Impact of Incremental Increase in CT Image Noise on Detection of Low-contrast Hypodense Liver Lesions

Rationale and Objectives To determine the impact of incremental increases in computed tomography (CT) image noise on detection of low-contrast hypodense liver lesions. Material and Methods We studied 50 CT examinations acquired at image noise index (NI) of 15 and hypodense liver lesions and 50 examinations with no lesions. Validation of a noise addition tool to be used in the evaluation of the CT examinations was performed with a liver phantom. Using this tool, three 100-image sets were assembled: an NI of 17.4 (simulating 75% of the original patient radiation dose), 21.2 (simulating 50% dose), and 29.7 (simulating 25%). Three readers scored certainty of lesion presence using a five-point Likert scale. Results For original images (NI 15) plus images with NI of 17.4 and 21.2, sensitivity was >90% threshold (range, 95%–98%). For images with NI of 29.7, sensitivity was just below the threshold (89%). Reader Az values for receiver operating characteristic curves were good for original, NI 17.4, and NI 21.2 images (0.976, 0.973, and 0.96, respectively). For NI of 29.7, the Az decreased to 0.913. Detection sensitivity was