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Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Radiology, Örebro University Hospital, Örebro, Sweden. (Datortomografi med låg stråldos(Lågdos-DT))ORCID iD: 0000-0003-0137-9991
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden. (Datortomografi med låg stråldos(Lågdos-DT))
Department of Medical Imaging and Physiology, Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
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2016 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 26, no 6, p. 1766-1774Article in journal (Refereed) Published
Abstract [en]

Objectives: Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels.

Methods: Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present.

Results: Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %.

Conclusions: Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain.

Key points: • Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.

Place, publisher, year, edition, pages
New York: Springer, 2016. Vol. 26, no 6, p. 1766-1774
Keywords [en]
X-ray computed tomography, abdominal radiography, sensitivity and specificity, abdominal pain, abdomen, acute
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
URN: urn:nbn:se:oru:diva-47089DOI: 10.1007/s00330-015-3984-9ISI: 000376100100030PubMedID: 26385800Scopus ID: 2-s2.0-84942013953OAI: oai:DiVA.org:oru-47089DiVA, id: diva2:883115
Note

Funding Agency:

Region Örebro County

Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2018-07-09Bibliographically approved
In thesis
1. Low-dose computed tomography of the abdomen and lumbar spine
Open this publication in new window or tab >>Low-dose computed tomography of the abdomen and lumbar spine
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Radiography is a common radiologic investigation despite abundant evidence of its limited diagnostic value. On the other hand, computed tomography (CT) has a high diagnostic value and is widely considered to be among the most important advances in medicine. However, CT exposes patients to a higher radiation dose and it might therefore not be acceptable simply to replace radiography with CT, despite the powerful diagnostic value of this technique. At the expense of reduced CT image quality, which could be adjusted to the diagnostic needs, low-dose CT of abdomen and lumbar spine can be performed at similar dose to radiography. The aim of the current thesis project was to evaluate low-dose CT of the abdomen and lumbar spine and to compare it with radiography. The hypothesis was that CT would give better image quality and diagnostic information compared to radiography at similar dose levels. Firstly, the diagnostic accuracy of low-dose CT of the abdomen was evaluated. Results showed that low-dose CT of abdomen has a high sensitivity and specificity compared to radiography, i.e., it has higher diagnostic accuracy. Similar results were obtained from our systematic review. Secondly, in a phantom study, an ovine phantom was scanned at various CT settings. The image quality was evaluated to obtain a protocol for the optimal settings for low-dose CT of lumbar spine at 1 mSv. This new protocol was then used in a clinical study to assess the image quality of low-dose CT of the lumbar spine and compare it to radiography. Results showed that low-dose CT has significantly better image quality than radiography. Finally, the impact of Iterative reconstruction (IR) on image quality of lumbar spine CT was tested. Iterative reconstruction is a recent CT technique aimed to reduce radiation dose and/or improve image quality. The results showed that the use of medium strength IR levels in the reconstruction of CT image improves image quality compared to filtered back projection. In conclusion, low-dose CT of the abdomen and lumbar spine, at about 1 mSv, has better image quality and gives diagnostic information compared to radiography at similar dose levels and it could therefore replace radiography.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. p. 87
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 137
Keywords
Tomography, X-Ray Computed, Radiography, Radiation Dosage, Abdomen, Spine, Lumbosacral Region, Regression Analysis
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-48242 (URN)978-91-7529-104-8 (ISBN)
Public defence
2016-04-08, Universitetssjukhuset, Bohmanssonsalen, Södra Grev Rosengatan, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2018-04-27Bibliographically approved

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Alshamari, MuhammedGeijer, Håkan

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