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Objective The aim of this study was to compare three different reconstruction algorithms for the volumetry of the visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) on ultra‐low‐dose computed tomography (CT) images. Methods Thirty‐seven male patients underwent ultra‐low‐dose CT at the level of the fourth lumbar vertebra (22.5 mm in z‐axis). The acquisitions were reconstructed in 5‐mm slices with 50% overlap using filtered back projection (FBP), hybrid iterative reconstruction (HIR), and iterative model‐based reconstruction (IMR) techniques. The volume of VAT and SAT was measured using an interactive seed‐growing segmentation and by thresholding (−30 to −190 HU). Results The volume of SAT measured by the interactive method was smaller in FBP compared with both HIR (P = 0.0011) and IMR (P = 0.0034), and the volume of VAT was greater in IMR compared with HIR (P = 0.0253) or FBP (P = 0.0065). Using the thresholding method, IMR volumes of VAT were greater compared with HIR (P < 0.0001), and volumes of SAT were greater compared with both HIR and FBP (both P ≤ 0.0001). The VAT to SAT ratio was greater in IMR compared with HIR or FBP (both P < 0.0001). Conclusions There are significant differences among FBP, HIR, and IMR in the volumetry of SAT and VAT, their ratios, and attenuation measured on ultra‐low‐dose images.

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