Diagnostic accuracy of low-mA chest CT reconstructed with Model Based Iterative Reconstruction in the detection of early pleuro-pulmonary complications following a lung transplantation.

objectivesTo assess the accuracy of reduced-dose, low-mA chest CT (RD-CT) reconstructed with model-based iterative reconstruction (MBIR) in detecting usual early complications following pulmonary transplantation, as compared to standard-dose chest CT (SD-CT) reconstructed with adaptative statistical iterative reconstruction (ASIR).

methodsOur institutional review board approved this prospective study and patients provided written informed consent. Two thoracic radiologists independently evaluated 47 examinations performed routinely in 20 patients during 6 months following lung transplantation for the detection and/or evolution of usual pleuropulmonary complications and for subjective image quality. Each examination consisted of successive acquisition of unenhanced SD-CT (100-120 kV, noise index 45, ASIR) and RD-CT (100 kV, 16-24mAs/slice, MBIR).

resultsMean CTDIvol was 4.12 ± 0.88 and 0.65 ± 0.09 mGy for SD-CT and RD-CT, respectively. Complications were found in 40/47 (85 %) examinations. Sensitivity and negative predictive value of RD-CT were 92-100 % for the detection of pneumonia, fungal infection, pleural effusion, pneumothorax, and bronchial dehiscence or stenosis, as compared to SD-CT. Image quality of RD-CT was graded good for 81 % of examinations.

conclusionsMBIR-RD-CT is accurate, as compared to SD-CT, for delineating most usual pleuropulmonary complications during the 6 months following pulmonary transplantation and might be used routinely for the early monitoring of pulmonary allografts. KEY POINTS: • Early chest complications are frequent following a pulmonary transplantation • CT has a key role for their detection and follow-up • Low-mAMBIR CT is accurate for monitoring most lung allograft early pleuropulmonary complications • MBIR chest CT allows a six-fold dose reduction compared to standard CT.