Low-dose corticomedullary phase CT urography with artificial intelligence iterative reconstruction for bladder cancer evaluation

Abstract Objectives To test the feasibility and quantify the performance of low-dose CT urography (CTU) with artificial intelligence iterative reconstruction (AIIR) for bladder cancer (BC) evaluation. Methods A total of 122 patients undergoing CTU examination were prospectively enrolled, where the routine-dose scan (120 kVp, ref 100 mAs) at corticomedullary phase (CMP) was followed immediately by a low-dose scan (120 kVp, ref 20 mAs). Routine-dose images were reconstructed with hybrid iterative reconstruction (HIR, RD-HIR), while low-dose images were with AIIR (LD-AIIR) and HIR (LD-HIR). The image quality was first evaluated regarding streak artifacts around the bladder and then in contrast-to-noise ratio (CNR) for various manifestations of bladder wall. The diagnostic performance of BC was characterized using receiver operating characteristic (ROC) analysis, in respect to the clinical diagnostic report. Results The effective dose at low-dose CMP was 80.2% lower than routine-dose scan (7.6 ± 1.2 vs 1.5 ± 0.3 mSv). Nineteen cases in LD-HIR were deemed clinically unacceptable for presenting severe artifacts around the bladder, while found well above the basic requirement in LD-AIIR. The highest CNR was found in LD-AIIR in all scenarios (all p < 0.001). The area under ROC curve in LD-AIIR was comparable to RD-HIR (0.988 vs. 0.990, p = 0.172) and significantly higher than LD-HIR (0.988 vs. 0.831, p < 0.001). Conclusions The low-dose AIIR protocol allows for a profound dose reduction (80.2%) while maintaining reliable diagnosis of bladder cancer on corticomedullary phase CTU images. Advances in knowledge Corticomedullary phase CTU with AIIR permits 80.2% dose reduction while preserving reliable BC diagnosis.