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Nishii T, Morikawa T, Nakajima H, Ohta Y, Kobayashi T, Umehara K, Ota J, Kakuta T, Fukushima S, Fukuda T. Deep learning-based post hoc denoising for 3D volume-rendered cardiac CT in mitral valve prolapse. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2025:10.1007/s10554-025-03403-z. [PMID: 40266552 DOI: 10.1007/s10554-025-03403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 04/10/2025] [Indexed: 04/24/2025]
Abstract
We hypothesized that deep learning-based post hoc denoising could improve the quality of cardiac CT for the 3D volume-rendered (VR) imaging of mitral valve (MV) prolapse. We aimed to evaluate the quality of denoised 3D VR images for visualizing MV prolapse and assess their diagnostic performance and efficiency. We retrospectively reviewed the cardiac CTs of consecutive patients who underwent MV repair in 2023. The original images were iteratively reconstructed and denoised with a residual dense network. 3DVR images of the "surgeon's view" were created with blood chamber transparency to display the MV leaflets. We compared the 3DVR image quality between the original and denoised images with a 100-point scoring system. Diagnostic confidence for prolapse was evaluated across eight MV segments: A1-3, P1-3, and the anterior and posterior commissures. Surgical findings were used as the reference to assess diagnostic ability with the area under curve (AUC). The interpretation time for the denoised 3DVR images was compared with that for multiplanar reformat images. For fifty patients (median age 64 years, 30 males), denoising the 3DVR images significantly improved their image quality scores from 50 to 76 (P <.001). The AUC in identifying MV prolapse improved from 0.91 (95% CI 0.87-0.95) to 0.94 (95% CI 0.91-0.98) (P =.009). The denoised 3DVR images were interpreted five-times faster than the multiplanar reformat images (P <.001). Deep learning-based denoising enhanced the quality of 3DVR imaging of the MV, improving the performance and efficiency in detecting MV prolapse on cardiac CT.
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Affiliation(s)
- Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Tomoro Morikawa
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroki Nakajima
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takuma Kobayashi
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kensuke Umehara
- Medical Informatics Section, QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan
- Applied MRI Research, Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan
| | - Junko Ota
- Medical Informatics Section, QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan
- Applied MRI Research, Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Shu Z, Entezari A. A nonlocal prior in iterative CT reconstruction. Med Phys 2025; 52:1436-1453. [PMID: 39620497 DOI: 10.1002/mp.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/19/2024] [Accepted: 10/30/2024] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Computed tomography (CT) reconstruction problems are always framed as inverse problems, where the attenuation map of an imaged object is reconstructed from the sinogram measurement. In practice, these inverse problems are often ill-posed, especially under few-view and limited-angle conditions, which makes accurate reconstruction challenging. Existing solutions use regularizations such as total variation to steer reconstruction algorithms to the most plausible result. However, most prevalent regularizations rely on the same priors, such as piecewise constant prior, hindering their ability to collaborate effectively and further boost reconstruction precision. PURPOSE This study aims to overcome the aforementioned challenge a prior previously limited to discrete tomography. This enables more accurate reconstructions when the proposed method is used in conjunction with most existing regularizations as they utilize different priors. The improvements will be demonstrated through experiments conducted under various conditions. METHODS Inspired by the discrete algebraic reconstruction technique (DART) algorithm for discrete tomography, we find out that pixel grayscale values in CT images are not uniformly distributed and are actually highly clustered. Such discovery can be utilized as a powerful prior for CT reconstruction. In this paper, we leverage the collaborative filtering technique to enable the collaboration of the proposed prior and most existing regularizations, significantly enhancing the reconstruction accuracy. RESULTS Our experiments show that the proposed method can work with most existing regularizations and significantly improve the reconstruction quality. Such improvement is most pronounced under limited-angle and few-view conditions. Furthermore, the proposed regularization also has the potential for further improvement and can be utilized in other image reconstruction areas. CONCLUSIONS We propose improving the performance of iterative CT reconstruction algorithms by applying the collaborative filtering technique along with a prior based on the densely clustered distribution of pixel grayscale values in CT images. Our experimental results indicate that the proposed methodology consistently enhances reconstruction accuracy when used in conjunction with most existing regularizations, particularly under few-view and limited-angle conditions.
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Affiliation(s)
- Ziyu Shu
- Department of Radiation Oncology, Stony Brook University, New York, USA
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Rezaie-Kalamtari K, Norouzi Z, Salmanipour A, Mehrali H. Updates on CAD risk assessment: using the coronary artery calcium score in combination with traditional risk factors. Egypt Heart J 2025; 77:14. [PMID: 39847250 PMCID: PMC11757844 DOI: 10.1186/s43044-025-00608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/07/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the third leading cause of death worldwide, so prevention and early diagnosis play important roles to reduce mortality and morbidity. Traditional risk-score assessments were used to find the at-risk patients in order to prevent or early treatment of CAD. Adding imaging data to traditional risk-score systems will able us to find these patients more confidently and reduce the probable mismanagements. MAIN TEXT Measuring the vascular calcification by coronary artery calcium (CAC) score can prepare valuable data for this purpose. Using CAC became more popular in recent years. The most applicable method to evaluate CAC is Agatston scoring using computed tomography (CT) scanning. Patients are classified into several subgroups: no evidence of CAD (score 0), mild CAD (score 1-10), minimal CAD (score 11-100), moderate CAD (score 101-400), and severe CAD (score > 400) and higher than1000 as the extreme risk of CVD events. CONCLUSIONS CAC assessment was recommended in the patients older than 40 years old with CAD risk factors, the ones with stable angina, borderline-to-intermediate-risk group, etc. According to the results of the CAC the patients may be candidate for further evaluation for needing revascularization, medical treatment, or routine follow-up. Adding artificial intelligence (AI) to CAC will prepare more data and can increase the reliability of our approach to the patients promising a bright future to improve this technology.
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Affiliation(s)
- Kiara Rezaie-Kalamtari
- Rajaie Cardiovascular, Medical and Research Institute, Valiasr Ave, Hashemi Rafsanjani (Niayesh) Intersection, Tehran, Iran
| | - Zeinab Norouzi
- Rajaie Cardiovascular, Medical and Research Institute, Valiasr Ave, Hashemi Rafsanjani (Niayesh) Intersection, Tehran, Iran.
| | - Alireza Salmanipour
- Rajaie Cardiovascular, Medical and Research Institute, Valiasr Ave, Hashemi Rafsanjani (Niayesh) Intersection, Tehran, Iran
| | - Hossein Mehrali
- Rajaie Cardiovascular, Medical and Research Institute, Valiasr Ave, Hashemi Rafsanjani (Niayesh) Intersection, Tehran, Iran
- Rajaie Cardiovascular, Medical & Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Kitera N, Fujioka C, Higaki T, Nishimaru E, Yokomachi K, Matsumoto Y, Kiguchi M, Ohashi K, Kasai H, Awai K. [Validation of Optimal Imaging Conditions for Coronary Computed Tomography Angiography Using High-definition Mode and Deep Learning Image Reconstruction Algorithm]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:499-509. [PMID: 38508756 DOI: 10.6009/jjrt.2024-1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE To verify the optimal imaging conditions for coronary computed tomography angiography (CCTA) examinations when using high-definition (HD) mode and deep learning image reconstruction (DLIR) in combination. METHOD A chest phantom and an in-house phantom using 3D printer were scanned with a 256-row detector CT scanner. The scan parameters were as follows - acquisition mode: ON (HD mode) and OFF (normal resolution [NR] mode), rotation time: 0.28 s/rotation, beam coverage width: 160 mm, and the radiation dose was adjusted based on CT-AEC. Image reconstruction was performed using ASiR-V (Hybrid-IR), TrueFidelity Image (DLIR), and HD-Standard (HD mode) and Standard (NR mode) reconstruction kernels. The task-based transfer function (TTF) and noise power spectrum (NPS) were measured for image evaluation, and the detectability index (d') was calculated. Visual evaluation was also performed on an in-house coronary phantom. RESULT The in-plane TTF was better for the HD mode than for the NR mode, while the z-axis TTF was lower for DLIR than for Hybrid-IR. The NPS values in the high-frequency region were higher for the HD mode compared to those for the NR mode, and the NPS was lower for DLIR than for Hybrid-IR. The combination of HD mode and DLIR showed the best value for in-plane d', whereas the combination of NR mode and DLIR showed the best value for z-axis d'. In the visual evaluation, the combination of NR mode and DLIR showed the best values from a noise index of 45 HU. CONCLUSION The optimal combination of HD mode and DLIR depends on the image noise level, and the combination of NR mode and DLIR was the best imaging condition under noisy conditions.
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Affiliation(s)
- Nobuo Kitera
- Department of Radiology, Hiroshima University Hospital
| | | | - Toru Higaki
- Graduate School of Advanced Science and Engineering, Hiroshima University
| | | | | | | | - Masao Kiguchi
- Department of Radiology, Hiroshima University Hospital
| | - Kazuya Ohashi
- Department of Radiology, Nagoya City University Hospital
| | - Harumasa Kasai
- Department of Radiology, Nagoya City University Hospital
| | - Kazuo Awai
- Graduate School of Biomedical and Health Sciences, Hiroshima University
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Nishii T, Kobayashi T, Saito T, Kotoku A, Ohta Y, Kitahara S, Umehara K, Ota J, Horinouchi H, Morita Y, Noguchi T, Ishida T, Fukuda T. Deep Learning-based Post Hoc CT Denoising for the Coronary Perivascular Fat Attenuation Index. Acad Radiol 2023; 30:2505-2513. [PMID: 36868878 DOI: 10.1016/j.acra.2023.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 03/05/2023]
Abstract
RATIONALE AND OBJECTIVES Coronary inflammation related to high-risk hemorrhagic plaques can be captured by the perivascular fat attenuation index (FAI) using coronary computed tomography angiography (CCTA). Since the FAI is susceptible to image noise, we believe deep learning (DL)-based post hoc noise reduction can improve diagnostic capability. We aimed to assess the diagnostic performance of the FAI in DL-based denoised high-fidelity CCTA images compared with coronary plaque magnetic resonance imaging (MRI) delivered high-intensity hemorrhagic plaques (HIPs). MATERIALS AND METHODS We retrospectively reviewed 43 patients who underwent CCTA and coronary plaque MRI. We generated high-fidelity CCTA images by denoising the standard CCTA images using a residual dense network that supervised the denoising task by averaging three cardiac phases with nonrigid registration. We measured the FAIs as the mean CT value of all voxels (range of -190 to -30 HU) located within a radial distance from the outer proximal right coronary artery wall. The diagnostic reference standard was defined as HIPs (high-risk hemorrhagic plaques) using MRI. The diagnostic performance of the FAI in the original and denoised images was assessed using receiver operating characteristic curves. RESULTS Of 43 patients, 13 had HIPs. The denoised CCTA improved the area under the curve (0.89 [95% confidence interval (CI) 0.78-0.99]) of the FAI compared with that in the original image (0.77 [95% CI, 0.62-0.91], p = 0.008). The optimal cutoff value for predicting HIPs in denoised CCTA was -69 HU with 0.85 (11/13) sensitivity, 0.79 (25/30) specificity, and 0.80 (36/43) accuracy. CONCLUSION DL-based denoised high-fidelity CCTA improved the AUC and specificity of the FAI for predicting HIPs.
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Affiliation(s)
- Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Takuma Kobayashi
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuya Saito
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akiyuki Kotoku
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Kitahara
- Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kensuke Umehara
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan; Medical Informatics Section, QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan; Applied MRI Research, Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan
| | - Junko Ota
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan; Medical Informatics Section, QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan; Applied MRI Research, Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, Japan
| | - Hiroki Horinouchi
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takayuki Ishida
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Fink N, Zsarnoczay E, Schoepf UJ, O'Doherty J, Griffith JP, Pinos D, Tesche C, Ricke J, Willemink MJ, Varga-Szemes A, Emrich T. Radiation Dose Reduction for Coronary Artery Calcium Scoring Using a Virtual Noniodine Algorithm on Photon-Counting Detector Computed-Tomography Phantom Data. Diagnostics (Basel) 2023; 13:diagnostics13091540. [PMID: 37174932 PMCID: PMC10177425 DOI: 10.3390/diagnostics13091540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Background: On the basis of the hypothesis that virtual noniodine (VNI)-based coronary artery calcium scoring (CACS) is feasible at reduced radiation doses, this study assesses the impact of radiation dose reduction on the accuracy of this VNI algorithm on a photon-counting detector (PCD)-CT. Methods: In a systematic in vitro setting, a phantom for CACS simulating three chest sizes was scanned on a clinical PCD-CT. The standard radiation dose was chosen at volumetric CT dose indices (CTDIVol) of 1.5, 3.3, 7.0 mGy for small, medium-sized, and large phantoms, and was gradually reduced by adjusting the tube current resulting in 100, 75, 50, and 25%, respectively. VNI images were reconstructed at 55 keV, quantum iterative reconstruction (QIR)1, and at 60 keV/QIR4, and evaluated regarding image quality (image noise (IN), contrast-to-noise ratio (CNR)), and CACS. All VNI results were compared to true noncontrast (TNC)-based CACS at 70 keV and standard radiation dose (reference). Results: INTNC was significantly higher than INVNI, and INVNI at 55 keV/QIR1 higher than at 60 keV/QIR4 (100% dose: 16.7 ± 1.9 vs. 12.8 ± 1.7 vs. 7.7 ± 0.9; p < 0.001 for every radiation dose). CNRTNC was higher than CNRVNI, but it was better to use 60 keV/QIR4 (p < 0.001). CACSVNI showed strong correlation and agreement at every radiation dose (p < 0.001, r > 0.9, intraclass correlation coefficient > 0.9). The coefficients of the variation in root-mean squared error were less than 10% and thus clinically nonrelevant for the CACSVNI of every radiation dose. Conclusion: This phantom study suggests that CACSVNI is feasible on PCD-CT, even at reduced radiation dose while maintaining image quality and CACS accuracy.
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Affiliation(s)
- Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Medical Imaging Center, Semmelweis University, Korányi Sándor utca 2, 1083 Budapest, Hungary
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Siemens Medical Solutions, 40 Liberty Boulevard, Malvern, PA 19355, USA
| | - Joseph P Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes-Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner Site Rhine-Main, 55131 Mainz, Germany
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Kędzierski B, Macek P, Dziadkowiec-Macek B, Truszkiewicz K, Poręba R, Gać P. Radiation Doses in Cardiovascular Computed Tomography. Life (Basel) 2023; 13:990. [PMID: 37109519 PMCID: PMC10141413 DOI: 10.3390/life13040990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
We discussed the contemporary views on the effects of ionising radiation on living organisms and the process of estimating radiation doses in CT examinations and the definitions of the CTDI, CTDIvol, DLP, SSDE, ED. We reviewed the reports from large analyses on the radiation doses in CT examinations of the coronary arteries prior to TAVI procedures, including the CRESCENT, PROTECTION, German Cardiac CT Registry studies. These studies were carried out over the last 10 years and can help confront the daily practice of performing cardiovascular CT examinations in most centres. The reference dose levels for these examinations were also collected. The methods to optimise the radiation dose included tube voltage reduction, ECG-monitored tube current modulation, iterative and deep learning reconstruction techniques, a reduction in the scan range, prospective study protocols, automatic exposure control, heart rate control, rational use of the calcium score, multi-slices and dual-source and wide-field tomography. We also present the studies that indicated the need to raise the organ conversion factor for cardiovascular studies from the 0.014-0.017 mSv/mGy*cm used for chest studies to date to a value of 0.0264-0.03 mSv/mGy*cm.
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Affiliation(s)
- Bartłomiej Kędzierski
- Department of Radiology and Imaging Diagnostics, Emergency Medicine Center, Marciniak Lower Silesian Specialist Hospital, Fieldorfa 2, 54-049 Wrocław, Poland
| | - Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Barbara Dziadkowiec-Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Krystian Truszkiewicz
- Department of Radiology and Imaging Diagnostics, Emergency Medicine Center, Marciniak Lower Silesian Specialist Hospital, Fieldorfa 2, 54-049 Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wrocław, Poland
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Renker M, Schoepf UJ, Kim WK. Combined CT Coronary Artery Assessment and TAVI Planning. Diagnostics (Basel) 2023; 13:1327. [PMID: 37046545 PMCID: PMC10093468 DOI: 10.3390/diagnostics13071327] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT-FFR) and machine learning-based CT-FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 61231 Bad Nauheim, Germany
| | - U. Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Won Keun Kim
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus Liebig University Giessen, 35392 Giessen, Germany
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Kasai R, Otsuka H. Noise Reduction Using Singular Value Decomposition with Jensen–Shannon Divergence for Coronary Computed Tomography Angiography. Diagnostics (Basel) 2023; 13:diagnostics13061111. [PMID: 36980419 PMCID: PMC10047110 DOI: 10.3390/diagnostics13061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Coronary computed tomography angiography (CCTA) is widely used due to its improvements in computed tomography (CT) diagnostic performance. Unlike other CT examinations, CCTA requires shorter rotation times of the X-ray tube, improving the temporal resolution and facilitating the imaging of the beating heart in a stationary state. However, reconstructed CT images, including those of the coronary arteries, contain insufficient X-ray photons and considerable noise. In this study, we introduce an image-processing technique for noise reduction using singular value decomposition (SVD) for CCTA images. The threshold of SVD was determined on the basis of minimization of Jensen–Shannon (JS) divergence. Experiments were performed with various numerical phantoms and varying levels of noise to reduce noise in clinical CCTA images using the determined threshold value. The numerical phantoms produced 10% higher-quality images than the conventional noise reduction method when compared on a quantitative SSIM basis. The threshold value determined by minimizing the JS–divergence was found to be useful for efficient noise reduction in actual clinical images, depending on the level of noise.
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The Impact of Novel Reconstruction Algorithms on Calcium Scoring: Results on a Dedicated Cardiac CT Scanner. Diagnostics (Basel) 2023; 13:diagnostics13040789. [PMID: 36832277 PMCID: PMC9955482 DOI: 10.3390/diagnostics13040789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
Contemporary reconstruction algorithms yield the potential of reducing radiation exposure by denoising coronary computed tomography angiography (CCTA) datasets. We aimed to assess the reliability of coronary artery calcium score (CACS) measurements with an advanced adaptive statistical iterative reconstruction (ASIR-CV) and model-based adaptive filter (MBAF2) designed for a dedicated cardiac CT scanner by comparing them to the gold-standard filtered back projection (FBP) calculations. We analyzed non-contrast coronary CT images of 404 consecutive patients undergoing clinically indicated CCTA. CACS and total calcium volume were quantified and compared on three reconstructions (FBP, ASIR-CV, and MBAF2+ASIR-CV). Patients were classified into risk categories based on CACS and the rate of reclassification was assessed. Patients were categorized into the following groups based on FBP reconstructions: 172 zero CACS, 38 minimal (1-10), 87 mild (11-100), 57 moderate (101-400), and 50 severe (400<). Overall, 19/404 (4.7%) patients were reclassified into a lower-risk group with MBAF2+ASIR-CV, while 8 additional patients (27/404, 6.7%) shifted downward when applying stand-alone ASIR-CV. The total calcium volume with FBP was 7.0 (0.0-133.25) mm3, 4.0 (0.0-103.5) mm3 using ASIR-CV, and 5.0 (0.0-118.5) mm3 with MBAF2+ASIR-CV (all comparisons p < 0.001). The concomitant use of ASIR-CV and MBAF2 may allow the reduction of noise levels while maintaining similar CACS values as FBP measurements.
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Sorooshfard E, Tahmasbi M, Chegeni N, Tahmasebi Birgani MJ. Evaluating the effects of variation in CT scanning parameters on the image quality and Hounsfield units for optimization of dose in radiotherapy treatment planning: A semi-anthropomorphic thorax phantom study. J Cancer Res Ther 2023; 19:426-434. [PMID: 37006077 DOI: 10.4103/jcrt.jcrt_260_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/09/2022] [Indexed: 04/04/2023]
Abstract
AIM The diagnosis accuracy of computed tomography (CT) systems and the reliability of calculated Hounsfield Units (HUs) are critical in tumor detection and cancer patients' treatment planning. This study evaluated the effects of scan parameters (Kilovoltage peak or kVp, milli-Ampere-second or mAS reconstruction kernels and algorithms, reconstruction field of view, and slice thickness) on image quality, HUs, and the calculated dose in the treatment planning system (TPS). MATERIALS AND METHODS A quality dose verification phantom was scanned several times by a 16-slice Siemens CT scanner. The DOSIsoft ISO gray TPS was applied for dose calculations. The SPSS.24 software was used to analyze the results and the P-value <0.05 was considered significant. RESULTS Reconstruction kernels and algorithms significantly affected noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The noise increased and CNR decreased by raising the sharpness of reconstruction kernels. SNR and CNR had considerable increments at iterative reconstruction compared with the filtered back-projection algorithm. The noise decreased by raising mAS in soft tissues. Also, KVp had a significant effect on HUs. TPS--calculated dose variations were less than 2% for mediastinum and backbone and less than 8% for rib. CONCLUSIONS Although HU variation depends on image acquisition parameters across a clinically feasible range, its dosimetric impact on the calculated dose in TPS can be neglected. Hence, it can be concluded that the optimized values of scan parameters can be applied to obtain the maximum diagnostic accuracy and calculate HUs more precisely without affecting the calculated dose in the treatment planning of cancer patients.
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Affiliation(s)
- Elahe Sorooshfard
- Department of Medical Physics, Medicine Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marziyeh Tahmasbi
- Department of Radiology Technology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Chegeni
- Department of Medical Physics, Medicine Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Tahmasebi Birgani
- Department of Medical Physics, Medicine Faculty, Ahvaz Jundishapur University of Medical Sciences; Department of Radiation Oncology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Tian Q, Li X, Li J, Cheng Y, Niu X, Zhu S, Xu W, Guo J. Image quality improvement in low-dose chest CT with deep learning image reconstruction. J Appl Clin Med Phys 2022; 23:e13796. [PMID: 36210060 PMCID: PMC9797160 DOI: 10.1002/acm2.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/10/2022] [Accepted: 09/06/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To investigate the clinical utility of deep learning image reconstruction (DLIR) for improving image quality in low-dose chest CT in comparison with 40% adaptive statistical iterative reconstruction-Veo (ASiR-V40%) algorithm. METHODS This retrospective study included 86 patients who underwent low-dose CT for lung cancer screening. Images were reconstructed with ASiR-V40% and DLIR at low (DLIR-L), medium (DLIR-M), and high (DLIR-H) levels. CT value and standard deviation of lung tissue, erector spinae muscles, aorta, and fat were measured and compared across the four reconstructions. Subjective image quality was evaluated by two blind readers from three aspects: image noise, artifact, and visualization of small structures. RESULTS The effective dose was 1.03 ± 0.36 mSv. There was no significant difference in CT values of erector spinae muscles and aorta, whereas the maximum difference for lung tissue and fat was less than 5 HU among the four reconstructions. Compared with ASiR-V40%, the DLIR-L, DLIR-M, and DLIR-H reconstructions reduced the noise in aorta by 11.44%, 33.03%, and 56.1%, respectively, and had significantly higher subjective quality scores in image artifacts (all p < 0.001). ASiR-V40%, DLIR-L, and DLIR-M had equivalent score in visualizing small structures (all p > 0.05), whereas DLIR-H had slightly lower score. CONCLUSIONS Compared with ASiR-V40%, DLIR significantly reduces image noise in low-dose chest CT. DLIR strength is important and should be adjusted for different diagnostic needs in clinical application.
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Affiliation(s)
- Qian Tian
- Department of RadiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP. R. China
| | - Xinyu Li
- Department of RadiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP. R. China
| | - Jianying Li
- GE Healthcare, Computed Tomography Research CenterBeijingP. R. China
| | - Yannan Cheng
- Department of RadiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP. R. China
| | - Xinyi Niu
- Department of RadiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP. R. China
| | - Shumeng Zhu
- Department of RadiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP. R. China
| | - Wenting Xu
- Department of RadiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP. R. China
| | - Jianxin Guo
- Department of RadiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP. R. China
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Benz DC, Ersözlü S, Mojon FLA, Messerli M, Mitulla AK, Ciancone D, Kenkel D, Schaab JA, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Radiation dose reduction with deep-learning image reconstruction for coronary computed tomography angiography. Eur Radiol 2022; 32:2620-2628. [PMID: 34792635 PMCID: PMC8921160 DOI: 10.1007/s00330-021-08367-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Deep-learning image reconstruction (DLIR) offers unique opportunities for reducing image noise without degrading image quality or diagnostic accuracy in coronary CT angiography (CCTA). The present study aimed at exploiting the capabilities of DLIR to reduce radiation dose and assess its impact on stenosis severity, plaque composition analysis, and plaque volume quantification. METHODS This prospective study includes 50 patients who underwent two sequential CCTA scans at normal-dose (ND) and lower-dose (LD). ND scans were reconstructed with Adaptive Statistical Iterative Reconstruction-Veo (ASiR-V) 100%, and LD scans with DLIR. Image noise (in Hounsfield units, HU) and quantitative plaque volumes (in mm3) were assessed quantitatively. Stenosis severity was visually categorized into no stenosis (0%), stenosis (< 20%, 20-50%, 51-70%, 71-90%, 91-99%), and occlusion (100%). Plaque composition was classified as calcified, non-calcified, or mixed. RESULTS Reduction of radiation dose from ND scans with ASiR-V 100% to LD scans with DLIR at the highest level (DLIR-H; 1.4 mSv vs. 0.8 mSv, p < 0.001) had no impact on image noise (28 vs. 27 HU, p = 0.598). Reliability of stenosis severity and plaque composition was excellent between ND scans with ASiR-V 100% and LD scans with DLIR-H (intraclass correlation coefficients of 0.995 and 0.974, respectively). Comparison of plaque volumes using Bland-Altman analysis revealed a mean difference of - 0.8 mm3 (± 2.5 mm3) and limits of agreement between - 5.8 and + 4.1 mm3. CONCLUSION DLIR enables a reduction in radiation dose from CCTA by 43% without significant impact on image noise, stenosis severity, plaque composition, and quantitative plaque volume. KEY POINTS •Deep-learning image reconstruction (DLIR) enables radiation dose reduction by over 40% for coronary computed tomography angiography (CCTA). •Image noise remains unchanged between a normal-dose CCTA reconstructed by ASiR-V and a lower-dose CCTA reconstructed by DLIR. •There is no impact on the assessment of stenosis severity, plaque composition, and quantitative plaque volume between the two scans.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Sara Ersözlü
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - François L A Mojon
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Anna K Mitulla
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Domenico Ciancone
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - David Kenkel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Jan A Schaab
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland.
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Jin L, Gao Y, Jiang A, Li Z, Wang P, Li M. Can the Coronary Artery Calcium Score Scan Reduce the Radiation Dose in Coronary Computed Tomography Angiography? Acad Radiol 2021; 28:364-369. [PMID: 32209277 DOI: 10.1016/j.acra.2020.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES Radiation exposure from coronary computed tomography angiography (CCTA) remains a cause for concern. The objective of this study was to investigate whether using the coronary artery calcium score scan (CACS) would reduce the radiation dose for CCTA scanning and the overall radiation exposure (ORE). MATERIALS AND METHODS In total, 256 patients were examined with a third-generation dual-source CT (n = 200) or 256-row CT (n = 56), among whom 105 (Group A) and 28 patients (Group B), respectively, underwent CCTA with CACS for field of view planning. The remaining patients, with the scout view for field of view planning, constituted Group A1 and B1. The scanning parameter settings were standardized between groups. RESULTS Shorter scan lengths were observed in Group A (9.98 ± 0.79 cm) compared to Group A1 (13.64 ± 1.79 cm; p < 0.001), which also resulted in a lower dose-length product (DLP) in Group A (115.04 ± 64.13) relative to Group A1 (138.67 ± 68.87; p < 0.05). Similarly, shorter scan lengths were found in Group B (14.92 ± 1.17 cm) compared to Group B1 (15.79 ± 0.63 cm; p = 0.001); this resulted in a lower DLP (322.07 ± 45.39) compared to Group B1 (354.34 ± 65.27; p = 0.036). The CACS resulted in an increase in ORE in both groups. CONCLUSION CACS may have a critical role in the reduction of radiation dose in CCTA scanning, but the potential effectiveness of CACS in reducing ORE is weak.
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Affiliation(s)
- Liang Jin
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - Yiyi Gao
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - An'qi Jiang
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China
| | - Zhenlin Li
- Radiology Department, West China Hospital, Affiliated to SiChuan University, Chengdu, China
| | - Peijun Wang
- Radiology Department, Tongji Hospital, Affiliated to Tongji University, Shanghai, China
| | - Ming Li
- Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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Impact of increasing levels of adaptive statistical iterative reconstruction on image quality in oil-based postmortem CT angiography in coronary arteries. Int J Legal Med 2021; 135:1869-1878. [PMID: 33629138 PMCID: PMC8354936 DOI: 10.1007/s00414-021-02530-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/03/2021] [Indexed: 01/03/2023]
Abstract
Introduction Postmortem multi-detector computed tomography (PMCT) has become an important part in forensic imaging. Modern reconstruction techniques such as iterative reconstruction (IR) are frequently used in postmortem CT angiography (PMCTA). The image quality of PMCTA depends on the strength of IR. For this purpose, we aimed to investigate the impact of different advanced IR levels on the objective and subjective PMCTA image quality. Material and methods We retrospectively analyzed the coronary arteries of 27 human cadavers undergoing whole-body postmortem CT angiography between July 2017 and March 2018 in a single center. Iterative reconstructions of the coronary arteries were processed in five different level settings (0%; 30%; 50%; 70%; 100%) by using an adaptive statistical IR method. We evaluated the objective (contrast-to-noise ratio (CNR)) and subjective image quality in several anatomical locations. Results Our results demonstrate that the increasing levels of an IR technique have relevant impact on the image quality in PMCTA scans in forensic postmortem examinations. Higher levels of IR have led to a significant reduction of image noise and therefore to a significant improvement of objective image quality (+ 70%). However, subjective image quality is inferior at higher levels of IR due to plasticized image appearance. Conclusion Objective image quality in PMCTA progressively improves with increasing level of IR with the best CNR at the highest IR level. However, subjective image quality is best at low to medium levels of IR. To obtain a “classic” image appearance with optimal image quality, PMCTAs should be reconstructed at medium levels of IR.
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Contrast medium administration with a body surface area protocol in step-and-shoot coronary computed tomography angiography with dual-source scanners. Sci Rep 2020; 10:16690. [PMID: 33028924 PMCID: PMC7541528 DOI: 10.1038/s41598-020-73915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/21/2020] [Indexed: 11/08/2022] Open
Abstract
We evaluated the feasibility and image quality of prospective electrocardiography (ECG)-triggered coronary computed tomography angiography (CCTA) using a body surface area (BSA) protocol for contrast-medium (CM) administration on both second- and third-generation scanners (Flash and Force CT), without using heart rate control. One-hundred-and-eighty patients with suspected coronary heart disease undergoing CCTA were divided into groups A (BSA protocol for CM on Flash CT), B (body mass index (BMI)-matched patients; BMI protocol for CM on Flash CT), and C (BMI-matched patients; BSA protocol for CM on Force CT). Patient characteristics, quantitative and qualitative measures, and radiation dose were compared between groups A and B, and A and C. Of the 180 patients, 99 were male (median age, 62 years). Average BSA in groups A, B, and C was 1.80 ± 0.17 m2, 1.74 ± 0.16 m2, and 1.64 ± 0.17 m2, respectively, with groups A and C differing significantly (P < 0.001). Contrast volume (50.50 ± 8.57 mL vs. 45.00 ± 6.18 mL) and injection rate (3.90 ± 0.44 mL/s vs. 3.63 ± 0.22 mL/s) differed significantly between groups A and C (P < 0.001). Groups A and C (both: all CT values > 250 HU, average scores > 4) achieved slightly lower diagnostic image quality than group B. The BSA protocol for CM administration was feasible in both Flash and Force CT, and therefore may be valuable in clinical practice.
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Benz DC, Benetos G, Rampidis G, von Felten E, Bakula A, Sustar A, Kudura K, Messerli M, Fuchs TA, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Validation of deep-learning image reconstruction for coronary computed tomography angiography: Impact on noise, image quality and diagnostic accuracy. J Cardiovasc Comput Tomogr 2020; 14:444-451. [DOI: 10.1016/j.jcct.2020.01.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/29/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
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Hong JH, Park EA, Lee W, Ahn C, Kim JH. Incremental Image Noise Reduction in Coronary CT Angiography Using a Deep Learning-Based Technique with Iterative Reconstruction. Korean J Radiol 2020; 21:1165-1177. [PMID: 32729262 PMCID: PMC7458859 DOI: 10.3348/kjr.2020.0020] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the feasibility of applying a deep learning-based denoising technique to coronary CT angiography (CCTA) along with iterative reconstruction for additional noise reduction. Materials and Methods We retrospectively enrolled 82 consecutive patients (male:female = 60:22; mean age, 67.0 ± 10.8 years) who had undergone both CCTA and invasive coronary artery angiography from March 2017 to June 2018. All included patients underwent CCTA with iterative reconstruction (ADMIRE level 3, Siemens Healthineers). We developed a deep learning based denoising technique (ClariCT.AI, ClariPI), which was based on a modified U-net type convolutional neural net model designed to predict the possible occurrence of low-dose noise in the originals. Denoised images were obtained by subtracting the predicted noise from the originals. Image noise, CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were objectively calculated. The edge rise distance (ERD) was measured as an indicator of image sharpness. Two blinded readers subjectively graded the image quality using a 5-point scale. Diagnostic performance of the CCTA was evaluated based on the presence or absence of significant stenosis (≥ 50% lumen reduction). Results Objective image qualities (original vs. denoised: image noise, 67.22 ± 25.74 vs. 52.64 ± 27.40; SNR [left main], 21.91 ± 6.38 vs. 30.35 ± 10.46; CNR [left main], 23.24 ± 6.52 vs. 31.93 ± 10.72; all p < 0.001) and subjective image quality (2.45 ± 0.62 vs. 3.65 ± 0.60, p < 0.001) improved significantly in the denoised images. The average ERDs of the denoised images were significantly smaller than those of originals (0.98 ± 0.08 vs. 0.09 ± 0.08, p < 0.001). With regard to diagnostic accuracy, no significant differences were observed among paired comparisons. Conclusion Application of the deep learning technique along with iterative reconstruction can enhance the noise reduction performance with a significant improvement in objective and subjective image qualities of CCTA images.
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Affiliation(s)
- Jung Hee Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Whal Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chulkyun Ahn
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Benz DC, Fuchs TA, Gräni C, Studer Bruengger AA, Clerc OF, Mikulicic F, Messerli M, Stehli J, Possner M, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Head-to-head comparison of adaptive statistical and model-based iterative reconstruction algorithms for submillisievert coronary CT angiography. Eur Heart J Cardiovasc Imaging 2019; 19:193-198. [PMID: 28200212 DOI: 10.1093/ehjci/jex008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/16/2017] [Indexed: 01/04/2023] Open
Abstract
Aims Iterative reconstruction (IR) algorithms allow for a significant reduction in radiation dose of coronary computed tomography angiography (CCTA). We performed a head-to-head comparison of adaptive statistical IR (ASiR) and model-based IR (MBIR) algorithms to assess their impact on quantitative image parameters and diagnostic accuracy for submillisievert CCTA. Methods and results CCTA datasets of 91 patients were reconstructed using filtered back projection (FBP), increasing contributions of ASiR (20, 40, 60, 80, and 100%), and MBIR. Signal and noise were measured in the aortic root to calculate signal-to-noise ratio (SNR). In a subgroup of 36 patients, diagnostic accuracy of ASiR 40%, ASiR 100%, and MBIR for diagnosis of coronary artery disease (CAD) was compared with invasive coronary angiography. Median radiation dose was 0.21 mSv for CCTA. While increasing levels of ASiR gradually reduced image noise compared with FBP (up to - 48%, P < 0.001), MBIR provided largest noise reduction (-79% compared with FBP) outperforming ASiR (-59% compared with ASiR 100%; P < 0.001). Increased noise and lower SNR with ASiR 40% and ASiR 100% resulted in substantially lower diagnostic accuracy to detect CAD as diagnosed by invasive coronary angiography compared with MBIR: sensitivity and specificity were 100 and 37%, 100 and 57%, and 100 and 74% for ASiR 40%, ASiR 100%, and MBIR, respectively. Conclusion MBIR offers substantial noise reduction with increased SNR, paving the way for implementation of submillisievert CCTA protocols in clinical routine. In contrast, inferior noise reduction by ASiR negatively affects diagnostic accuracy of submillisievert CCTA for CAD detection.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Annina A Studer Bruengger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
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Dai T, Wang JR, Hu PF. Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis. Eur Radiol 2017; 28:1373-1382. [DOI: 10.1007/s00330-017-5097-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/10/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
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Halliburton SS, Tanabe Y, Partovi S, Rajiah P. The role of advanced reconstruction algorithms in cardiac CT. Cardiovasc Diagn Ther 2017; 7:527-538. [PMID: 29255694 DOI: 10.21037/cdt.2017.08.12] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Non-linear iterative reconstruction (IR) algorithms have been increasingly incorporated into clinical cardiac CT protocols at institutions around the world. Multiple IR algorithms are available commercially from various vendors. IR algorithms decrease image noise and are primarily used to enable lower radiation dose protocols. IR can also be used to improve image quality for imaging of obese patients, coronary atherosclerotic plaques, coronary stents, and myocardial perfusion. In this article, we will review the various applications of IR algorithms in cardiac imaging and evaluate how they have changed practice.
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Affiliation(s)
| | - Yuki Tanabe
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sasan Partovi
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, TX, USA
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Iterative reconstruction improves detection of in-stent restenosis by high-pitch dual-source coronary CT angiography. Sci Rep 2017; 7:6956. [PMID: 28761180 PMCID: PMC5537291 DOI: 10.1038/s41598-017-07499-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/27/2017] [Indexed: 01/13/2023] Open
Abstract
Recent studies demonstrated that sinogram affirmed iterative reconstructions (SAFIRE) can produce higher-resolution images with greater robustness for the reduction of various imaging artefacts. Eighty-five patients were prospectively evaluated and underwent a high-pitch spiral acquisition CT scan. In-stent noise, signal-to-noise ratio(SNR), stent-lumen attenuation increase ratio (SAIR), and subjective image quality score were measured and compared between the SAFIRE and Filter back projection (FBP) reconstructions. Conventional coronary angiography served as the standard of reference. In 159 evaluated stents, SAFIRE was superior to FBP with regards to in-stent noise, SNR, SAIR, and image quality score. On per-stent analysis, SAFIRE vs. FBP reconstruction yielded 85% vs. 85%sensitivity, 89% vs. 78%specificity, 73% vs. 57%positive predictive value, 95% vs. 94%negative predictive value, and 0.87 vs. 0.82 area under curve, although these improvements did not reach statistical significance (P > 0.05). However, in the subgroup of small diameter stents (≤3 mm; n = 95), specificity(82% vs. 62%), positive predictive value(66% vs. 50%) and area under curve (0.81 vs. 0.70) improved significantly (P < 0.05) with SAFIRE. SAFIRE image reconstruction can thus improve the evaluation for ISR, especially in smaller stents.
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23
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Baumann S, Kryeziu P, Rutsch M, Lossnitzer D. Coronary Computed Tomography Angiography. Interv Cardiol 2017. [DOI: 10.5772/67800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Correction Factors for CT Coronary Artery Calcium Scoring Using Advanced Modeled Iterative Reconstruction Instead of Filtered Back Projection. Acad Radiol 2016; 23:1480-1489. [PMID: 27614365 DOI: 10.1016/j.acra.2016.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Iterative reconstruction (IR) computed tomography (CT) techniques allow for radiation dose reduction while maintaining image quality. However, CT coronary artery calcium (CAC) scores may be influenced by certain IR algorithms. The aim of our study is to identify suitable correction factors to ensure consistency between IR and filtered back projection (FBP)-based CAC scoring. MATERIAL AND METHODS A phantom study was performed to derive suitable correction factors for CAC scores and volume (VOL) values with advanced modeled iterative reconstruction (or ADMIRE) strength level 3 (ADM3) and 5 (ADM5) vs FBP. CT data from 40 patients were retrospectively analyzed, and CAC score and VOL values were obtained following reconstruction with FBP, ADM3, and ADM5. Linear regression analysis was performed to obtain correction factors. Results with and without application of the correction factors were compared. Inter-reader agreement for risk class stratification was analyzed. RESULTS Phantom experiments determined a correction factor of 1.14 for ADM3 and 1.25 for ADM5. FBP-based CAC scores (897 ± 1413) were significantly higher than uncorrected scores with ADM3 (746 ± 1184, P ≤ .001) and ADM5 (640 ± 1036, P ≤ .001). After application of correction factors, no significant differences were found for CAC scores based on FBP (897 ± 1413) and ADM3 (853 ± 1353, P = .07). The inter-reader agreement for risk stratification was excellent (k = 0.91). CONCLUSION ADM3 can be applied to CAC scoring with use of a correction factor. When applying a correction factor of 1.14, excellent agreement with standard FBP for both CAC score and VOL can be achieved.
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Effect of the forward-projected model-based iterative reconstruction solution algorithm on image quality and radiation dose in pediatric cardiac computed tomography. Pediatr Radiol 2016; 46:1663-1670. [PMID: 27531216 DOI: 10.1007/s00247-016-3676-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/22/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Some iterative reconstruction algorithms are useful for reducing the radiation dose in pediatric cardiac CT. A new iterative reconstruction algorithm (forward-projected model-based iterative reconstruction solution) has been developed, but its usefulness for radiation dose reduction in pediatric cardiac CT is unknown. OBJECTIVE To investigate the effect of the new algorithm on CT image quality and on radiation dose in pediatric cardiac CT. MATERIALS AND METHODS We obtained phantom data at six dose levels, as well as pediatric cardiac CT data, and reconstructed CT images using filtered back projection, adaptive iterative dose reduction 3-D (AIDR 3-D) and the new algorithm. We evaluated phantom image quality using physical assessment. Four radiologists performed visual evaluation of cardiac CT image quality. RESULTS In the phantom study, the new algorithm effectively suppressed noise in the low-dose range and moderately generated modulation transfer function, yielding a higher signal-to-noise ratio compared with filtered back projection or AIDR 3-D. When clinical cardiac CT was performed, images obtained by the new method had less perceived image noise and better tissue contrast at similar resolution compared with AIDR 3-D images. CONCLUSION The new algorithm reduced image noise at moderate resolution in low-dose CT scans and improved the perceived quality of cardiac CT images to some extent. This new algorithm might be superior to AIDR 3-D for radiation dose reduction in pediatric cardiac CT.
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Mangold S, Wichmann JL, Schoepf UJ, Caruso D, Tesche C, Steinberg DH, Varga-Szemes A, Stubenrauch AC, Bayer RR, Biancalana M, Nikolaou K, De Cecco CN. Diagnostic accuracy of coronary CT angiography using 3 rd-generation dual-source CT and automated tube voltage selection: Clinical application in a non-obese and obese patient population. Eur Radiol 2016; 27:2298-2308. [PMID: 27682312 DOI: 10.1007/s00330-016-4601-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/15/2016] [Accepted: 09/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate diagnostic accuracy of 3rd-generation dual-source CT (DSCT) coronary angiography in obese and non-obese patients. METHODS We retrospectively analyzed 76 patients who underwent coronary CT angiography (CCTA) and invasive coronary angiography. Prospectively ECG-triggered acquisition was performed with automated tube voltage selection (ATVS). Patients were dichotomized based on body mass index in groups A (<30 kg/m2, n = 37) and B (≥30 kg/m2, n = 39) and based on tube voltage in groups C (<120 kV, n = 46) and D (120 kV, n = 30). Coronary arteries were assessed for significant stenoses (≥50 % luminal narrowing) and diagnostic accuracy was calculated. RESULTS Per-patient overall sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 96.9 %, 95.5 %, 93.9 %, 97.7 % and 96.1 %, respectively. Sensitivity and NPV were lower in groups B and D compared to groups A and C, but no statistically significant differences were observed (group A vs. B: sensitivity, 100.0 % vs. 93.3 %, p = 0.9493; NPV, 100 % vs. 95.5 %, p = 0.9812; group C vs. D: sensitivity, 100.0 % vs. 92.3 %, p = 0.8462; NPV, 100.0 % vs. 94.1 %, p = 0.8285). CONCLUSION CCTA using 3rd-generation DSCT and (ATVS) provides high diagnostic accuracy in both non-obese and obese patients. KEY POINTS • Coronary CTA provides high diagnostic accuracy in non-obese and obese patients. • Diagnostic accuracy between obese and non-obese patients showed no significant difference. • <120 kV studies were performed in 44 % of obese patients. • Current radiation dose-saving approaches can be applied independent of body habitus.
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Affiliation(s)
- Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA. .,Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Damiano Caruso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Cardiology, Heart Centre Munich-Bogenhausen, Munich, Germany
| | - Daniel H Steinberg
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Andrew C Stubenrauch
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Richard R Bayer
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew Biancalana
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
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Wu Q, Wang Y, Kai H, Wang T, Tang X, Wang X, Pan C. Application of 80-kVp tube voltage, low-concentration contrast agent and iterative reconstruction in coronary CT angiography: evaluation of image quality and radiation dose. Int J Clin Pract 2016; 70 Suppl 9B:B50-5. [PMID: 27577515 DOI: 10.1111/ijcp.12852] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 06/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIM To evaluate image quality and radiation dosage in coronary CT angiography using 80-kVp tube voltage combined with low-concentration contrast media (CM) and iterative reconstruction (IR) for coronary CT angiography (CCTA) and employing dual-source CT without heart-rate control. METHODS 154 patients were randomly assigned to Group A (Control Group, 120-kVp tube voltage, high-concentration CM and filtered back projection reconstruction) and Group B (Low-Dose Group, 80 kVp, low-concentration CM and iterative construction). Two experienced radiologists double-blindly evaluated the following parameters: CT attenuation, signal-noise ratio (SNR), contrast-noise ratio (CNR), radiation dose, size-specific dose estimates (SSDE) and total iodine intake. Pearson correlation analysis was used to assess the relationship between SSDE and BMI. RESULTS 98.1% vessel segments in Group A and 97.6% in Group B passed diagnostics, indicating no significant differences; the average aorta scores and CT attenuation values showed no significant differences between groups. Similar SNR and CNR results were obtained for the two groups, although values were slightly lower in Group A compared with Group B. The Effective Dose in Group B was 63% lower than that in Group A (P<.001). SSDE results were significantly different between the two groups (P<.001) but did not correlate with BMI. Finally, the total iodine intake in Group B was 22.9% lower than that in Group A. CONCLUSIONS Coronary CTA conducted with a low tube voltage of 80 kVp, a low-concentration CM and IR without heart rate control can achieve images of similar quality to those obtained using standard procedures, significantly reducing the associated radiation dose and iodine intake.
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Affiliation(s)
- Qiyong Wu
- Department of Thoracic and Cardiac Surgery, The Second People's Hospital of Changzhou, Affiliated of Nanjing Medical University, Changzhou, China
| | - Yong Wang
- Department of Thoracic and Cardiac Surgery, The Second People's Hospital of Changzhou, Affiliated of Nanjing Medical University, Changzhou, China
| | - Huihua Kai
- Department of Radiology, The Second People's Hospital of Changzhou, Affiliated of Nanjing Medical University, Changzhou, China
| | - Tao Wang
- Department of Radiology, The Second People's Hospital of Changzhou, Affiliated of Nanjing Medical University, Changzhou, China
| | - Xiaoqiang Tang
- Department of Radiology, The Second People's Hospital of Changzhou, Affiliated of Nanjing Medical University, Changzhou, China
| | - Xiaoqin Wang
- Department of Radiology, The Second People's Hospital of Changzhou, Affiliated of Nanjing Medical University, Changzhou, China
| | - Changjie Pan
- Department of Radiology, The Second People's Hospital of Changzhou, Affiliated of Nanjing Medical University, Changzhou, China
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Gassenmaier T, Petri N, Allmendinger T, Flohr T, Weng AM, Kunz AS, Petritsch B, Voelker W, Bley TA. In Vitro Comparison of Second- and Third-generation Dual-source CT for Coronary Stent Visualization at Different Tube Potentials. Acad Radiol 2016; 23:961-8. [PMID: 27236611 DOI: 10.1016/j.acra.2016.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 11/14/2015] [Accepted: 03/14/2016] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES The study aimed to evaluate in vitro stent lumen visibility of coronary stents in a second- and third-generation dual-source computed tomography (CT) system at 100 and 120 kVp tube potential. MATERIALS AND METHODS Twenty-six coronary stents ranging from 2.25 to 4.0 mm in diameter were implanted in a coronary vessel phantom. Scans were performed at 100 and 120 kVp tube potential. Evaluation was performed using a medium-sharp kernel in both systems (B46f in the second-generation and Bv49 in the third-generation model) and a sharp (Bv59) convolution kernel optimized for vascular imaging in the third-generation CT. RESULTS The median visible stent lumen diameter in the second-generation system was higher at 120 kVp with a median of 62.0% compared to 56.3% at 100 kVp (P < 0.001). The median visible diameter in the third-generation system was significantly higher applying the Bv49 kernel with 66.7% at 120 kVp and 61.1% at 100 kVp (both P < 0.001). When applying the Bv59 kernel, visible stent lumen further increased to 69.3% at 120 kVp and 66.7% at 100 kVp. Additionally, stent lumen was assessed using full width at half maximum, resulting in a comparable increase in luminal diameter at corresponding tube potential. CONCLUSIONS Third-generation dual-source CT provides superior stent lumen visibility at equivalent tube potential and at reduced tube potential of 100 kVp when compared to 120 kVp in a second-generation system, at least when manually assessed.
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Affiliation(s)
- Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.
| | - Nils Petri
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | | | | | - Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Andreas S Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Wolfram Voelker
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
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Abdullah KA, McEntee MF, Reed W, Kench PL. Radiation dose and diagnostic image quality associated with iterative reconstruction in coronary CT angiography: A systematic review. J Med Imaging Radiat Oncol 2016; 60:459-68. [PMID: 27241506 DOI: 10.1111/1754-9485.12473] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review is to evaluate the radiation dose reduction achieved using iterative reconstruction (IR) compared to filtered back projection (FBP) in coronary CT angiography (CCTA) and assess the impact on diagnostic image quality. A systematic search of seven electronic databases was performed to identify all studies using a developed keywords strategy. A total of 14 studies met the criteria and were included in a review analysis. The results showed that there was a significant reduction in radiation dose when using IR compared to FBP (P < 0.05). The mean and standard deviation (SD) difference of CTDIvol and dose-length-product (DLP) were 14.70 ± 6.87 mGy and 186 ± 120 mGy.cm respectively. The mean ± SD difference of effective dose (ED ) was 2.9 ± 1.7 mSv with the range from 1.0 to 5.0 mSv. The assessment of diagnostic image quality showed no significant difference (P > 0.05). The mean ± SD difference of image noise, signal-noise ratio (SNR) and contrast-noise ratio (CNR) were 1.05 ± 1.29 HU, 0.88 ± 0.56 and 0.63 ± 1.83 respectively. The mean ± SD percentages of overall image quality scores were 71.79 ± 12.29% (FBP) and 67.31 ± 22.96% (IR). The mean ± SD percentages of coronary segment analysis were 95.43 ± 2.57% (FBP) and 97.19 ± 2.62% (IR). In conclusion, this review analysis shows that CCTA with the use of IR leads to a significant reduction in radiation dose as compared to the use of FBP. Diagnostic image quality of IR at reduced dose (30-41%) is comparable to FBP at standard dose in the diagnosis of CAD.
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Affiliation(s)
- Kamarul Amin Abdullah
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.,Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Mark F McEntee
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Warren Reed
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Peter L Kench
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
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Mangold S, De Cecco CN, Schoepf UJ, Yamada RT, Varga-Szemes A, Stubenrauch AC, Caruso D, Fuller SR, Vogl TJ, Nikolaou K, Todoran TM, Wichmann JL. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography. Eur Radiol 2016; 26:4380-4389. [DOI: 10.1007/s00330-016-4304-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/14/2015] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
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Nishii T, Kono AK, Tani W, Suehiro E, Negi N, Takahashi S, Sugimura K. Four-dimensional noise reduction using the time series of medical computed tomography datasets with short interval times: a static-phantom study. PeerJ 2016; 4:e1680. [PMID: 26893966 PMCID: PMC4756736 DOI: 10.7717/peerj.1680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/21/2016] [Indexed: 12/04/2022] Open
Abstract
Backgrounds. This study examines the hypothesis that four-dimensional noise reduction (4DNR) with short interval times reduces noise in cardiac computed tomography (CCT) using “padding” phases. Furthermore, the capability of reducing the reduction dose in CCT using this post-processing technique was assessed. Methods. Using base and quarter radiation doses for CCT (456 and 114 mAs/rot with 120 kVp), a static phantom was scanned ten times with retrospective electrocardiogram gating, and 4DNR with short interval times (50 ms) was performed using a post-processing technique. Differences in the computed tomography (CT) attenuation, contrast-to-noise ratio (CNR) and spatial resolution with modulation transfer function in each dose image obtained with and without 4DNR were assessed by conducting a Tukey–Kramer’s test and non-inferiority test. Results. For the base dose, by using 4DNR, the CNR was improved from 1.18 ± 0.15 to 2.08 ± 0.20 (P = 0.001), while the CT attenuation and spatial resolution of the image of 4DNR did not were significantly inferior to those of reference image (P < 0.001). CNRs of the quarter-dose image in 4DNR also improved to 1.28 ± 0.11, and were not inferior to those of the non-4DNR images of the base dose (P < 0.001). Conclusions. 4DNR with short interval times significantly reduced noise. Furthermore, applying this method to CCT would have the potential of reducing the radiation dose by 75%, while maintaining a similar image noise level.
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Affiliation(s)
- Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine , Kobe , Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine , Kobe , Japan
| | - Wakiko Tani
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe University Hospital , Kobe , Japan
| | - Erina Suehiro
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe University Hospital , Kobe , Japan
| | - Noriyuki Negi
- Division of Radiology, Center for Radiology and Radiation Oncology, Kobe University Hospital , Kobe , Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine , Kobe , Japan
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Halliburton SS, Rajiah P. Cardiac CT Scanner Technology: What Is New and What Is Next? CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9370-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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McKavanagh P, Walls G, McCune C, Malloy J, Harbinson MT, Ball PA, Donnelly PM. The Essentials of Cardiac Computerized Tomography. Cardiol Ther 2015; 4:117-29. [PMID: 26536882 PMCID: PMC4675750 DOI: 10.1007/s40119-015-0052-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Indexed: 10/25/2022] Open
Abstract
Cardiac computerized tomography (CT) has evolved from a research tool to an important diagnostic investigation in cardiology, and is now recommended in European, US, and UK guidelines. This review is designed to give the reader an overview of the current state of cardiac CT. The role of cardiac CT is multifaceted, and includes risk stratification, disease detection, coronary plaque quantification, defining congenital heart disease, planning for structural intervention, and, more recently, assessment of ischemia. This paper addresses basic principles as well as newer evidence.
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Den Harder AM, Willemink MJ, De Ruiter QMB, De Jong PA, Schilham AMR, Krestin GP, Leiner T, Budde RPJ. Dose reduction with iterative reconstruction for coronary CT angiography: a systematic review and meta-analysis. Br J Radiol 2015; 89:20150068. [PMID: 26562096 DOI: 10.1259/bjr.20150068] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the achievable radiation dose reduction for coronary CT angiography (CCTA) with iterative reconstruction (IR) in adults and the effects on image quality. METHODS PubMed and EMBASE were searched, and original articles concerning IR for CCTA in adults using prospective electrocardiogram triggering were included. Primary outcome was the effective dose using filtered back projection (FBP) and IR. Secondary outcome was the effect of IR on objective and subjective image quality. RESULTS The search yielded 1616 unique articles, of which 10 studies (1042 patients) were included. The pooled routine effective dose with FBP was 4.2 mSv [95% confidence interval (CI) 3.5-5.0]. A dose reduction of 48% to a pooled effective dose of 2.2 mSv (95% CI 1.3-3.1) using IR was reported. Noise, contrast-to-noise ratio and subjective image quality were equal or improved in all but one study, whereas signal-to-noise ratio was decreased in two studies with IR at reduced dose. CONCLUSION IR allows for CCTA acquisition with an effective dose of 2.2 mSv with preserved objective and subjective image quality.
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Affiliation(s)
| | - Martin J Willemink
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Quirina M B De Ruiter
- 2 Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pim A De Jong
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arnold M R Schilham
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gabriel P Krestin
- 3 Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Tim Leiner
- 1 Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ricardo P J Budde
- 3 Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands
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Kim H, Park CH, Han KH, Kim TH. Predicting the image noise level of prospective ECG-triggered coronary computed tomography angiography: quantitative measurement of thoracic component versus body mass index. Int J Cardiovasc Imaging 2015; 31 Suppl 2:213-21. [PMID: 26507324 DOI: 10.1007/s10554-015-0796-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Abstract
We evaluated the feasibility of using quantitatively measured thoracic components, as compared to body mass index (BMI), for predicting the image noise of coronary computed tomography angiography (CCTA). One hundred subjects (M:F = 64:36; mean age, 55 ± 8.8 years) who underwent prospective electrocardiography-gated CCTA and low-dose chest computed tomography (CT) were analyzed retrospectively. The image noise of the CCTA was determined by the standard deviation of the attenuation value in a region of interest on the aortic root level. On the low-dose chest CT, the areas of the thoracic components were measured at the aortic root level. An auto-segmentation technique with the following threshold levels was used: quantitatively measured area of total thorax [QMAtotal: -910 to 1000 Hounsfield units (HU)], lung (QMAlung: -910 to -200 HU), fat (QMAfat: -200 to 0 HU), muscle (QMAmuscle: 0-300 HU), soft tissue (fat + muscle, QMAsoft tissue: -200 to 300 HU), bone (QMAbone: 300-1000 HU) and solid tissue (fat + muscle + bone, QMAsolid tissue: -200 to 1000 HU). The relationship between image noise and variable biometric parameters including QMA was analyzed, and the linear correlation coefficients were used as indicators of the strength of association. Among the variable biometric parameters, including BMI, QMAsolid tissue showed the highest correlation coefficient with image noise in all subjects (r = 0.804), males (r = 0.716), females (r = 0.889), the overweight (r = 0.556), and the non-overweight subgroups (r = 0.783). QMAsolid tissue can be used as a potential surrogate predictor of the image noise level in low tube voltage CCTA.
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Affiliation(s)
- Hyeongmin Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Kyung Hwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zhang LJ, Wang Y, Schoepf UJ, Meinel FG, Bayer RR, Qi L, Cao J, Zhou CS, Zhao YE, Li X, Gong JB, Jin Z, Lu GM. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography. Eur Radiol 2015; 26:797-806. [PMID: 26382844 DOI: 10.1007/s00330-015-3868-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/05/2015] [Accepted: 05/29/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate image quality, radiation dose, and diagnostic performance of prospectively ECG-triggered high-pitch coronary CT angiography (CCTA) at 70 kVp compared to invasive coronary angiography (ICA) as reference standard. MATERIALS AND METHODS Forty-three patients underwent prospectively ECG-triggered high-pitch CCTA at 70 kVp using 30 cc (11 g iodine) contrast medium and ICA. Subjective and objective image quality was evaluated for each CCTA study. CCTA performance for diagnosing ≥50% stenosis was assessed. Results were stratified according to heart rate (HR), body mass index (BMI), Agatston score, and image quality. RESULTS At CCTA, 94.3% (500/530) of coronary segments were of diagnostic quality. Using ICA as reference standard, sensitivity and accuracy were 100% and 93.0% on a per-patient basis. Per-vessel and per-segment performances were 92.2% and 89.5%; 79.5% and 88.3%, respectively. No differences were found in diagnostic accuracy between different HR, BMI, and calcification subgroups (all P > 0.05) on a per-patient basis. However, low image quality reduced diagnostic accuracy on a per-patient, per-vessel and per-segment basis (all P < 0.05). The mean effective radiation dose was 0.2 ± 0.0 mSv. CONCLUSION Our presented protocol results in an effective radiation dose of 0.2 mSv and high diagnostic accuracy for stenosis detection in a selected, non-obese population. KEY POINTS Prospectively ECG-triggered high-pitch CCTA at 70 kVp is feasible. This protocol has a high diagnostic accuracy for stenosis detection. The mean effective radiation dose was 0.2 ± 0.0 mSv. Only 30 cc of contrast material is used in this protocol. Low image quality reduced diagnostic accuracy of CCTA.
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Affiliation(s)
- Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.,Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Felix G Meinel
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Li Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jian Cao
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Yan E Zhao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Xie Li
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jian Bin Gong
- Department of Cardiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
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Geyer LL, Schoepf UJ, Meinel FG, Nance JW, Bastarrika G, Leipsic JA, Paul NS, Rengo M, Laghi A, De Cecco CN. State of the Art: Iterative CT Reconstruction Techniques. Radiology 2015. [PMID: 26203706 DOI: 10.1148/radiol.2015132766] [Citation(s) in RCA: 434] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Lucas L Geyer
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - U Joseph Schoepf
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Felix G Meinel
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - John W Nance
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Gorka Bastarrika
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Jonathon A Leipsic
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Narinder S Paul
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Marco Rengo
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Andrea Laghi
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
| | - Carlo N De Cecco
- From the Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425 (L.L.G., U.J.S., F.G.M., J.W.N., C.N.D.); Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (G.B.); Department of Radiology, University of British Columbia, Vancouver, BC, Canada (J.A.L.); Department of Radiology, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (N.S.P.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza-Polo Pontino, Latina, Italy (M.R., A.L., C.N.D.)
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Iterative reconstruction in cardiac CT. J Cardiovasc Comput Tomogr 2015; 9:255-63. [PMID: 26088375 DOI: 10.1016/j.jcct.2015.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 12/29/2022]
Abstract
Iterative reconstruction (IR) has the ability to reduce image noise in CT without compromising diagnostic quality, which permits a significant reduction in effective radiation dose. This been increasingly integrated into clinical CT practice over the past 7 years and has been particularly important in the field of cardiac CT with multiple vendors introducing cardiac CT-compatible IR algorithms. The following review will summarize the principles of IR algorithms, studies validating their noise- and dose-reducing abilities, and the specific applications of IR in cardiac CT.
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Effect of iDose4 iterative reconstruction algorithm on image quality and radiation exposure in prospective and retrospective electrocardiographically gated coronary computed tomographic angiography. J Comput Assist Tomogr 2014; 38:956-62. [PMID: 25119063 DOI: 10.1097/rct.0000000000000137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to compare a commercially available reconstruction algorithm (iDose4) with filtered back projection (FBP) in terms of image quality (IQ) for both retrospective electrocardiographically gated and prospective electrocardiographically triggered cardiac computed tomographic angiography (CCTA) protocols and to evaluate the achievable radiation dose reduction. METHODS A total cohort of 58 patients underwent either prospective CTCA or retrospective CTCA with full or reduced tube current-time product (in milliampere-second) protocol on a 64-slice multidetector computed tomographic scanner. All images were reconstructed with FBP, whereas the reduced milliampere-second images were also reconstructed using 2 levels (levels 4 and 6) of iDose4. Subjective and objective IQ was evaluated. RESULTS Dose reductions of 43% in the retrospective CCTA protocol and 27% in the prospective CCTA protocol were achieved without compromising IQ. In the prospective CCTA protocol, the reduced-dose images were highly scored; thus, additional reduction of exposure settings is feasible. In the retrospective acquisition, dose reduction has led to similar IQ scores between the reduced-dose iDose4 images and the full-dose FBP images. Considering different reconstructions (FBP, iDose-L4 and -L6) of the same acquisition data, increase in iDose4 level resulted in less noisy images. A slight improvement was also noticed in all IQ indices; however, this improvement was not statistically significant for both acquisition protocols. CONCLUSIONS This study demonstrated that the application of iDose at CCTA facilitates significant radiation dose reduction by maintaining diagnostic quality. The combination of iDose4 with prospective acquisition is able to significantly reduce effective dose associated with CTCA at values of approximately 2 mSv and even lower.
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Layritz C, Schmid J, Achenbach S, Ulzheimer S, Wuest W, May M, Ropers D, Klinghammer L, Daniel WG, Pflederer T, Lell M. Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization. Eur Heart J Cardiovasc Imaging 2014; 15:1238-45. [DOI: 10.1093/ehjci/jeu113] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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van Osch JAC, Mouden M, van Dalen JA, Timmer JR, Reiffers S, Knollema S, Greuter MJW, Ottervanger JP, Jager PL. Influence of iterative image reconstruction on CT-based calcium score measurements. Int J Cardiovasc Imaging 2014; 30:961-7. [PMID: 24676668 DOI: 10.1007/s10554-014-0409-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/21/2014] [Indexed: 01/07/2023]
Abstract
Iterative reconstruction techniques for coronary CT angiography have been introduced as an alternative for traditional filter back projection (FBP) to reduce image noise, allowing improved image quality and a potential for dose reduction. However, the impact of iterative reconstruction on the coronary artery calcium score is not fully known. In 112 consecutive stable patients with suspected coronary artery disease, the coronary calcium scores were assessed. Comparisons were made between the Agatston, volume and mass scores obtained with traditional FBP, and by using adaptive statistical iterative reconstruction (ASIR). A significant reduction of the Agatston score, volume score and mass score was observed for ASIR when compared to FBP, with median differences of resp. 26, 5 mm(3) and 1 mg. Using the ASIR reconstruction, the number of patients with a calcium score of zero increased by 13 %. Iterative CT reconstruction significantly reduces the Agatston, volume and mass scores. Since the calcium score is used as a prognostic tool for coronary artery disease, caution must be taken when using iterative reconstruction.
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Renker M, Geyer LL, Krazinski AW, Silverman JR, Ebersberger U, Schoepf UJ. Iterative image reconstruction: a realistic dose-saving method in cardiac CT imaging? Expert Rev Cardiovasc Ther 2014; 11:403-9. [DOI: 10.1586/erc.12.178] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Iterative Reconstruction to Preserve Image Quality and Diagnostic Accuracy at Reduced Radiation Dose in Coronary CT Angiography. JACC Cardiovasc Imaging 2013; 6:1239-49. [DOI: 10.1016/j.jcmg.2013.08.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 08/02/2013] [Accepted: 08/09/2013] [Indexed: 11/19/2022]
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Suh YJ, Kim YJ, Hong SR, Hong YJ, Lee HJ, Hur J, Choi BW. Combined Use of Automatic Tube Potential Selection with Tube Current Modulation and Iterative Reconstruction Technique in Coronary CT Angiography. Radiology 2013; 269:722-9. [DOI: 10.1148/radiol.13130408] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Carrascosa P, Rodriguez-Granillo GA, Capuñay C, Deviggiano A. Low-dose CT coronary angiography using iterative reconstruction with a 256-slice CT scanner. World J Cardiol 2013; 5:382-386. [PMID: 24198908 PMCID: PMC3817280 DOI: 10.4330/wjc.v5.i10.382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/25/2013] [Accepted: 09/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore whether computer tomography coronary angiography (CTCA) using iterative reconstruction (IR) leads to significant radiation dose reduction without a significant loss in image interpretability compared to conventional filtered back projection (FBP).
METHODS: A consecutive series of 200 patients referred to our institution to undergo CTCA constituted the study population. Patients were sequentially assigned to FBP or IR. All studies were acquired with a 256-slice CT scanner. A coronary segment was considered interpretable if image quality was adequate for evaluation of coronary lesions in all segments ≥ 1.5 mm.
RESULTS: The mean age was 56.3 ± 9.6 years and 165 (83%) were male, with no significant differences between groups. Most scans were acquired using prospective ECG triggering, without differences between groups (FBP 84% vs IR 82%; P = 0.71). A total of 3198 (94%) coronary segments were deemed of diagnostic quality. The percent assessable coronary segments was similar between groups (FBP 91.7% ± 4.0% vs IR 92.5% ± 2.8%; P = 0.12). Radiation dose was significantly lower in the IR group (2.8 ± 1.4 mSv vs 4.6 ± 3.0 mSv; P < 0.0001). Image noise (37.8 ± 1.4 HU vs 38.2 ± 2.4 HU; P = 0.20) and signal density (461.7 ± 51.9 HU vs 462.2 ± 51.2 HU; P = 0.54) levels did not differ between FBP and IR groups, respectively. The IR group was associated to significant effective dose reductions, irrespective of the acquisition mode.
CONCLUSION: Application of IR in CTCA preserves image interpretability despite a significant reduction in radiation dose.
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Improved evaluation of calcified segments on coronary CT angiography: a feasibility study of coronary calcium subtraction. Int J Cardiovasc Imaging 2013; 29 Suppl 2:75-81. [PMID: 24158235 DOI: 10.1007/s10554-013-0316-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
We explore the feasibility of coronary calcium subtraction computed tomography angiography (CCTA) in patients with high calcium scores using invasive coronary angiography as the gold standard. Eleven patients with calcium scores of >400 underwent CCTA using a subtraction protocol followed by invasive coronary angiography. In addition to standard reconstructions, subtracted images were obtained using a dedicated subtraction algorithm. A total of 55 calcified segments were evaluated for image quality [using a 4-point scale ranging from 1 (uninterpretable) to 4 (good)] and the presence of significant (≥ 50 %) luminal stenosis. Conventional and subtracted CCTA were compared using quantitative coronary angiography (QCA) as the gold standard. The average image quality of conventional CCTA was 2.5 ± 0.6 versus 3.1 ± 0.6 on subtraction CCTA (P < 0.001). The percentage of segments with a score 1 or 2 was reduced from 41.8 to 12.7 % after coronary calcium subtraction (P = 0.002). On QCA, significant stenosis was observed in 16 segments. The area under the receiver operating characteristics curve to detect ≥ 50 % stenosis on QCA increased from 0.741 [95 % confidence interval (CI) 0.598-0.885] for conventional CCTA to 0.905 (95 % CI 0.791-1.000) for subtraction CCTA (P = 0.003). In patients with extensive calcifications undergoing CCTA, coronary calcium subtraction may improve the evaluation of calcified segments.
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Linde JJ, Kofoed KF, Sørgaard M, Kelbæk H, Jensen GB, Nielsen WB, Hove JD. Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain. Int J Cardiol 2013; 168:5257-62. [DOI: 10.1016/j.ijcard.2013.08.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/25/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
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Nance JW, Schoepf UJ, Ebersberger U. The Role of Iterative Reconstruction Techniques in Cardiovascular CT. CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-013-0023-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wuest W, May MS, Scharf M, Layritz C, Eisentopf J, Ropers D, Pflederer T, Uder M, Achenbach S, Lell MM. Stent evaluation in low-dose coronary CT angiography: Effect of different iterative reconstruction settings. J Cardiovasc Comput Tomogr 2013; 7:319-25. [DOI: 10.1016/j.jcct.2013.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 11/30/2022]
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Detection of coronary artery stenosis with sub-milliSievert radiation dose by prospectively ECG-triggered high-pitch spiral CT angiography and iterative reconstruction. Eur Radiol 2013; 23:2927-33. [PMID: 23807568 DOI: 10.1007/s00330-013-2920-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/26/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of sub-milliSievert (mSv) coronary CT angiography (cCTA) using prospectively ECG-triggered high-pitch spiral CT acquisition combined with iterative image reconstruction. METHODS Forty consecutive patients (52.9 ± 8.7 years; 30 men) underwent dual-source cCTA using prospectively ECG-triggered high-pitch spiral acquisition. The tube current-time product was set to 50 % of standard-of-care CT examinations. Images were reconstructed with sinogram-affirmed iterative reconstruction. Image quality was scored and diagnostic performance for detection of ≥50 % stenosis was determined with catheter coronary angiography (CCA) as the reference standard. RESULTS CT was successfully performed in all 40 patients. Of the 601 assessable coronary segments, 543 (90.3 %) had diagnostic image quality. Per-patient sensitivity for detection of ≥50 % stenosis was 95.7 % [95 % confidence interval (CI), 76.0-99.8 %] and specificity was 94.1 % (95 % CI, 69.2-99.7 %). Per-vessel sensitivity was 89.5 % (95 % CI, 77.8-95.6 %) with 93.2 % specificity (95 % CI, 86.0-97.0 %). The area under the receiver-operating characteristic curve on per-patient and per-vessel levels was 0.949 and 0.913. Mean effective dose was 0.58 ± 0.17 mSv. Mean size-specific dose estimate was 3.14 ± 1.15 mGy. CONCLUSIONS High-pitch prospectively ECG-triggered cCTA combined with iterative image reconstruction provides high diagnostic accuracy with a radiation dose below 1 mSv for detection of coronary artery stenosis. KEY POINTS • Cardiac CT with sub-milliSievert radiation dose is feasible in many patients • High-pitch spiral CT acquisition with iterative reconstruction detects coronary stenosis accurately. • Iterative reconstruction increases who can benefit from low-radiation cardiac CT.
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