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Research ArticleHead & Neck

Low-Tube-Voltage 80-kVp Neck CT: Evaluation of Diagnostic Accuracy and Interobserver Agreement

J.L. Wichmann, J. Kraft, E.-M. Nöske, B. Bodelle, I. Burck, J.-E. Scholtz, C. Frellesen, J. Wagenblast, J.M. Kerl, R.W. Bauer, T. Lehnert, T.J. Vogl and B. Schulz
American Journal of Neuroradiology December 2014, 35 (12) 2376-2381; DOI: https://doi.org/10.3174/ajnr.A4052
J.L. Wichmann
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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J. Kraft
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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E.-M. Nöske
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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B. Bodelle
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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I. Burck
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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J.-E. Scholtz
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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C. Frellesen
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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J. Wagenblast
bOtolaryngology, Head and Neck Surgery (J.W.), University Hospital Frankfurt, Frankfurt, Germany.
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J.M. Kerl
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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R.W. Bauer
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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T. Lehnert
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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T.J. Vogl
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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B. Schulz
aFrom the Departments of Diagnostic and Interventional Radiology (J.L.W., J.K., E.-M.N., B.B., I.B., J.-E.S, C.F., J.M.K., R.W.B., T.L., T.J.V., B.S.)
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    Fig 1.

    A 61-year-old female patient with a primary supraglottic laryngeal carcinoma (T4a N2c). Low-tube-voltage acquisition (A) improves tumor attenuation (large arrow) compared with the standard blended 120-kVp image series (B) and also shows a higher contrast and improved depiction of cervical lymph node metastasis (small arrows) (window settings: width, 400 HU; level, 80 HU).

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    Fig 2.

    A 66-year-old female patient with a vascularized mass (arrow) in the left parotid gland. She underwent excision, and a Warthin tumor was confirmed by histopathology. The increased iodine attenuation with an 80-kVp acquisition (A) results in a distinctly increased image contrast of the mass compared with the standard 120-kVp acquisition (B) (window settings: width, 400 HU; level, 80 HU).

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    Table 1:

    Indications for neck CT imaging (n = 170)

    IndicationNo.
    Squamous cell carcinoma107
        Primary staging or detection of suspected squamous cell carcinoma66
        Follow-up to detect tumor recurrence41
    Lymphoma40
        Primary staging or detection of suspected lymphoma19
        Follow-up to detect lymphoma recurrence21
    Benign conditions23
        Suspected benign cervical mass (eg, Warthin tumor, adenoma)5
        Suspected cervical abscess13
        Suspected sialadenitis3
        Suspected branchial cleft cyst2
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    Table 2:

    Comparison of diagnostic accuracy of the 3 observersa

    ValueGlobal (n = 170)SCC-Related (n = 107)Lymphoma-Related (n = 40)bBenign Conditions (n = 23)
    80-kVp image series
        Sensitivity94.8% (93.5%–95.4%)94.8% (91.4%–97.2%)95.0%94.3% (88.9%–100.0%)
        Specificity93.0% (91.9%–95.1%)89.1% (86.5%–91.7%)100.0%93.3% (80.0%–100.0%)
        PPV95.9% (95.3%–97.2%)94.3% (93.1%–95.8%)100.0%98.2% (94.7%–100.0%)
        NPV91.1% (89.1%–92.1%)90.1% (84.6%–94.3%)95.2%85.7% (71.4%–100.0%)
    120-kVp image series
        Sensitivity94.8% (92.6%–96.3%)95.3% (91.4%–97.2%)95.0%92.5% (88.9%–94.4%)
        Specificity93.0% (91.9%–95.1%)89.1% (86.5%–91.7%)100.0%93.3% (80.0%–100.0%
        PPV95.9% (95.3%–97.2%)94.4% (93.2%–95.8%)100.0%98.1% (94.4%–100.0%)
        NPV91.1% (87.7%–93.5%91.0% (84.6%–94.3%)95.2%79.0% (71.4%–85.7%)
    • ↵a Values are given as mean (range).

    • ↵b No interobserver differences, therefore no ranges, are given.

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American Journal of Neuroradiology: 35 (12)
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1 Dec 2014
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J.L. Wichmann, J. Kraft, E.-M. Nöske, B. Bodelle, I. Burck, J.-E. Scholtz, C. Frellesen, J. Wagenblast, J.M. Kerl, R.W. Bauer, T. Lehnert, T.J. Vogl, B. Schulz
Low-Tube-Voltage 80-kVp Neck CT: Evaluation of Diagnostic Accuracy and Interobserver Agreement
American Journal of Neuroradiology Dec 2014, 35 (12) 2376-2381; DOI: 10.3174/ajnr.A4052

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Low-Tube-Voltage 80-kVp Neck CT: Evaluation of Diagnostic Accuracy and Interobserver Agreement
J.L. Wichmann, J. Kraft, E.-M. Nöske, B. Bodelle, I. Burck, J.-E. Scholtz, C. Frellesen, J. Wagenblast, J.M. Kerl, R.W. Bauer, T. Lehnert, T.J. Vogl, B. Schulz
American Journal of Neuroradiology Dec 2014, 35 (12) 2376-2381; DOI: 10.3174/ajnr.A4052
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