CT colonography with spectral filtration and advanced modeled iterative reconstruction in the third-generation dual-source CT: image quality, radiation dose and performance in clinical utility

Rationale and Objectives: To evaluate image quality, radiation dose and its diagnostic performance in clinical utility of CT colonography (CTC) applying spectral filtration and advanced modeled iterative reconstruction (ADMIRE) techniques in third-generation dual-source CT.Materials and Methods: A total of 125 patients for screening or diagnostic purposes underwent CTC at 120kVp standard dose (120kVpSTD) with filtered-back projection reconstruction (FBP) in supine position, then at a tin-filtered 150 kVp low dose (Sn150kVp-LD) and a tinfiltered 100 kVp ultra-low dose (Sn100kVp-ULD) with ADMIRE reconstruction in prone position. Radiation metrics were recorded. Objective and subjective image qualities were compared, and the diagnostic performance was assessed for both colonic and extracolonic findings using CTC reporting and data system (C-RADS).Results: The effective dose was significantly lower for Sn150kVp-LD and Sn100kVp-ULD than 120kVp-STD protocol, resulting in 22.5% and 87.5% reductions (1.55 +/- 0.30 and 0.25 +/- 0.07 mSv vs. 2.00 +/- 0.52 mSv; both p<0.01), respectively. Image noise and signal-to-noise ratio were improved significantly for Sn150kVp-LD with ADMIRE compared with 120kVp-STD, both of which had similar excellent 2D and 3D subjective image quality with equivalent diagnostic performance. Sn100kVp-ULD with ADMIRE had decreased subjective image quality and significant different C-RADS extracolonic-score (E-score) compared with 120kVp-STD, however, C-RADS colonic-score (C-score) of that showed no significantly difference.Conclusion: Sn150kVp and Sn100kVp with ADMIRE reconstruction provide an alternative low dose CTC strategy and could be feasible in clinical screening or diagnostic scenarios.