Image quality of ct angiography using model-based iterative reconstruction in infants with congenital heart disease: Comparison with filtered back projection and hybrid iterative reconstruction

Coronary CT angiography: First comparison of model-based and hybrid iterative reconstruction with the reference standard invasive catheter angiography for CAD-RADS reporting

Background

The purpose of this study was to compare CCTA images generated using HIR and IMR algorithm with the reference standard ICA, and to determine to what extend further improvements of IMR over HIR can be expected.

Methods

This retrospective study included 60 patients with low to intermediate CAD risk, who underwent coronary CTA (with HIR and IMR) and ICA. ICA was used as reference standard. Two independent and blinded readers evaluated 2226 segments, classifying stenosis with CAD-RADS (significant stenosis ≥3). Image quality was assessed with a 5-point scale, SNR in the ascending aorta, and FWHM of proximal LCA calibers. The impact of image noise, radiation dose, and BMI on diagnostic accuracy was evaluated using ROC curves and Fisher's Exact Test. Quantitative plaque analysis was performed on 28 plaques.

Results

IMR showed higher image quality than HIR (IMR 4.4, HIR 3.97, p<0.001) with better SNR (21.4 vs. 13.28, p<0.001) and FWHM (4.44 vs. 4.55, p=0.003). IMR had better diagnostic accuracy (ROC AUC 0.967 vs. 0.948, p=0.16, performed better at higher radiation doses (p=0.02) and showed a larger minimum lumen area (p=0.022 and p=0.046).

Conclusion

IMR offers significantly superior image quality of CCTA, more precise measurements, and a stronger positive correlation with ICA. The overall diagnostic accuracy may be superior with IMR, although the differences were not statistically significant. However, in patients who are exposed to higher radiation doses during CCTA due to their constitution, IMR enables significantly better diagnostic accuracy than HIR thus providing a specific benefit for obese patients.

Contrast-Enhanced CT Protocol for the Fontan Pathway: Comparison Between 1- and 3-Minute Scan Delays

Optimal enhancement of the Fontan pathway is crucial for the accurate CT evaluation. Current guidelines for contrast-enhanced CT protocols are rather inconsistent in scan delays and injection methods. This single-center, retrospective study was performed to compare objective measures of contrast enhancement between 1- and 3-min scan delays (41 and 36 patients, respectively) to determine a better contrast-enhanced CT protocols for evaluating the Fontan pathway. In both groups, a biphasic injection protocol, in which 50% diluted contrast agent (the amount of iodinated contrast agent: 2.0 mL/kg; the amount of saline: 2.0 mL/kg) was injected at the injection rate of 0.5‒2.5 mL/s for 50 s followed by a saline flush at the same injection rate (0.5‒2.5 mL/s), was used. The degree and heterogeneity of cardiovascular enhancement, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantitatively evaluated. The mean densities of all cardiovascular structures were significantly higher in the 1-min delay protocol than in the 3-min delay protocols (p < 0.001). Heterogeneous enhancement (normalized standard deviation > 0.70) in the Fontan pathway was significantly more frequent in the 1-min delay protocol (p < 0.001). No significant differences were found in image noise (p > 0.141) and the frequency showing suboptimal noise (p = 1.000) between the two protocols. SNR and CNR were significantly lower in the 3-min delay protocol (p < 0.001). Compared with the 1-min delay protocol, the 3-min delay protocol achieved more homogeneous enhancement in the Fontan pathway on CT but showed lower contrast enhancement, SNR, and, CNR, indicating the need for further improvement.

Application of low-dose CT combined with model-based iterative reconstruction algorithm in oncologic patients during follow-up: dose reduction and image quality

OBJECTIVES

To compare image quality and radiation dose of CT images reconstructed with model-based iterative reconstruction (MBIR) and hybrid-iterative (HIR) algorithm in oncologic patients.

METHODS

125 oncologic patients underwent both contrast-enhanced low- (100 kV), and standard (120 kV) dose CT, were enrolled. Image quality was assessed by using a 4-point Likert scale. CT attenuation values, expressed in Hounsfield unit (HU), were recorded within a regions of interest (ROI) of liver, spleen, paraspinal muscle, aortic lumen, and subcutaneous fat tissue. Image noise, expressed as standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated. Radiation dose were analyzed. Paired Student's t-test was used to compare all continuous variables.

RESULTS

The overall median score assessed as image quality for CT images with the MBIR algorithm was significantly higher in comparison with HIR [4 (range 3-4) vs 3 (3-4), p = 0.017].CT attenuation values and SD were significantly higher and lower, respectively, in all anatomic districts in images reconstructed with MBIR in comparison with HIR ones (all p < 0.001). SNR and CNR values were higher in CT images reconstructed with MBIR, reaching a significant difference in all districts (all p < 0.001). Radiation dose were significantly lower in the MBIR group compared with the HIR group (p < 0.001).

CONCLUSIONS

MBIR combined with low-kV setting allows an important dose reduction in whole-body CT imaging, reaching a better image quality both qualitatively and quantitatively.

ADVANCES IN KNOWLEDGE

MBIR with low-dose approach allows a reduction of dose exposure, maintaining high image quality, especially in patients which deserve a longlasting follow-up.

Forward-projected Model-based Iterative Reconstruction SoluTion in Temporal Bone Computed Tomography: A Comparison Study of All Reconstruction Modes

OBJECTIVE

Identify appropriate reconstruction modes of Forward-projected model-based Iterative Reconstruction SoluTion (FIRST) in temporal bone computed tomography (CT) and investigate the contribution of spatial resolution and noise to the visual assessment.

METHODS

Sixteen temporal bone CT images were reconstructed. Two blinded radiologists assessed 8 anatomical structures and classified the visual assessment. These visual scores were compared across reconstruction modes among each anatomical structure. Visual scores and contrast-to-noise ratio, noise power spectrum (NPS) at low (NPSLow) and high (NPSHigh) spatial frequencies, and 50% modulation transfer function relationships were evaluated.

RESULTS

Visual scores differed significantly for the stapedius muscle and osseous spiral lamina, with CARDIAC SHARP, BONE, and LUNG modes for the osseous spiral lamina scoring highest. Visual scores significantly positively correlated with NPSLow, NPSHigh, and 50% modulation transfer function but negatively with contrast-to-noise ratio.

CONCLUSIONS

Modes providing higher spatial resolution and lower noise reduction showed an improved visual assessment of CT images reconstructed with FIRST.

Evaluating the severity of aortic coarctation in infants using anatomic features measured on CTA

OBJECTIVES

A machine learning model was developed to evaluate the severity of aortic coarctation (CoA) in infants based on anatomical features measured on CTA.

METHODS

In total, 239 infant patients undergoing both thorax CTA and echocardiography were retrospectively reviewed. The patients were assigned to either mild or severe CoA group based on their pressure gradient on echocardiography. They were further divided into patent ductus arteriosus (PDA) and non-PDA groups. The anatomical features were measured on double-oblique multiplanar reconstructed CTA images. Then, the optimal features were identified by using the Boruta algorithm. Subsequently, the coarctation severity was classified using linear discriminant analysis (LDA). We further investigated the relationship between the anatomical features and re-coarctation using Cox regression.

RESULTS

Four anatomical features showed significant differences between the mild and severe CoA groups, including the smallest aortic cross-sectional area indexed to body surface area (p < 0.001), the narrowest aortic diameter (CoA diameter) indexed to height (p < 0.001), the diameter of the descending aorta at the diaphragmatic level (p < 0.001) and weight (p = 0.005). With these features, accuracy of 88.6% and 90.2%, sensitivity of 65.0% and 72.1%, and specificity of 92.9% and 100% were obtained for classifying the CoA severity in the non-PDA and PDA groups, respectively. Moreover, CoA diameter indexed to weight was associated with the risk of re-coarctation.

CONCLUSIONS

CoA severity can be evaluated by using LDA with anatomical features. When quantifying the severity of CoA and risk of re-coarctation, both anatomical alternations at the CoA site and the growth of the patients need to be considered.

KEY POINTS

• CTA is routinely ordered for infants with coarctation of the aorta; however, whether anatomical variations observed with CTA could be used to assess the severity of CoA remains unknown. • Using the diameter and area of the coarctation site adjusted to body growth as features, the LDA model achieved an accuracy of 88.6% and 90.2% in differentiating between the mild and severe CoA patients in the non-PDA group and PDA group, respectively. • The narrowest aortic diameter (CoA diameter) indexed to weight has a hazard ratio of 10.29 for re-coarctation.

User-Friendly Vendor-Specific Guideline for Pediatric Cardiothoracic Computed Tomography Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 1. Imaging Techniques

Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challenging and may need different approaches for different types of CT scanners. To meet the technical demands and improve clinical standards, a practical, user-friendly, and vendor-specific guideline for pediatric cardiothoracic CT needs to be developed for children with congenital heart disease (CHD). In this article, we have attempted to describe such guideline based on the consensus of experts in the Asian Society of Cardiovascular Imaging CHD Study Group. This first part describes the imaging techniques of pediatric cardiothoracic CT, and it includes recommendations for patient preparation, scan techniques, radiation dose, intravenous injection protocol, post-processing, and vendor-specific protocols.

Evaluation of the depiction ability of the microanatomy of the temporal bone in quarter-detector CT: Model-based iterative reconstruction vs hybrid iterative reconstruction

Little is known regarding differences between model-based iterative reconstruction (MBIR) and hybrid iterative reconstruction (HIR) in temporal bone computed tomography (CT). This study compared the ability to depict microstructures in temporal bone in quarter-detector CT (QDCT) between MBIR and HIR.Sixty-two temporal bones in 31 consecutive adult patients who underwent QDCT were included. Reconstruction was performed with Forward projected model-based Iterative Reconstruction SoluTion (FIRST) BONE mild mode and Adaptive Iterative Dose Reduction 3D (AIDR3D) enhanced mild mode. Imaging quality was graded for 3 microstructures (spiral osseous lamina, tympanic membrane, and singular canal).Spiral osseous lamina was significantly well-delineated in the AIDR3D enhanced group, compared with the FIRST group. In nearly all cases with FIRST, spiral osseous lamina was poorly defined. Although there was no significant difference, depiction of the tympanic membrane and singular canal tended to be better with AIDR3D enhanced mode.Routine reconstruction for preoperative temporal bone CT should be performed with HIR, rather than MBIR.

Radiation dose management for pediatric cardiac computed tomography: a report from the Image Gently 'Have-A-Heart' campaign

Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease.

Assessment of transposition of the great arteries associated with multiple malformations using dual-source computed tomography

Purpose

To determine the value of dual-source computed tomography (DSCT) in depicting the morphological characteristics and diagnosing the associated malformations for patients with transposition of the great arteries (TGA) before surgery.

Materials and methods

Twenty-five patients with TGA who underwent DSCT and transthoracic echocardiography (TTE) examination were retrospectively reviewed. The morphological types of TGA, the spatial relationship between the pulmonary artery and the aorta, as well as coronary artery-associated abnormalities were assessed by DSCT. In contrast to TTE, the diagnostic accuracy of associated malformations on DSCT were analyzed and calculated with reference to surgical or digital subtraction angiography (DSA) findings. Effective doses (EDs) were also calculated.

Results

Among the 25 patients, 12 (48%) had ventricular septal defects and left ventricular outflow tract stenosis. Sixteen patients (16/25, 64%) had great arteries with an oblique spatial relationship on DSCT. In addition, we found seven patients (7/25, 28%) with coronary artery malformation, including five with an abnormal coronary origin and two with signs of a myocardial bridge. According to DSA or surgical findings, DSCT was superior to TTE in demonstrating extracardiac anomalies (sensitivity, anomalies of great vessels: 100% vs. 93.33%, other anomalies: 100% vs. 46.15%). The mean estimated ED for those aged <10 years was <2 mSv (1.59 ± 0.95 mSv).

Conclusions

DSCT can achieve an overall assessment of patients with TGA, including any associated malformations as well as the identification of the spatial relationship of the great arteries. DSCT can therefore be considered as an alternative imaging modality for surgical decision making.

The role of advanced reconstruction algorithms in cardiac CT

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.