Low-dose CT coronary angiography using iterative reconstruction with a 256-slice CT scanner

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.

Computer-Aided Detection of Colorectal Lesions with Super-Resolution CT Colonography: Pilot Evaluation

Reliable computer-aided detection (CADe) of small polyps and flat lesions is limited by the relatively low image resolution of computed tomographic colonography (CTC). We developed a sinogram-based super-resolution (SR) method to enhance the images of lesion candidates detected by CADe. First, CADe is used to detect lesion candidates at high sensitivity from conventional CTC images. Next, the signal patterns of the lesion candidates are enhanced in sinogram domain by use of non-uniform compressive sampling and iterative reconstruction to produce SR images of the lesion candidates. For pilot evaluation, an anthropomorphic phantom including simulated lesions was filled partially with fecal tagging and scanned by use of a CT scanner. A fully automated CADe scheme was used to detect lesion candidates in the images reconstructed at conventional 0.61-mm and at 0.10-mm SR image resolution. The proof-of-concept results indicate that the SR method has potential to reduce the number of FP CADe detections below that obtainable with the conventional CTC imaging technology.

80-kVp CT using Iterative Reconstruction in Image Space algorithm for the detection of hypervascular hepatocellular carcinoma: phantom and initial clinical experience

Objective

To investigate whether the low-tube-voltage (80-kVp), intermediate-tube-current (340-mAs) MDCT using the Iterative Reconstruction in Image Space (IRIS) algorithm improves lesion-to-liver contrast at reduced radiation dosage while maintaining acceptable image noise in the detection of hepatocellular carcinomas (HCC) in thin (mean body mass index, 24 ± 0.4 kg/m²) adults.

Subjects and Methods

A phantom simulating the liver with HCC was scanned at 50-400 mAs for 80, 100, 120 and 140-kVp. In addition, fifty patients with HCC who underwent multiphasic liver CT using dual-energy (80-kVp and 140-kVp) arterial scans were enrolled. Virtual 120-kVP scans (protocol A) and 80-kVp scans (protocol B) of the late arterial phase were reconstructed with filtered back-projection (FBP), while corresponding 80-kVp scans were reconstructed with IRIS (protocol C). Contrast-to-noise ratio (CNR) of HCCs and abdominal organs were assessed quantitatively, whereas lesion conspicuity, image noise, and overall image quality were assessed qualitatively.

Results

IRIS effectively reduced image noise, and yielded 29% higher CNR than the FBP at equivalent tube voltage and current in the phantom study. In the quantitative patient study, protocol C helped improve CNR by 51% and 172% than protocols A and B (p < 0.001), respectively, at equivalent radiation dosage. In the qualitative study, protocol C acquired the highest score for lesion conspicuity albeit with an inferior score to protocol A for overall image quality (p < 0.001). Mean effective dose was 2.63-mSv with protocol A and 1.12-mSv with protocols B and C.

Conclusion

CT using the low-tube-voltage, intermediate-tube-current and IRIS help improve lesion-to-liver CNR of HCC in thin adults during the arterial phase at a lower radiation dose when compared with the standard technique using 120-kVp and FBP.

Estimation of 6-Degree-of-Freedom (6-DOF) Rigid-Body Patient Motion From Projection Data by the Principal-Axes Method in Iterative Reconstruction

We developed a unique method for estimating and compensating rigid-body translations and rotations from scatter and-attenuation-compensated projection data in iterative reconstruction when multiple projection angles are acquired at the same time. During reconstruction, both the non-attenuated and attenuated line-integrals are calculated. Their ratios are then multiplied to the scatter-corrected projection data to estimate scatter-and-attenuation- compensated projection data. At the end of each iteration, the sets of compensated projection data for the angles acquired at the same time are employed to calculate the center-of mass and the inertia tensor, which are used to estimate the location and orientation of the imaging object by the principle-axes method. The estimated motion is applied in the next iteration to reposition the estimated slices and attenuation map in the projector and back-projector to match the pose of the patient at time the projections were acquired. To evaluate our method, we simulated an acquisition of the MCAT phantom with a 3-head SPECT system and imaged the Data Spectrum anthropomorphic phantom on a 3-head IRIX SPECT system. In simulations the phantom translated and rotated by the same amount 9 times. A numerical projector modeling the motion, attenuation, and distance-dependent blurring was used to generate the projection data. Poisson noise was added and 30 noise-realizations were generated. In the experiment with the anthropomorphic phantom, four 360-degree acquisitions were performed with the phantom translated or rotated beforehand. A motion-present dataset was made by mixing the 4 acquisitions. For both the MCAT phantom simulations and anthropomorphic phantom experiment, the motion-present data were reconstructed with 10 iterations of the OSEM which estimates and corrects the motion as described above. Our method obtained visually artifact-free reconstructions, while the reconstruction with no motion correction showed severe artifacts. The motion estimated from our method was in good agreement with the motion simulated. We determined in MCAT simulated and actual phantom acquisitions that our data-driven approach was effective reducing motion artifacts.