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Du H, Sui X, Zhao R, Wang J, Ming Y, Piao S, Wang J, Ma Z, Wang Y, Song L, Song W. A comparative analysis of deep learning and hybrid iterative reconstruction algorithms with contrast-enhancement-boost post-processing on the image quality of indirect computed tomography venography of the lower extremities. BMC Med Imaging 2024; 24:163. [PMID: 38956583 PMCID: PMC11218076 DOI: 10.1186/s12880-024-01342-0] [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: 03/15/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE To examine whether there is a significant difference in image quality between the deep learning reconstruction (DLR [AiCE, Advanced Intelligent Clear-IQ Engine]) and hybrid iterative reconstruction (HIR [AIDR 3D, adaptive iterative dose reduction three dimensional]) algorithms on the conventional enhanced and CE-boost (contrast-enhancement-boost) images of indirect computed tomography venography (CTV) of lower extremities. MATERIALS AND METHODS In this retrospective study, seventy patients who underwent CTV from June 2021 to October 2022 to assess deep vein thrombosis and varicose veins were included. Unenhanced and enhanced images were reconstructed for AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images were obtained using subtraction software. Objective and subjective image qualities were assessed, and radiation doses were recorded. RESULTS The CT values of the inferior vena cava (IVC), femoral vein ( FV), and popliteal vein (PV) in the CE-boost images were approximately 1.3 (1.31-1.36) times higher than in those of the enhanced images. There were no significant differences in mean CT values of IVC, FV, and PV between AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images. Noise in AiCE, AiCE-boost images was significantly lower than in AIDR 3D and AIDR 3D-boost images ( P < 0.05). The SNR (signal-to-noise ratio), CNR (contrast-to-noise ratio), and subjective scores of AiCE-boost images were the highest among 4 groups, surpassing AiCE, AIDR 3D, and AIDR 3D-boost images (all P < 0.05). CONCLUSION In indirect CTV of the lower extremities images, DLR with the CE-boost technique could decrease the image noise and improve the CT values, SNR, CNR, and subjective image scores. AiCE-boost images received the highest subjective image quality score and were more readily accepted by radiologists.
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Affiliation(s)
- Huayang Du
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xin Sui
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Ruijie Zhao
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jiaru Wang
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Ying Ming
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Sirong Piao
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jinhua Wang
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhuangfei Ma
- Canon Medical Systems (China), No.3, Xinyuan South Road, Chaoyang District, Beijing, 100027, China
| | - Yun Wang
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Lan Song
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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Zhou X, Cui M, Liu Y, Wu Y, Hu D, Zhai D, Qin M, Shen J, Ju S, Fan G, Cai W. Low Dose Iodinated Contrast Material and Radiation for Virtual Monochromatic Imaging in Craniocervical Dual-Layer Spectral Detector Computed Tomography Angiography: A Prospective and Randomized Study. Acad Radiol 2024; 31:2501-2510. [PMID: 38135625 DOI: 10.1016/j.acra.2023.12.004] [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: 10/05/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of virtual monochromatic imaging (VMI) of dual-layer spectral detector computed tomography (SDCT) to reduce iodinated contrast material (CM) and radiation dose in craniocervical computed tomography angiography (CTA). MATERIALS AND METHODS A total of 280 consecutively selected patients performed craniocervical CTA with SDCT were prospectively selected and randomly divided into four groups (A, DoseRight index (DRI) 31, iopromide 370mgI/mL, volume 0.8 mL/kg; B, DRI 26, iopromide 370mgI/mL, volume 0.4 mL/kg; C, DRI 26, ioversol 320mgI/mL, volume 0.4 mL/kg; D, DRI 26, iohexol 300mgI/mL, volume 0.4 mL/kg). 50-70 kiloelectron volts (keV) VMIs in group B were reconstructed and compared to group A to select the optimal keV. Then, the optimal keV in groups B, C and D was reconstructed and compared. Objective image quality, including vascular attenuation, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), was evaluated. Subjective image quality was assessed using a 5-point Likert scale. In addition, the effective dose (ED), iodine load and iodine delivery rate (IDR) were compared between groups A and D. RESULTS 55 keV VMI was the optimal VMI in group B. The objective and subjective image quality of 55 keV VMI in group B were equal to or better than those of the CI in group A. The SNR, CNR and subjective image quality in group D were similar to those in group B (P > 0.05). The ED, iodine load and IDR of group D were reduced by 44%, 59% and 19%, respectively, when compared to those of group A. CONCLUSION Low dose iodinated CM and radiation for 55 keV VMI in craniocervical CTA using SDCT could still provide equivalent or better image quality than the conventional scanning protocol.
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Affiliation(s)
- Xiuzhi Zhou
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Manman Cui
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Yan Liu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Yuanyuan Wu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Dongliang Hu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Duchang Zhai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Mingyu Qin
- Suzhou Medical College of Soochow University, Suzhou, 215026, Jiangsu, China (M.Q.)
| | - Junkang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, Jiangsu, China (S.J.)
| | - Guohua Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.)
| | - Wu Cai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.).
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Leng Y, Liu Y, Li S, Wang X, Deng W, Wang Y, Gong L. Feasibility of using 8 mL of iodinated contrast media in cerebral computed tomographic angiography with a dual-layer spectral detector. Quant Imaging Med Surg 2024; 14:514-526. [PMID: 38223031 PMCID: PMC10784050 DOI: 10.21037/qims-23-914] [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: 06/24/2023] [Accepted: 10/24/2023] [Indexed: 01/16/2024]
Abstract
Background Virtual monoenergetic images (VMIs) at a low energy level can improve image quality when the amount of iodinated contrast media (CM) is reduced. The purpose was to evaluate the feasibility of using an extremely low CM volume and injection rate in cerebral computed tomography angiography (CTA) on a dual-layer spectral detector computed tomography (CT). Methods Patients who were clinically suspected of intracranial aneurysm or cerebrovascular diseases were included in our study (from June to November 2022). In this prospective study, 80 patients were randomly enrolled into group A (8 mL of CM with a 1-mL/s flow rate) or group B (40 mL of CM with 4-mL/s flow rate). The VMIs at 40-70 keV in group A and polychromatic conventional images in the 2 groups were reconstructed. CT attenuation, image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were evaluated via the t-test or Mann-Whitney test (2 groups), while analysis of variance or Kruskal-Wallis test (multiple groups). Subjective image quality was assessed on a 5-point scale. Results In group A, the subjective image quality score, CT attenuation, and CNR of the internal carotid artery (ICA) and middle cerebral artery (MCA) were the highest on VMIs at 40 keV. The image noise on VMIs at 40 keV was 5.08±0.84 Hounsfield units. The subjective image quality score, CT value of the ICA, MCA, and cerebral parenchyma on VMIs at 40 keV in group A were similar to those in group B (all P values >0.05). Compared to those in group B, the VMIs at 40 keV in group A demonstrated a significantly higher mean SNR and CNR of the ICA (mean SNR: 46.22±20.18 vs. 34.32±12.40, P=0.002; CNR: 55.47±13.43 vs. 46.18±12.30, P=0.002) and MCA [SNR: 13.66 (9.78, 20.29) vs. 9.99 (7.53, 14.00), P=0.003; CNR: 47.00±12.71 vs. 39.45±10.47, P=0.005]. Conclusions Cerebral CTA on VMIs at 40 keV with 8 mL of CM and a 1-mL/s injection rate can provide diagnostic image quality.
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Affiliation(s)
- Yinping Leng
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ying Liu
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuhao Li
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiwen Wang
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weiwei Deng
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Lianggeng Gong
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
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Zhou XZ, Lu K, Zhai DC, Cui MM, Liu Y, Wang TT, Shi D, Fan GH, Ju SH, Cai W. The image quality and diagnostic performance of CT perfusion-derived CT angiography versus that of conventional CT angiography. Quant Imaging Med Surg 2023; 13:7294-7303. [PMID: 37869348 PMCID: PMC10585561 DOI: 10.21037/qims-22-988] [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: 09/19/2022] [Accepted: 07/07/2023] [Indexed: 10/24/2023]
Abstract
Background The combination of computed tomography angiography (CTA) and computed tomography perfusion (CTP) evaluation of cerebral perfusion status and vascular conditions can improve the diagnostic accuracy of infarction, ischemia, and vascular occlusion in stroke patients, as well as a comprehensive assessment of cerebral edema, collateral circulation, and blood perfusion in the lesion area. However, the consequent radiation safety and contrast agent nephropathy have aroused increasing concern. The purpose of this study was to assess the image quality and diagnostic accuracy of CTA images derived from CTP data, and to explore the feasibility of replacing conventional CTA. Methods A total of 31 consecutive patients with suspected acute ischemic stroke were retrospectively analyzed. All patients underwent head and neck CTA and brain CTP examinations. All the CTP images were transmitted to the ShuKun artificial intelligence system, which reconstructs CTA derived from CTP (CTA-DF-CTP). The images were divided into 2 groups, including CTA-DF-CTP (Group A) and conventional CTA (Group B). The CT attenuation values, subjective image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), image quality, CT volume dose index (CTDIvol), dose length product (DLP), and effective radiation dose (ED) were compared between the 2 groups. Moreover, the consistency of vascular stenosis and stenosis degree between the 2 groups were measured and evaluated. Results There were no significant differences in image noise, SNR, or CNR between Groups A and B (P>0.05). The CT attenuation values of the arteries were higher in Group A than in B [internal carotid artery (ICA) =548±112 vs. 454±85 Hounsfield units (HU), middle cerebral artery (MCA) =453±118 vs. 388±70 HU, and basilar artery (BA) =431±99 vs. 360±83 HU] (P<0.01). The image quality of the 2 groups met the requirement of clinical diagnosis (4.97±0.18 vs. 4.94±0.25). No significant difference was found in subjective evaluation (P>0.05). In Group A compared with Group B, the following reductions were observed: CTDIvol (10.7%; 100.8 vs. 112.9 mGy), DLP (23.0%; 1,613±0 vs. 2,093±88 mGy·cm), and ED (23.0%; 5.00±0.00 vs. 6.49±0.27 mSv). Conclusions CTA-DF-CTP data provide diagnostic accuracy and image quality similar to those of conventional CTA of head and neck CTA.
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Affiliation(s)
- Xiu-Zhi Zhou
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kuan Lu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Du-Chang Zhai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Man-Man Cui
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Liu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ting-Ting Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dai Shi
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guo-Hua Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng-Hong Ju
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Wu Cai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Kristiansen CH, Thomas O, Tran TT, Roy S, Hykkerud DL, Sanderud A, Geitung JT, Lauritzen PM. Halved contrast medium dose in lower limb dual-energy computed tomography angiography-a randomized controlled trial. Eur Radiol 2023; 33:6033-6044. [PMID: 37071166 PMCID: PMC10415441 DOI: 10.1007/s00330-023-09575-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To compare vascular attenuation (VA) of an experimental half iodine-load dual-layer spectral detector CT (SDCT) lower limb computed tomography angiography (CTA) with control (standard iodine-load conventional 120-kilovolt peak (kVp) CTA). METHODS Ethical approval and consent were obtained. In this parallel RCT, CTA examinations were randomized into experimental or control. Patients received 0.7 vs 1.4 mL/kg of iohexol 350 mgI/mL in the experimental- vs the control group. Two experimental virtual monoenergetic image (VMI) series at 40 and 50 kiloelectron volts (keV) were reconstructed. PRIMARY OUTCOME VA. SECONDARY OUTCOMES image noise (noise), contrast- and signal-to-noise ratio (CNR and SNR), and subjective examination quality (SEQ). RESULTS A total of 106 vs 109 were randomized and 103 vs 108 were analyzed in the experimental vs, control groups, respectively. VA was higher on experimental 40 keV VMI than on control (p < 0.0001), but lower on 50 keV VMI (p < 0.022). Noise was higher on experimental 40 keV VMI than on control (p = 0.00022), but lower on 50 keV VMI (p = 0.0033). CNR and SNR were higher than the control on experimental 40 keV VMI (both p < 0.0001) and 50 keV (p = 0.0058 and p = 0.0023, respectively). SEQ was better on both VMIs in the experimental group than in the control (both p < 0.0001). CONCLUSIONS Half iodine-load SDCT lower limb CTA at 40 keV achieved higher VA than the control. CNR, SNR, noise, and SEQ were higher at 40 keV, while 50 keV showed lower noise. CLINICAL RELEVANCE STATEMENT Spectral detector CT with low-energy virtual monoenergetic imaging performed halved iodine contrast medium (CM) lower limb CT-angiography with sustained objective and subjective quality. This facilitates CM reduction, improvement of low CM-dosage examinations, and examination of patients with more severe kidney impairment. TRIAL REGISTRATION Retrospectively registered 5 August 2022 at clinicaltrials.gov NCT05488899. KEY POINTS • Contrast medium dosage may be halved in lower limb dual-energy CT angiography with virtual monoenergetic images at 40 keV, which may reduce contrast medium consumption in the face of a global shortage. • Experimental half-iodine-load dual-energy CT angiography at 40 keV showed higher vascular attenuation, contrast-to-noise ratio, signal-to-noise ratio, and subjective examination quality than standard iodine-load conventional. • Half-iodine dual-energy CT angiography protocols may allow us to reduce the risk of PC-AKI, examine patients with more severe kidney impairment, and provide higher quality examinations or salvage poor examinations when impaired kidney function limits the CM dose.
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Affiliation(s)
- Cathrine Helgestad Kristiansen
- Health Faculty, Oslo Metropolitan University, Oslo, Norway.
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway.
| | - Owen Thomas
- Health Services Research Department (HØKH), Akershus University Hospital, Lørenskog, Norway
| | - Thien Trung Tran
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
| | - Sumit Roy
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
| | - Dan Levi Hykkerud
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
| | - Audun Sanderud
- Health Faculty, Oslo Metropolitan University, Oslo, Norway
| | - Jonn Terje Geitung
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter M Lauritzen
- Health Faculty, Oslo Metropolitan University, Oslo, Norway
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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