +/- 0.15 mSv, which would mean a dose reduction of 59.1% compared with the standard-dose scan. 85 of the 87 pulmonary nodules were detected in the low-dose targeted scan, with 2 of the ground-glass density nodules with size less than 1cm missed, resulting in 97.7% overall detection rate. There was no difference between the low-dose ASIR-V images and standard-dose FBP images for the size (1.49 +/- 0.74 cm vs 1.48 +/- 0.75cm), CT value [33.02 +/- 1.95Hounsfield unit (HU) vs 34.6 +/- 3.07 HU], standard deviation (27.64 +/- 14.42 HU vs 30.38 +/- 20.04 HU), signal-to-noise ratio (1.44 +/- 0.88 vs 1.43 +/- 1.31) and contrast-to-noise ratio (38.95 +/- 18.43 vs 38.23 +/- 14.99) of nodules (all p > 0.05). There was no difference in the subjective scores between the two scanning modes. Conclusion: The low-dose CT scan combined with ASIR-V algorithm is of comparable value in the detection and the display of pulmonary nodules when compared with the FBP images obtained by standard-dose scan. Advances in knowledge: This is a clinical study to evaluate the clinical value of pulmonary nodules using ASIR-V algorithm in the same patients in the low-dose chest CT scans. It suggests that ASIR-V provides similar image quality and detection rate for pulmonary nodules at much reduced radiation dose.