The Effects of Computed Tomography with Iterative Reconstruction on Solid Pulmonary Nodule Volume Quantification

BACKGROUND: The objectives of this study were to evaluate the influence of iterative reconstruction (IR) on pulmonary nodule volumetry with chest computed tomography (CT). METHODS: Twenty patients (12 women and 8 men, mean age 61.9, range 32–87) underwent evaluation of pulmonary nodules with a 64-slice CT-scanner. Data were reconstructed using filtered back projection (FBP) and IR (Philips Healthcare, iDose(4)-levels 2, 4 and 6) at similar radiation dose. Volumetric nodule measurements were performed with semi-automatic software on thin slice reconstructions. Only solid pulmonary nodules were measured, no additional selection criteria were used for the nature of nodules. For intra-observer and inter-observer variability, measurements were performed once by one observer and twice by another observer. Algorithms were compared using the concordance correlation-coefficient (p(c)) and Friedman-test, and post-hoc analysis with the Wilcoxon-signed ranks-test with Bonferroni-correction (significance-level p<0.017). RESULTS: Seventy-eight nodules were present including 56 small nodules (volume<200 mm(3), diameter<8 mm) and 22 large nodules (volume≥200 mm(3), diameter≥8 mm). No significant differences in measured pulmonary nodule volumes between FBP, iDose(4)-levels 2, 4 and 6 were found in both small nodules and large nodules. FBP and iDose(4)-levels 2, 4 and 6 were correlated with p(c)-values of 0.98 or higher for both small and large nodules. P(c)-values of intra-observer and inter-observer variability were 0.98 or higher. CONCLUSIONS: Measurements of solid pulmonary nodule volume measured with standard-FBP were comparable with IR, regardless of the IR-level and no significant differences between measured volumes of both small and large solid nodules were found.