Imaging quality and diagnostic reliability of low-dose computed tomography lumbar spine for evaluating patients with spinal disorders

Abstract Background context Computed tomography (CT) scans of the lumbar spine (CTLS) have demonstrated a higher level of accuracy than plain films and have been used to assess patients with spinal disorder when magnetic resonance imaging is not available. Nevertheless, radiation exposure remains a serious safety concern. Iterative reconstruction (IR) decreases the CT radiation dose for diagnostic imaging. However, the feasibility of using IR in CTLS is unclear. Purpose To evaluate the imaging quality and diagnostic reliability of CTLS with IR. Study design A prospective study. Patient sample All patients from outpatient departments who suffered from spinal disorders and were referred for CTLS. Outcome measures In acquired CT images, the signal-to-noise ratio (SNR) of the dural sac (DS), intervertebral disc (IVD), psoas muscle (PM), and L5 vertebral body, the contrast-to-noise ratio between the DS and IVD (D-D CNR), and the subjective imaging qualities were compared across groups. Interobserver agreement was evaluated with kappa values. Methods Patients receiving low radiation CTLS were divided into three groups. A 150 mAs tube current with 120 kVp tube voltage was used with Group A and a 230 mAs tube current with 100 kVp tube voltage with Group B. Intended end radiation exposure was 50% less than that of the control group. Tube modulation was active for all groups. The images of the two low-radiation groups were reconstructed by IR; those of the control group by filtered back-projection (FBP). Results The SNRs of the DS, IVD, PM, BM, and D-D CNR of Group A were not inferior to those of the control group. All SNRs and D-D CNRs for Group B were inferior to those of the control group. Except for that of the facet joint, all subjective imaging ratings for anatomic regions were equivalent between Groups A and B. Interobserver agreement was highest for the control group (0.72–0.88), followed by Group A (0.69–0.83) and B (0.55–0.83). Conclusions Fifty percent tube current reduction combined with IR provides equivalent diagnostic accuracy and improved patient safety when compared with conventional CTLS. Our results support its use as a screening tool. With the tube modulation technique, further adjustments in weighting IR and FBP algorithms based on body mass index become unnecessary.