Ultra-low dose chest-abdomen-pelvis CT with deep-learning image reconstruction for cancer follow-up: Impact on image quality and lesion detection.

Authors

Fabien de Oliveira, Sinda Ghabri, Souha Benhalilou, Sandrine Alonso, Elodie Dhombres, Jean-Paul Beregi, Djamel Dabli, Julien Frandon, Joël Greffier

Published in

Diagnostic and interventional imaging. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

The purpose of this study was to compare the image quality and lesion detection between ultra-low dose (ULD) chest-abdomen-pelvis computed tomography (CAP-CT) reconstructed with a deep-learning image reconstruction (DLR) algorithm, and standard-dose CT (STD-CT) in cancer follow-up.
A total of 106 patients undergoing CAP-CT for the follow-up of cancer were prospectively included. Each patient underwent both STD-CT and ULD-CT acquisitions. ULD-CT images were reconstructed using two DLR levels (Smooth/Smoother). Dosimetric indicators, objective image quality, subjective image quality, and lesion detection were compared. Agreement between protocols and readers was assessed using Gwet's AC1 or AC2 coefficients.
ULD-CT significantly reduced radiation exposure, with a mean CTDI_vol reduction of -71.5% and dose-length product reduction of -71.5% (P < 0.05). Minor but statistically significant differences in HU values were observed between STD-CT and ULD-CT across most tissues. For all organs or tissues, image noise was significantly higher with ULD-CT-Smooth than with STD-CT (P < 0.001), and with ULD-CT-Smoother than with STD-CT, except for dorsal vertebra (P = 0.39) and trachea (P = 0.26). For all organs or tissues, image noise was significantly lower with the Smoother DLR level than with Smooth DLR level (P < 0.001). Agreement between STD-CT and ULD-CT regarding lesion detection was almost perfect for thoracic, abdominal, and bone lesions. Detection of infracentimetric hepatic was lower with ULD-CT, whereas detection of larger lesions (≥ 10 mm) remained similar. Subjective image quality was lower with ULD-CT, with moderate inter-reader agreement, and lower diagnostic confidence than with STD-CT. One of the two readers considered that 19%-24% of ULD-CT examinations were uninterpretable.
ULD-CT with DLR offers substantial radiation dose reduction but resulted in poorer image quality and lower detection of small low-contrast abdominal lesions compared with STD-CT. Although lesion detection remained equivalent for thoracic and skeletal lesions, the high proportion of suboptimal or uninterpretable examinations may limit routine use of ULD protocols in cancer follow-up.

PMID:
42580928
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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