Diagnostic accuracy of cT enterography for active inflammatory terminal ileal Crohn disease: Comparison of full-dose and half-dose images reconstructed with FBP and half-dose images with SAFIRE1

Namita S. Gandhi, Mark E. Baker, Ajit H. Goenka, Jennifer A. Bullen, Nancy A. Obuchowski, Erick M. Remer, Christopher P. Coppa, David Einstein, Myra K. Feldman, Devaraju Kanmaniraja, Andrei S. Purysko, Noushin Vahdat, Andrew N. Primak, Wadih Karim, Brian R. Herts

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: To compare the diagnostic accuracy and image quality of computed tomographic (CT) enterographic images obtained at half dose and reconstructed with filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) with those of full-dose CT enterographic images reconstructed with FBP for active inflammatory terminal or neoterminal ileal Crohn disease. Materials and Methods: This retrospective study was compliant with HIPAA and approved by the institutional review board. The requirement to obtain informed consent was waived. Ninety subjects (45 with active terminal ileal Crohn disease and 45 without Crohn disease) underwent CT enterography with a dualsource CT unit. The reference standard for confirmation of active Crohn disease was active terminal ileal Crohn disease based on ileocolonoscopy or established Crohn disease and imaging features of active terminal ileal Crohn disease. Data from both tubes were reconstructed with FBP (100% exposure); data from the primary tube (50% exposure) were reconstructed with FBP and SAFIRE strengths 3 and 4, yielding four datasets per CT enterographic examination. The mean volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) at full dose were 13.1 mGy (median, 7.36 mGy) and 15.9 mGy (median, 13.06 mGy), respectively, and those at half dose were 6.55 mGy (median, 3.68 mGy) and 7.95 mGy (median, 6.5 mGy). Images were subjectively evaluated by eight radiologists for quality and diagnostic confidence for Crohn disease. Areas under the receiver operating characteristic curves (AUCs) were estimated, and the multireader, multicase analysis of variance method was used to compare reconstruction methods on the basis of a noninferiority margin of 0.05. Results: The mean AUCs with half-dose scans (FBP, 0.908; SAFIRE 3, 0.935; SAFIRE 4, 0.924) were noninferior to the mean AUC with full-dose FBP scans (0.908; P <.003). The proportion of images with inferior quality was significantly higher with all half-dose reconstructions than with full-dose FBP (mean proportion: 0.117 for half-dose FBP, 0.054 for half-dose SAFIRE 3, 0.054 for half-dose SAFIRE 4, and 0.017 for full-dose FBP; P <.001). Conclusion: The diagnostic accuracy of half-dose CT enterography with FBP and SAFIRE is statistically noninferior to that of full-dose CT enterography for active inflammatory terminal ileal Crohn disease, despite an inferior subjective image quality.

Original languageEnglish (US)
Pages (from-to)436-445
Number of pages10
JournalRadiology
Volume280
Issue number2
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

Fingerprint

Ileal Diseases
Crohn Disease
Area Under Curve
Health Insurance Portability and Accountability Act
Research Ethics Committees
Informed Consent
ROC Curve
Analysis of Variance
Retrospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Diagnostic accuracy of cT enterography for active inflammatory terminal ileal Crohn disease : Comparison of full-dose and half-dose images reconstructed with FBP and half-dose images with SAFIRE1. / Gandhi, Namita S.; Baker, Mark E.; Goenka, Ajit H.; Bullen, Jennifer A.; Obuchowski, Nancy A.; Remer, Erick M.; Coppa, Christopher P.; Einstein, David; Feldman, Myra K.; Kanmaniraja, Devaraju; Purysko, Andrei S.; Vahdat, Noushin; Primak, Andrew N.; Karim, Wadih; Herts, Brian R.

In: Radiology, Vol. 280, No. 2, 01.08.2016, p. 436-445.

Research output: Contribution to journalArticle

Gandhi, NS, Baker, ME, Goenka, AH, Bullen, JA, Obuchowski, NA, Remer, EM, Coppa, CP, Einstein, D, Feldman, MK, Kanmaniraja, D, Purysko, AS, Vahdat, N, Primak, AN, Karim, W & Herts, BR 2016, 'Diagnostic accuracy of cT enterography for active inflammatory terminal ileal Crohn disease: Comparison of full-dose and half-dose images reconstructed with FBP and half-dose images with SAFIRE1', Radiology, vol. 280, no. 2, pp. 436-445. https://doi.org/10.1148/radiol.2016151281
Gandhi, Namita S. ; Baker, Mark E. ; Goenka, Ajit H. ; Bullen, Jennifer A. ; Obuchowski, Nancy A. ; Remer, Erick M. ; Coppa, Christopher P. ; Einstein, David ; Feldman, Myra K. ; Kanmaniraja, Devaraju ; Purysko, Andrei S. ; Vahdat, Noushin ; Primak, Andrew N. ; Karim, Wadih ; Herts, Brian R. / Diagnostic accuracy of cT enterography for active inflammatory terminal ileal Crohn disease : Comparison of full-dose and half-dose images reconstructed with FBP and half-dose images with SAFIRE1. In: Radiology. 2016 ; Vol. 280, No. 2. pp. 436-445.
@article{4244b82a6bdf43f2bd296c430c4b876b,
title = "Diagnostic accuracy of cT enterography for active inflammatory terminal ileal Crohn disease: Comparison of full-dose and half-dose images reconstructed with FBP and half-dose images with SAFIRE1",
abstract = "Purpose: To compare the diagnostic accuracy and image quality of computed tomographic (CT) enterographic images obtained at half dose and reconstructed with filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) with those of full-dose CT enterographic images reconstructed with FBP for active inflammatory terminal or neoterminal ileal Crohn disease. Materials and Methods: This retrospective study was compliant with HIPAA and approved by the institutional review board. The requirement to obtain informed consent was waived. Ninety subjects (45 with active terminal ileal Crohn disease and 45 without Crohn disease) underwent CT enterography with a dualsource CT unit. The reference standard for confirmation of active Crohn disease was active terminal ileal Crohn disease based on ileocolonoscopy or established Crohn disease and imaging features of active terminal ileal Crohn disease. Data from both tubes were reconstructed with FBP (100{\%} exposure); data from the primary tube (50{\%} exposure) were reconstructed with FBP and SAFIRE strengths 3 and 4, yielding four datasets per CT enterographic examination. The mean volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) at full dose were 13.1 mGy (median, 7.36 mGy) and 15.9 mGy (median, 13.06 mGy), respectively, and those at half dose were 6.55 mGy (median, 3.68 mGy) and 7.95 mGy (median, 6.5 mGy). Images were subjectively evaluated by eight radiologists for quality and diagnostic confidence for Crohn disease. Areas under the receiver operating characteristic curves (AUCs) were estimated, and the multireader, multicase analysis of variance method was used to compare reconstruction methods on the basis of a noninferiority margin of 0.05. Results: The mean AUCs with half-dose scans (FBP, 0.908; SAFIRE 3, 0.935; SAFIRE 4, 0.924) were noninferior to the mean AUC with full-dose FBP scans (0.908; P <.003). The proportion of images with inferior quality was significantly higher with all half-dose reconstructions than with full-dose FBP (mean proportion: 0.117 for half-dose FBP, 0.054 for half-dose SAFIRE 3, 0.054 for half-dose SAFIRE 4, and 0.017 for full-dose FBP; P <.001). Conclusion: The diagnostic accuracy of half-dose CT enterography with FBP and SAFIRE is statistically noninferior to that of full-dose CT enterography for active inflammatory terminal ileal Crohn disease, despite an inferior subjective image quality.",
author = "Gandhi, {Namita S.} and Baker, {Mark E.} and Goenka, {Ajit H.} and Bullen, {Jennifer A.} and Obuchowski, {Nancy A.} and Remer, {Erick M.} and Coppa, {Christopher P.} and David Einstein and Feldman, {Myra K.} and Devaraju Kanmaniraja and Purysko, {Andrei S.} and Noushin Vahdat and Primak, {Andrew N.} and Wadih Karim and Herts, {Brian R.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1148/radiol.2016151281",
language = "English (US)",
volume = "280",
pages = "436--445",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "2",

}

TY - JOUR

T1 - Diagnostic accuracy of cT enterography for active inflammatory terminal ileal Crohn disease

T2 - Comparison of full-dose and half-dose images reconstructed with FBP and half-dose images with SAFIRE1

AU - Gandhi, Namita S.

AU - Baker, Mark E.

AU - Goenka, Ajit H.

AU - Bullen, Jennifer A.

AU - Obuchowski, Nancy A.

AU - Remer, Erick M.

AU - Coppa, Christopher P.

AU - Einstein, David

AU - Feldman, Myra K.

AU - Kanmaniraja, Devaraju

AU - Purysko, Andrei S.

AU - Vahdat, Noushin

AU - Primak, Andrew N.

AU - Karim, Wadih

AU - Herts, Brian R.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Purpose: To compare the diagnostic accuracy and image quality of computed tomographic (CT) enterographic images obtained at half dose and reconstructed with filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) with those of full-dose CT enterographic images reconstructed with FBP for active inflammatory terminal or neoterminal ileal Crohn disease. Materials and Methods: This retrospective study was compliant with HIPAA and approved by the institutional review board. The requirement to obtain informed consent was waived. Ninety subjects (45 with active terminal ileal Crohn disease and 45 without Crohn disease) underwent CT enterography with a dualsource CT unit. The reference standard for confirmation of active Crohn disease was active terminal ileal Crohn disease based on ileocolonoscopy or established Crohn disease and imaging features of active terminal ileal Crohn disease. Data from both tubes were reconstructed with FBP (100% exposure); data from the primary tube (50% exposure) were reconstructed with FBP and SAFIRE strengths 3 and 4, yielding four datasets per CT enterographic examination. The mean volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) at full dose were 13.1 mGy (median, 7.36 mGy) and 15.9 mGy (median, 13.06 mGy), respectively, and those at half dose were 6.55 mGy (median, 3.68 mGy) and 7.95 mGy (median, 6.5 mGy). Images were subjectively evaluated by eight radiologists for quality and diagnostic confidence for Crohn disease. Areas under the receiver operating characteristic curves (AUCs) were estimated, and the multireader, multicase analysis of variance method was used to compare reconstruction methods on the basis of a noninferiority margin of 0.05. Results: The mean AUCs with half-dose scans (FBP, 0.908; SAFIRE 3, 0.935; SAFIRE 4, 0.924) were noninferior to the mean AUC with full-dose FBP scans (0.908; P <.003). The proportion of images with inferior quality was significantly higher with all half-dose reconstructions than with full-dose FBP (mean proportion: 0.117 for half-dose FBP, 0.054 for half-dose SAFIRE 3, 0.054 for half-dose SAFIRE 4, and 0.017 for full-dose FBP; P <.001). Conclusion: The diagnostic accuracy of half-dose CT enterography with FBP and SAFIRE is statistically noninferior to that of full-dose CT enterography for active inflammatory terminal ileal Crohn disease, despite an inferior subjective image quality.

AB - Purpose: To compare the diagnostic accuracy and image quality of computed tomographic (CT) enterographic images obtained at half dose and reconstructed with filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) with those of full-dose CT enterographic images reconstructed with FBP for active inflammatory terminal or neoterminal ileal Crohn disease. Materials and Methods: This retrospective study was compliant with HIPAA and approved by the institutional review board. The requirement to obtain informed consent was waived. Ninety subjects (45 with active terminal ileal Crohn disease and 45 without Crohn disease) underwent CT enterography with a dualsource CT unit. The reference standard for confirmation of active Crohn disease was active terminal ileal Crohn disease based on ileocolonoscopy or established Crohn disease and imaging features of active terminal ileal Crohn disease. Data from both tubes were reconstructed with FBP (100% exposure); data from the primary tube (50% exposure) were reconstructed with FBP and SAFIRE strengths 3 and 4, yielding four datasets per CT enterographic examination. The mean volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) at full dose were 13.1 mGy (median, 7.36 mGy) and 15.9 mGy (median, 13.06 mGy), respectively, and those at half dose were 6.55 mGy (median, 3.68 mGy) and 7.95 mGy (median, 6.5 mGy). Images were subjectively evaluated by eight radiologists for quality and diagnostic confidence for Crohn disease. Areas under the receiver operating characteristic curves (AUCs) were estimated, and the multireader, multicase analysis of variance method was used to compare reconstruction methods on the basis of a noninferiority margin of 0.05. Results: The mean AUCs with half-dose scans (FBP, 0.908; SAFIRE 3, 0.935; SAFIRE 4, 0.924) were noninferior to the mean AUC with full-dose FBP scans (0.908; P <.003). The proportion of images with inferior quality was significantly higher with all half-dose reconstructions than with full-dose FBP (mean proportion: 0.117 for half-dose FBP, 0.054 for half-dose SAFIRE 3, 0.054 for half-dose SAFIRE 4, and 0.017 for full-dose FBP; P <.001). Conclusion: The diagnostic accuracy of half-dose CT enterography with FBP and SAFIRE is statistically noninferior to that of full-dose CT enterography for active inflammatory terminal ileal Crohn disease, despite an inferior subjective image quality.

UR - http://www.scopus.com/inward/record.url?scp=84979916730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979916730&partnerID=8YFLogxK

U2 - 10.1148/radiol.2016151281

DO - 10.1148/radiol.2016151281

M3 - Article

C2 - 27077382

AN - SCOPUS:84979916730

VL - 280

SP - 436

EP - 445

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 2

ER -