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Altmann S, Abello Mercado MA, Ucar FA, Kronfeld A, Al-Nawas B, Mukhopadhyay A, Booz C, Brockmann MA, Othman AE. Ultra-High-Resolution CT of the Head and Neck with Deep Learning Reconstruction-Assessment of Image Quality and Radiation Exposure and Intraindividual Comparison with Normal-Resolution CT. Diagnostics (Basel) 2023; 13:diagnostics13091534. [PMID: 37174926 PMCID: PMC10177822 DOI: 10.3390/diagnostics13091534] [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: 03/23/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES To assess the benefits of ultra-high-resolution CT (UHR-CT) with deep learning-based image reconstruction engine (AiCE) regarding image quality and radiation dose and intraindividually compare it to normal-resolution CT (NR-CT). METHODS Forty consecutive patients with head and neck UHR-CT with AiCE for diagnosed head and neck malignancies and available prior NR-CT of a different scanner were retrospectively evaluated. Two readers evaluated subjective image quality using a 5-point Likert scale regarding image noise, image sharpness, artifacts, diagnostic acceptability, and assessability of various anatomic regions. For reproducibility, inter-reader agreement was analyzed. Furthermore, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and slope of the gray-value transition between different tissues were calculated. Radiation dose was evaluated by comparing CTDIvol, DLP, and mean effective dose values. RESULTS UHR-CT with AiCE reconstruction led to significant improvement in subjective (image noise and diagnostic acceptability: p < 0.000; ICC ≥ 0.91) and objective image quality (SNR: p < 0.000; CNR: p < 0.025) at significantly lower radiation doses (NR-CT 2.03 ± 0.14 mSv; UHR-CT 1.45 ± 0.11 mSv; p < 0.0001) compared to NR-CT. CONCLUSIONS Compared to NR-CT, UHR-CT combined with AiCE provides superior image quality at a markedly lower radiation dose. With improved soft tissue assessment and potentially improved tumor detection, UHR-CT may add further value to the role of CT in the assessment of head and neck pathologies.
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Affiliation(s)
- Sebastian Altmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Mario A Abello Mercado
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Felix A Ucar
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Andrea Kronfeld
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Anirban Mukhopadhyay
- Department of Computer Science, Technical University of Darmstadt, Fraunhoferst. 5, 64283 Darmstadt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Clinic Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany
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Feasibility of Ultra-High Resolution Supra-Aortic CT Angiography: An Assessment of Diagnostic Image Quality and Radiation Dose. Tomography 2021; 7:711-720. [PMID: 34842838 PMCID: PMC8628996 DOI: 10.3390/tomography7040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To evaluate diagnostic image quality and radiation exposure of ultra-high resolution cerebral Computed-Tomography (CT) angiography (CTA) obtained on an ultra-high resolution computed tomography scanner (UHR-CT). (2) Methods: Fifty consecutive patients with UHR-CTA were enrolled. Image reconstruction was processed with a 1024 × 1024 matrix and a slice thickness of 0.25 mm. Quantitative analyses comprising CT values, contrast-noise ratio (CNR) and signal-to-noise ratio (SNR) were performed. Subjective assessment of image quality, vessel contrast, noise, artefacts and delineation of different sized vessels were assessed by two readers on a 4-point scale. Radiation exposure was determined. (3) Results: Hounsfield values (ACI: 461.8 ± 16.8 HU; MCA: 406.1 ± 24.2 HU; BA: 412.2 ± 22.3 HU), SNR (ACI: 35.4 ± 13.1; MCA: 20.8 ± 12.4; BA: 23.7 ± 12.9) and CNR (ACI: 48.7 ± 21; MCA: 63.9 ± 26.9; BA: 48.1 ± 21.4) were remarkably high in all segments. Subjective analysis by two raters (fair agreement, k = 0.26) indicated excellent image qualities (image quality = 4; contrast = 4; noise = 3; artefacts = 4).Our analysis revealed a notably high traceability of the cerebral perforators (3 Points). Radiation exposure was at moderate dose levels (effective dose = 2.5 ± 0.6mSv). (4) Conclusions: UHR-CTA generates highly valuable image qualities that allow the depiction of vessels including cerebral perforators at acceptable dose levels. The UHR-CTA may therefore enhance the detection of small cerebral pathologies and may improve interpretability, especially in settings where high image qualities are crucial for the diagnostic accuracy.
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Vimala LR, Eifer DA, Karimzad Y, Paul NS. Prospective Clinical Trial Comparing IV Esmolol to IV Metoprolol in CT Coronary Angiography: Effect on Hemodynamic, Technical Parameters and Cost. Can Assoc Radiol J 2021; 73:240-248. [PMID: 34293933 DOI: 10.1177/08465371211023947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intravenous [IV] esmolol, an alternative to IV metoprolol for coronary computed tomography angiography [CCTA], has shorter half-life that decreases the risk of prolonged hypotension. The primary aim was to prospectively compare IV esmolol alone to IV metoprolol alone for effectiveness in achieving heart rate [HR] of 60 beats per minute[bpm] during CCTA. The secondary aim was to compare hemodynamic response, image quality, radiation dose and cost. MATERIALS AND METHODS Institutional Review Board approved prospective randomized study of 28 CCTA patients medicated in a 1:1 blinded match with IV esmolol or IV metoprolol to achieve HR of 60 bpm. Serial hemodynamic response was measured at 6 specified times. Two cardiac radiologists independently scored the image quality. RESULTS Both IV esmolol and IV metoprolol achieved the target HR. IV esmolol resulted in significantly less profound and shorter duration of reduction in systolic blood pressure [BP] than IV metoprolol with a difference of -10, -14 and -9 mm Hg compared to -20, -26 and -25 mmHg at 2, 15 & 30 min respectively. No significant difference in HR at image acquisition, exposure window, radiation dose and image quality. Although IV esmolol was expensive, the overall cost of care was comparable to IV metoprolol due to shortened post CCTA observation period consequent to faster restoration of hemodynamic status. CONCLUSION Comparison of IV esmolol and IV metoprolol demonstrate that both are effective in achieving the target HR but significantly faster recovery of HR and BP in patients who receive IV esmolol was found.
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Affiliation(s)
- Leena Robinson Vimala
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada.,Department of Medical Imaging, London Health Sciences Centre, University Hospital, London, United Kingdom
| | - Diego Andre Eifer
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
| | - Yasser Karimzad
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
| | - Narinder S Paul
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada.,Department of Medical Imaging, London Health Sciences Centre, University Hospital, London, United Kingdom
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Zhang L, Chen YF, Che YX, Xu YF, Zheng J, Yu SJ. The impact of adaptive iterative dose reduction 3D on the improvement of shoulder image quality in head and neck CTA. Curr Med Res Opin 2019; 35:887-891. [PMID: 30366505 DOI: 10.1080/03007995.2018.1541446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to determine the impact of adaptive iterative dose reduction 3 D (AIDR3D) on the improvement of shoulder image quality in low-radiographic dose head and neck CT angiography (CTA). MATERIALS AND METHODS Ninety patients who underwent CTA examination were randomly divided into two groups, namely group A (n = 45) and B (n = 45). Patients in group A were scanned under 120 kV and 300 mA, with images reconstructed by filtered back projection (FBP), and patients in group B were scanned under 80 kV and auto mA with images reconstructed by AIDR3D. Image quality was accessed by two experienced radiologists. The noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of common carotid artery (CCA) at C7 level, and radiation dosage were compared between the two groups. RESULTS The score of CCA in group B was significantly higher than group A (p < 0.05), and there were no significant differences in the scores of carotid sinus and internal carotid artery between the two groups (p > 0.05). The score of intracranial artery in group B was lower than that of group A, however, the image quality in group B can meet the requirement of clinical diagnosis. The noise value of CCA at C7 level in group B was significantly lower than that of group A (p < 0.05). SNR and CNR values of CCA at C7 level in group B were significantly higher than those of group A (p < 0.05). Effective radiation dose in group B was significantly decreased compared with group A (p < 0.05). CONCLUSION AIDR3D remarkably improved image quality in low-radiographic dose head and neck CTA over FBP, which made the low-dose CTA images meet the requirement of clinical diagnosis.
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Affiliation(s)
- Li Zhang
- a Department of CT Diagnosis , Cangzhou Central Hospital , Cangzhou , Hebei 061001 , PR China
| | - Yue-Feng Chen
- a Department of CT Diagnosis , Cangzhou Central Hospital , Cangzhou , Hebei 061001 , PR China
| | - Yan-Xu Che
- a Department of CT Diagnosis , Cangzhou Central Hospital , Cangzhou , Hebei 061001 , PR China
| | - Yan-Feng Xu
- a Department of CT Diagnosis , Cangzhou Central Hospital , Cangzhou , Hebei 061001 , PR China
| | - Jing Zheng
- a Department of CT Diagnosis , Cangzhou Central Hospital , Cangzhou , Hebei 061001 , PR China
| | - Shu-Jing Yu
- a Department of CT Diagnosis , Cangzhou Central Hospital , Cangzhou , Hebei 061001 , PR China
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Richards CE, Dorman S, John P, Davies A, Evans S, Ninan T, Martin D, Kannoly S, Roberts-Davies G, Ramsey M, Obaid DR. Low-radiation and high image quality coronary computed tomography angiography in “real-world” unselected patients. World J Radiol 2018; 10:135-142. [PMID: 30386498 PMCID: PMC6205842 DOI: 10.4329/wjr.v10.i10.135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/14/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the radiation dose and image quality in coronary computed tomography angiography (CCTA) using state-of-the-art dose reduction methods in unselected “real world” patients.
METHODS In this single-centre study, consecutive patients in sinus rhythm underwent CCTA for suspected coronary artery disease (CAD) using a 320-row detector CT scanner. All patients underwent the standard CT acquisition protocol at our institute (Morriston Hospital) a combination of dose saving advances including prospective electrocardiogram-gating, automated tube current modulation, tube voltage reduction, heart rate reduction, and the most recent novel adaptive iterative dose reconstruction 3D (AIDR3D) algorithm. The cohort comprised real-world patients for routine CCTA who were not selected on age, body mass index, or heart rate. Subjective image quality was graded on a 4-point scale (4 = excellent, 1 = non-diagnostic).
RESULTS A total of 543 patients were included in the study with a mean body weight of 81 ± 18 kg and a pre-scan mean heart rate of 70 ± 11 beats per minute (bpm). When indicated, patients received rate-limiting medication with an oral beta-blocker followed by additional intravenous beta-blocker to achieve a heart rate below 65 bpm. The median effective radiation dose was 0.88 mSv (IQR, 0.6-1.4 mSv) derived from a Dose Length Product of 61.45 mGy.cm (IQR, 42.86-100.00 mGy.cm). This also includes what we believe to be the lowest ever-reported radiation dose for a routine clinical CCTA (0.18 mSv). The mean image quality (± SD) was 3.65 ± 0.61, with a subjective image quality score of 3 (“good”) or above for 93% of patient CCTAs.
CONCLUSION Combining a low-dose scan protocol and AIDR3D with a 320-detector row CT scanner can provide high quality images at exceptionally low radiation dose in unselected patients being investigated for CAD.
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Affiliation(s)
- Caryl Elizabeth Richards
- Swansea University Medical School, Swansea University, Grove Building, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
| | - Stephen Dorman
- Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom
| | - Patricia John
- Department of Radiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom
| | - Anthony Davies
- Department of Radiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom
| | - Sharon Evans
- Department of Radiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom
| | - Tishi Ninan
- Department of Radiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom
| | - David Martin
- Department of Radiology, Singleton Hospital, Sketty Ln, Sketty, Swansea SA2 8QA, United Kingdom
| | - Sriranj Kannoly
- Department of Cardiology, Singleton Hospital, Sketty Ln, Sketty, Swansea SA2 8QA, United Kingdom
| | - Gail Roberts-Davies
- Department of Radiology, Singleton Hospital, Sketty Ln, Sketty, Swansea SA2 8QA, United Kingdom
| | - Mark Ramsey
- Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom
| | - Daniel Rhys Obaid
- Swansea University Medical School, Swansea University, Grove Building, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
- Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea SA6 6NL, United Kingdom
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Feger S, Kendziorra C, Lukas S, Shaban A, Bokelmann B, Zimmermann E, Rief M, Dewey M. Effect of iterative reconstruction and temporal averaging on contour sharpness in dynamic myocardial CT perfusion: Sub-analysis of the prospective 4D CT perfusion pilot study. PLoS One 2018; 13:e0205922. [PMID: 30325969 PMCID: PMC6191149 DOI: 10.1371/journal.pone.0205922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose Myocardial computed tomography perfusion (CTP) allows the assessment of the functional relevance of coronary artery stenosis. This study investigates to what extent the contour sharpness of sequences acquired by dynamic myocardial CTP is influenced by the following noise reduction methods: temporal averaging and adaptive iterative dose reduction 3D (AIDR 3D). Materials and methods Dynamic myocardial CT perfusion was conducted in 29 patients at a dose level of 9.5±2.0 mSv and was reconstructed with both filtered back projection (FBP) and strong levels of AIDR 3D. Temporal averaging to reduce noise was performed as a post-processing step by combining two, three, four, six and eight original consecutive 3D datasets. We evaluated the contour sharpness at four distinct edges of the left-ventricular myocardium based on two different approaches: the distance between 25% and 75% of the maximal grey value (d) and the slope in the contour (m). Results Iterative reconstruction reduced contour sharpness: both measures of contour sharpness performed better for FBP than for AIDR 3D (d = 1.7±0.4 mm versus 2.0±0.5 mm, p>0.059 at all edges; m = 255.9±123.9 HU/mm versus 160.6±123.5 HU/mm; p<0.023 for all edges). Increasing levels of temporal averaging degraded contour sharpness. When FBP reconstruction was applied, contour sharpness was best without temporal averaging (d = 1.7±0.4 mm, m = 255.9±123.9 HU/mm) and poorest for the strongest levels of temporal averaging (d = 2.1±0.3 mm, m = 142.2±104.9 HU/mm; comparison between lowest and highest temporal averaging level: for d p>0.052 at all edges and for m p<0.001 at all edges). Conclusion The use of both temporal averaging and iterative reconstruction degrades objective contour sharpness parameters of dynamic myocardial CTP. Thus, further advances in image processing are needed to optimise contour sharpness of 4D myocardial CTP.
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Affiliation(s)
- Sarah Feger
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Carsten Kendziorra
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Lukas
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmed Shaban
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Björn Bokelmann
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Zimmermann
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
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Dual-Energy Computed Tomography Angiography of the Head and Neck With Single-Source Computed Tomography. Invest Radiol 2016; 51:618-23. [DOI: 10.1097/rli.0000000000000290] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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