Evaluation of automatic image quality assessment in chest CT – A human cadaver study

PurposeThe evaluation of clinical image quality (IQ) is important to optimize CT protocols and to keep patient doses as low as reasonably achievable. Considering the significant amount of effort needed for human observer studies, automatic IQ tools are a promising alternative. The purpose of this study was to evaluate automatic IQ assessment in chest CT using Thiel embalmed cadavers.MethodsChest CT’s of Thiel embalmed cadavers were acquired at different exposures. Clinical IQ was determined by performing a visual grading analysis. Physical-technical IQ (noise, contrast-to-noise and contrast-detail) was assessed in a Catphan phantom. Soft and sharp reconstructions were made with filtered back projection and two strengths of iterative reconstruction. In addition to the classical IQ metrics, an automatic algorithm was used to calculate image quality scores (IQs). To be able to compare datasets reconstructed with different kernels, the IQs values were normalized.ResultsGood correlations were found between IQs and the measured physical-technical image quality: noise (ρ = −1.00), contrast-to-noise (ρ = 1.00) and contrast-detail (ρ = 0.96). The correlation coefficients between IQs and the observed clinical image quality of soft and sharp reconstructions were 0.88 and 0.93, respectively.ConclusionsThe automatic scoring algorithm is a promising tool for the evaluation of thoracic CT scans in daily clinical practice. It allows monitoring of the image quality of a chest protocol over time, without human intervention. Different reconstruction kernels can be compared after normalization of the IQs.     

Optimizing Radiation Dose Levels in Prospectively Electrocardiogram-Triggered Coronary Computed Tomography Angiography Using Iterative Reconstruction Techniques: A Phantom and Patient Study

Aim

To investigate the potential of reducing the radiation dose in prospectively electrocardiogram-triggered coronary computed tomography angiography (CCTA) while maintaining diagnostic image quality using an iterative reconstruction technique (IRT).

Methods and Materials

Prospectively-gated CCTA were first performed on a phantom using 256-slice multi-detector CT scanner at 120 kVp, with the tube output gradually reduced from 210 mAs (Group A) to 125, 105, 84, and 63 mAs (Group B–E). All scans were reconstructed using filtered back projection (FBP) algorithm and five IRT levels (L2-6), image quality (IQ) assessment was performed. Based on the IQ assessment, Group D(120 kVp, 84 mAs) reconstructed with L5 was found to provide IQ comparable to that of Group A with FBP. In the patient study, 21 patients underwent CCTA using 120 kV, 210 mAs with FBP reconstruction (Group 1) followed by 36 patients scanned with 120 kV, 84 mAs with IRT L5 (Group 2). Subjective and objective IQ and effective radiation dose were compared between two groups.

Results

In the phantom scans, there were no significant differences in image noise, contrast-to-noise ratio (CNR) and modulation transfer function (MTF) curves between Group A and the 84 mAs, 63 mAs groups (Groups D and E). Group D (120 kV, 84 mAs and L5) provided an optimum balance, producing equivalent image quality to Group A, at the lowest possible radiation dose. In the patient study, there were no significant difference in image noise, signal-to-noise ratio (SNR) and CNR between Group 1 and Group 2 (p = 0.71, 0.31, 0.5, respectively). The effective radiation dose in Group 2 was 1.21±0.14 mSv compared to 3.20±0.58 mSv (Group 1), reflecting dose savings of 62.5% (p<0.05).

Conclusion

iterative reconstruction technique used in prospectively ECG-triggered 256-slice coronary CTA can provide radiation dose reductions of up to 62.5% with acceptable image quality.     

Toward standardized quantitative image quality (IQ) assessment in computed tomography (CT): A comprehensive framework for automated and comparative IQ analysis based on ICRU Report 87

PurposeBased on the guidelines from “Report 87: Radiation Dose and Image-quality Assessment in Computed Tomography” of the International Commission on Radiation Units and Measurements (ICRU), a software framework for automated quantitative image quality analysis was developed and its usability for a variety of scientific questions demonstrated.MethodsThe extendable framework currently implements the calculation of the recommended Fourier image quality (IQ) metrics modulation transfer function (MTF) and noise-power spectrum (NPS), and additional IQ quantities such as noise magnitude, CT number accuracy, uniformity across the field-of-view, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of simulated lesions for a commercially available cone-beam phantom. Sample image data were acquired with different scan and reconstruction settings on CT systems from different manufacturers.ResultsSpatial resolution is analyzed in terms of edge-spread function, line-spread-function, and MTF. 3D NPS is calculated according to ICRU Report 87, and condensed to 2D and radially averaged 1D representations. Noise magnitude, CT numbers, and uniformity of these quantities are assessed on large samples of ROIs. Low-contrast resolution (CNR, SNR) is quantitatively evaluated as a function of lesion contrast and diameter. Simultaneous automated processing of several image datasets allows for straightforward comparative assessment.ConclusionsThe presented framework enables systematic, reproducible, automated and time-efficient quantitative IQ analysis. Consistent application of the ICRU guidelines facilitates standardization of quantitative assessment not only for routine quality assurance, but for a number of research questions, e.g. the comparison of different scanner models or acquisition protocols, and the evaluation of new technology or reconstruction methods.     

Can the non-pre-whitening model observer,including aspects of the human visual system,predict human observer performance in mammography?

PurposeIn mammography, images are processed prior to display. Current methodologies based on physical image quality measurements are however not designed for the evaluation of processed images. Model observers (MO) might be suitable for this evaluation. The aim of this study was to investigate whether the non-pre-whitening (NPW) MO can be used to predict human observer performance in mammography-like images by including different aspects of the human visual system (HVS).MethodsThe correlation between human and NPW MO performance has been investigated for the detection of disk shaped objects in simulated white noise (WN) and clustered lumpy backgrounds (CLB), representing quantum noise limited and mammography-like images respectively. The images were scored by the MO and five human observers in a 2-alternative forced choice experiment.ResultsFor WN images it was found that the log likelihood ratio (R_LR²), which expresses the goodness of fit, was highest (0.44) for the NPW MO without addition of HVS aspects. For CLB the R_LR² improved from 0.46 to 0.65 with addition of HVS aspects. The correlation was affected by object size and background.ConclusionsThis study shows that by including aspects of the HVS, the performance of the NPW MO can be improved to better predict human observer performance. This demonstrates that the NPW MO has potential for image quality assessment. However, due to the dependencies found in the correlation, the NPW MO can only be used for image quality assessment for a limited range of object sizes and background variability.     

Reproducibility of geometrical acquisition of intra-thoracic organs of children on CT scans

This paper analyses geometry of intra-thoracic organs from computed tomography (CT) scans performed on 20 children aged from 4 months to 16 years. A set of two measurements on lungs and heart were performed by the same observer. A third set was performed by a second observer. Thus, the intra- and inter-observer relative deviation of measurements was analysed. Multiple regressions were used in order to study the relationship between the CT properties (scanner, voltage, dose, pixel size, slice increment) and the relative deviation of measurements. There is a very low systematic intra- and inter-observer bias in measurements except for the volume of the heart. None of the CT data properties has a significant influence on the relative deviation of measurement. In the present paper, the measurements and 3D reconstruction protocol described can be applied to characterise the growth of the intra-thoracic organs.     

Reproducibility of geometrical acquisition of intra-thoracic organs of children on CT scans

This paper analyses geometry of intra-thoracic organs from computed tomography (CT) scans performed on 20 children aged from 4 months to 16 years. A set of two measurements on lungs and heart were performed by the same observer. A third set was performed by a second observer. Thus, the intra- and inter-observer relative deviation of measurements was analysed. Multiple regressions were used in order to study the relationship between the CT properties (scanner, voltage, dose, pixel size, slice increment) and the relative deviation of measurements. There is a very low systematic intra- and inter-observer bias in measurements except for the volume of the heart. None of the CT data properties has a significant influence on the relative deviation of measurement. In the present paper, the measurements and 3D reconstruction protocol described can be applied to characterise the growth of the intra-thoracic organs.     

Determination of the Optimal Dose Reduction Level via Iterative Reconstruction Using 640-Slice Volume Chest CT in a Pig Model

Aim

To determine the optimal dose reduction level of iterative reconstruction technique for paediatric chest CT in pig models.

Materials and Methods

27 infant pigs underwent 640-slice volume chest CT with 80kVp and different mAs. Automatic exposure control technique was used, and the index of noise was set to SD10 (Group A, routine dose), SD12.5, SD15, SD17.5, SD20 (Groups from B to E) to reduce dose respectively. Group A was reconstructed with filtered back projection (FBP), and Groups from B to E were reconstructed using iterative reconstruction (IR). Objective and subjective image quality (IQ) among groups were compared to determine an optimal radiation reduction level.

Results

The noise and signal-to-noise ratio (SNR) in Group D had no significant statistical difference from that in Group A (P = 1.0). The scores of subjective IQ in Group A were not significantly different from those in Group D (P>0.05). There were no obvious statistical differences in the objective and subjective index values among the subgroups (small, medium and large subgroups) of Group D. The effective dose (ED) of Group D was 58.9% lower than that of Group A (0.20±0.05mSv vs 0.48±0.10mSv, p <0.001).

Conclusions

In infant pig chest CT, using iterative reconstruction can provide diagnostic image quality; furthermore, it can reduce the dosage by 58.9%.     

Quality and dose optimization in hand computed radiography

The objective of the present study was to optimize a radiographic technique for hand examinations using a computed radiography (CR) system and demonstrate the potential for dose reductions compared with clinically established technique. An exposure index was generated from the optimized technique to guide operators when imaging hands. Homogeneous and anthropomorphic phantoms that simulated a patient's hand were imaged using a CR system at various tube voltages and current settings (40–55 kVp, 1.25–2.8 mAs), including those used in clinical routines (50 kVp, 2.0 mAs) to obtain an optimized chart. The homogeneous phantom was used to assess objective parameters that are associated with image quality, including the signal difference-to-noise ratio (SdNR), which is used to define a figure of merit (FOM) in the optimization process. The anthropomorphic phantom was used to subjectively evaluate image quality using Visual Grading Analysis (VGA) that was performed by three experienced radiologists. The technique that had the best VGA score and highest FOM was considered the gold standard (GS) in the present study. Image quality, dose and the exposure index that are currently used in the clinical routine for hand examinations in our institution were compared with the GS technique. The effective dose reduction was 67.0%. Good image quality was obtained for both techniques, although the exposure indices were 1.60 and 2.39 for the GS and clinical routine, respectively.     

Image reconstruction of optical computed tomography by using the algebraic reconstruction technique for dose readouts of polymer gel dosimeters

Optical computed tomography (optical CT) has been proven to be a useful tool for dose readouts of polymer gel dosimeters. In this study, the algebraic reconstruction technique (ART) for image reconstruction of gel dosimeters was used to improve the image quality of optical CT. Cylindrical phantoms filled with N-isopropyl-acrylamide polymer gels were irradiated using a medical linear accelerator. A circular dose distribution and a hexagonal dose distribution were produced by applying the VMAT technique and the six-field dose delivery, respectively. The phantoms were scanned using optical CT, and the images were reconstructed using the filtered back-projection (FBP) algorithm and the ART. For the circular dose distribution, the ART successfully reduced the ring artifacts and noise in the reconstructed image. For the hexagonal dose distribution, the ART reduced the hot spots at the entrances of the beams and increased the dose uniformity in the central region. Within 50% isodose line, the gamma pass rates for the 2 mm/3% criteria for the ART and FBP were 99.2% and 88.1%, respectively. The ART could be used for the reconstruction of optical CT images to improve image quality and provide accurate dose conversion for polymer gel dosimeters.     

Objective assessment of low-contrast computed tomography images with iterative reconstruction

ObjectiveThis study aims to assess low-contrast image quality using a low-contrast object specific contrast-to-noise ratio (CNR_LO) analysis for iterative reconstruction (IR) computed tomography (CT) images.MethodsA phantom composed of low-contrast rods placed in a uniform material was used in this study. Images were reconstructed using filtered back projection (FBP) and IR (Adaptive Iterative Dose Reduction 3D). Scans were performed at six dose levels: 1.0, 1.8, 3.1, 4.6, 7.1 and 13.3 mGy. Objective image quality was assessed by comparing CNR_LO with CNR using a human observer test.ResultsCompared with FBP, IR yielded increased CNR at the same dose levels. The results of CNR_LO and observer tests showed similarities or only marginal differences between FBP and IR at the same dose levels. The coefficient of determination for CNR_LO was significantly better (R² = 0.86) than that of CNR (R² = 0.47).ConclusionFor IR, CNR_LO could potentially serve as an objective index reflective of a human observer assessment. The results of CNR_LO test indicated that the IR algorithm was not superior to FBP in terms of low-contrast detectability at the same radiation doses.     

Objective assessment of low contrast detectability in computed tomography with Channelized Hotelling Observer

PurposeIterative algorithms introduce new challenges in the field of image quality assessment. The purpose of this study is to use a mathematical model to evaluate objectively the low contrast detectability in CT.Materials and methodsA QRM 401 phantom containing 5 and 8 mm diameter spheres with a contrast level of 10 and 20 HU was used. The images were acquired at 120 kV with CTDI_vol equal to 5, 10, 15, 20 mGy and reconstructed using the filtered back-projection (FBP), adaptive statistical iterative reconstruction 50% (ASIR 50%) and model-based iterative reconstruction (MBIR) algorithms. The model observer used is the Channelized Hotelling Observer (CHO). The channels are dense difference of Gaussian channels (D-DOG). The CHO performances were compared to the outcomes of six human observers having performed four alternative forced choice (4-AFC) tests.ResultsFor the same CTDI_vol level and according to CHO model, the MBIR algorithm gives the higher detectability index. The outcomes of human observers and results of CHO are highly correlated whatever the dose levels, the signals considered and the algorithms used when some noise is added to the CHO model. The Pearson coefficient between the human observers and the CHO is 0.93 for FBP and 0.98 for MBIR.ConclusionThe human observers' performances can be predicted by the CHO model. This opens the way for proposing, in parallel to the standard dose report, the level of low contrast detectability expected. The introduction of iterative reconstruction requires such an approach to ensure that dose reduction does not impair diagnostics.     

基于图像重建的CT三维重建提升腹部增强扫描图像质量的价值

摘要 目的：探讨基于图像重建的电子计算机断层扫描仪器(Computed Tomography,CT)三维成像提升腹部增强扫描图像质量的价值。方法：2019年11月到2020年10月选择在本院进行腹部CT增强扫描的患者76例作为研究对象,采用电脑随机数字法将研究对象分为对照组和重建组各38例,对照组给予常规扫描成像,重建组给予基于自适应统计迭代重建(adaptive statistical iterative reconstruction,ASIR)的CT三维成像,记录两组成像质量与噪声情况。结果：两名医师对重建组的图像主观质量评分都高于对照组(P<0.05)。重建组的图像相对细腻柔和,能清晰显示图像细小血管断面,末梢血管显示良好,血管壁光滑柔和。重建组的动脉期、门静脉期、平衡期的肝脏CT值高于对照组(P<0.05),动脉期、门静脉期、平衡期的肝脏、胰腺对比噪声比(contrast to noise ratio,CNR)值低于对照组(P<0.05)。重建组的容积剂量指数(volume CT dose index,CTDIvol)和剂量长度乘积(Dose-Length product,DLP)、有效剂量(effective dose,ED)值都低于对照组(P<0.05)。结论：基于图像重建的CT三维成像能提升腹部增强扫描主客观图像质量,降低图像噪声,更利于腹部疾病的显示,从而提高正确诊断率。     

Real-time determination of the optimal reconstruction phase to control ECG pulsing in spiral cardiac CT

The reconstruction phase providing optimal image quality in coronary CT angiography is dependent on the heart rate but additionally displays substantial patient-dependent variation. The purpose of this study was to provide online identification of the patient-specific optimal reconstruction phase during CT coronary angiography data acquisition and to allow adaptation of tube current modulation for the individual patient. A raw data-based cardiac motion signal (kymogram) was used for the detection of the optimal reconstruction phase. The individual motion curve of each patient was correlated with dedicated template curves to reduce signal noise. Data sets of 90 consecutive patients were used for validation purposes. The reliability of our approach increased with scan time and provided highest correlation with the visually identified optimal reconstruction phase already after half of the total scan time indicated by a difference value of 13.2% and 8.2%, respectively. A high correlation of the computed and the visually identified optimal reconstruction phase was assured in most cases providing a dose reduction of 36% compared to conventional TCM application for a confidence interval of 80%. Our method is a fully automatic computer-assisted approach identifying the optimal reconstruction phase with high reliability while online capability can be ensured. We conclude that our method can identify cardiac phases providing highest image quality already during CT scanning. Reduction of the tube current by a patient-specific optimization providing a minimal dose level is the major benefit for the patients.     

64层螺旋CT不同剂量扫描对活动性继发性肺结核患者诊断价值、图像质量和辐射剂量的影响

目的:研究64层螺旋CT不同剂量扫描对活动性继发性肺结核患者诊断价值、图像质量和辐射剂量的影响,旨在为临床活动性继发性肺结核患者提供更为安全有效的检查方案。方法:将我院从2018年1月2020年1月收治的100例活动性继发性肺结核患者纳入研究。对所有患者分别进行低剂量(40 m A)以及常规剂量(120 m A)扫描和薄层重建。比较不同剂量扫描的诊断准确率、影像学表现、图像质量以及辐射参数、患者满意度。结果:64层螺旋CT低剂量扫描与常规剂量扫描诊断活动性继发性肺结核的准确率分别为92.00%、93.00%,两者比较差异无统计学意义(P>0.05)。低剂量扫描及常规剂量扫描在空洞、钙化灶、实变、磨玻璃密度影及树芽征发生率方面对比差异均无统计学意义(P>0.05)。低剂量扫描及常规剂量扫描在扫描图像质量、薄层重建图像质量方面对比差异均无统计学意义(P>0.05)。低剂量扫描各项扫描辐射参数均低于常规剂量扫描,差异有统计学意义(P<0.05)。低剂量扫描的患者满意度高于常规剂量扫描的患者(P<0.05)。结论:64层螺旋CT不同剂量扫描对活动性继发性肺结核患者的诊断价值及生成的图像质量相近,但低剂量扫描可有效降低辐射剂量,从而在一定程度上增加扫描的安全性,使患者满意度提升。     

Image quality comparison of a nonlinear image-based noise reduction technique with a hybrid-type iterative reconstruction for pediatric computed tomography

PurposeTo compare computed tomography (CT) image properties between a vendor-independent image-based noise reduction technique, Image-space Noise Reduction (iNoir) and a hybrid-type iterative reconstruction technique, Adaptive Statistical Iterative Reconstruction (ASIR).MethodsA cylindrical water phantom, corresponding to pediatric body size, containing soft-tissue-equivalent rod and 12-mg iodine/ml rod was scanned at size-specific dose estimates of 8.4 and 16.7 mGy. For assessments of image quality and noise texture change, task-based system performance function (SPF) and peak frequency difference (PFD) were compared, respectively, among filtered back projection (FBP), IR image with 50%-blending rate (50%ASIR), 100%ASIR, 50%iNoir, and 100%iNoir. Human observer test for pediatric CT images was performed by radiologists.ResultsFor the soft-tissue contrast, SPF² of 100%iNoir was the highest. The average SPF² between 0.1 and 0.5 cycles/mm for 100%iNoir increased by approximately 70% compared with FBP, while ASIR indicted slight increases in the frequency region of >0.2 cycles/mm. For the iodine contrast, 100%iNoir indicated highest values at the spatial frequencies corresponding pediatric artery diameters. The PFDs of iNoir were negligible and lower than that of ASIR. The results of human observer test supported results of SPF² and PFD.ConclusionsCompared with ASIR, iNoir provided better image quality for pediatric abdominal CT without compromising noise texture change.     

不同剂量64排CT增强扫描结合三维重建在胃癌应用中的图像质量研究

目的:研究不同剂量64排CT增强扫描结合三维重建在胃癌应用中的图像质量。方法:90例胃癌行胃部64层螺旋CT三期增强扫描患者后根据管电压设置分成A、B、C三组:A组120KV、B组100KV、C组80KV。通过轴位图像结合三维重建(VR、MPR和MIP等)分析不同剂量下螺旋CT扫描结合三维重建图像诊断质量。结果:A、B两组的图像清晰度的差异无统计学意义(P0.05),A、B组剂量加权指数降低率的差异具有统计学意义,A、C两组间图像清晰度及剂量加权指数降低率的差异具有统计学意义(P0.05),B、C组两项差异具有统计学意义。结论:适当调整MSCT的剂量,可以获得与常规MSCT剂量完全相同的图像而且可以降低辐射。     

Experimental assessment of the influence of beam hardening filters on image quality and patient dose in volumetric 64-slice X-ray CT scanners

Beam hardening filters have long been employed in X-ray Computed Tomography (CT) to preferentially absorb soft and low-energy X-rays having no or little contribution to image formation, thus allowing the reduction of patient dose and beam hardening artefacts. In this work, we studied the influence of additional copper (Cu) and aluminium (Al) flat filters on patient dose and image quality and seek an optimum filter thickness for the GE LightSpeed VCT 64-slice CT scanner using experimental phantom measurements. Different thicknesses of Cu and Al filters (0.5–1.6 mm Cu, 0.5–4 mm Al) were installed on the scanner’s collimator. A planar phantom consisting of 13 slabs of Cu having different thicknesses was designed and scanned to assess the impact of beam filtration on contrast in the intensity domain (CT detector’s output). To assess image contrast and image noise, a cylindrical phantom consisting of a polyethylene cylinder having 16 holes filled with different concentrations of K₂HPO₄ solution mimicking different tissue types was used. The GE performance and the standard head CT dose index (CTDI) phantoms were also used to assess image resolution characterized by the modulation transfer function (MTF) and patient dose defined by the weighted CTDI. A 100 mm pencil ionization chamber was used for CTDI measurement. Finally, an optimum filter thickness was determined from an objective figure of merit (FOM) metric. The results show that the contrast is somewhat compromised with filter thickness in both the planar and cylindrical phantoms. The contrast of the K₂HPO₄ solutions in the cylindrical phantom was degraded by up to 10% for a 0.68 mm Cu filter and 6% for a 4.14 mm Al filter. It was shown that additional filters increase image noise which impaired the detectability of low density K₂HPO₄ solutions. It was found that with a 0.48 mm Cu filter the 50% MTF value is shifted by about 0.77 lp/cm compared to the case where the filter is not used. An added Cu filter with approximately 0.5 mm thickness accounts for 50% reduction in radiation-absorbed dose as measured by the weighted CTDI. The FOM results indicate that with an additional filter of 0.5 mm Cu or minimum 4 mm Al, a good compromise between image quality and patient dose is achieved for CT images acquired at tube voltages of 120 and 140 kVp. The results seem to indicate that an optimum filter for high kVp acquisitions, routinely used in cardiovascular imaging, should be 0.5 mm copper or 4 mm aluminium minimum.     

Image Quality in Children with Low-Radiation Chest CT Using Adaptive Statistical Iterative Reconstruction and Model-Based Iterative Reconstruction

Objective

To evaluate noise reduction and image quality improvement in low-radiation dose chest CT images in children using adaptive statistical iterative reconstruction (ASIR) and a full model-based iterative reconstruction (MBIR) algorithm.

Methods

Forty-five children (age ranging from 28 days to 6 years, median of 1.8 years) who received low-dose chest CT scans were included. Age-dependent noise index (NI) was used for acquisition. Images were retrospectively reconstructed using three methods: MBIR, 60% of ASIR and 40% of conventional filtered back-projection (FBP), and FBP. The subjective quality of the images was independently evaluated by two radiologists. Objective noises in the left ventricle (LV), muscle, fat, descending aorta and lung field at the layer with the largest cross-section area of LV were measured, with the region of interest about one fourth to half of the area of descending aorta. Optimized signal-to-noise ratio (SNR) was calculated.

Result

In terms of subjective quality, MBIR images were significantly better than ASIR and FBP in image noise and visibility of tiny structures, but blurred edges were observed. In terms of objective noise, MBIR and ASIR reconstruction decreased the image noise by 55.2% and 31.8%, respectively, for LV compared with FBP. Similarly, MBIR and ASIR reconstruction increased the SNR by 124.0% and 46.2%, respectively, compared with FBP.

Conclusion

Compared with FBP and ASIR, overall image quality and noise reduction were significantly improved by MBIR. MBIR image could reconstruct eligible chest CT images in children with lower radiation dose.     

Whole-Organ CT Perfusion of the Pancreas: Impact of Iterative Reconstruction on Image Quality,Perfusion Parameters and Radiation Dose in 256-Slice CT-Preliminary Findings

Background

This study was performed to assess whether iterative reconstruction can reduce radiation dose while maintaining acceptable image quality, and to investigate whether perfusion parameters vary from conventional filtered back projection (FBP) at the low-tube-voltage (80-kVp) during whole-pancreas perfusion examination using a 256-slice CT.

Methods

76 patients with known or suspected pancreatic mass underwent whole-pancreas perfusion by a 256-slice CT. High- and low-tube-voltage CT images were acquired. 120-kVp image data (protocol A) and 80-kVp image data (protocol B) were reconstructed with conventional FBP, and 80-kVp image data were reconstructed with iDose⁴ (protocol C) iterative reconstruction. The image noise; contrast-to-noise ratio (CNR) relative to muscle for the pancreas, liver, and aorta; and radiation dose of each protocol were assessed quantitatively. Overall image quality was assessed qualitatively. Among 76 patients, 23 were eventually proven to have a normal pancreas. Perfusion parameters of normal pancreas in each protocol including blood volume, blood flow, and permeability-surface area product were measured.

Results

In the quantitative study, protocol C reduced image noise by 36.8% compared to protocol B (P<0.001). Protocol C yielded significantly higher CNR relative to muscle for the aorta, pancreas and liver compared to protocol B (P<0.001), and offered no significant difference compared to protocol A. In the qualitative study, protocols C and A gained similar scores and protocol B gained the lowest score for overall image quality (P<0.001). Mean effective doses were 23.37 mSv for protocol A and 10.81 mSv for protocols B and C. There were no significant differences in the normal pancreas perfusion values among three different protocols.

Conclusion

Low-tube-voltage and iDose⁴ iterative reconstruction can dramatically decrease the radiation dose with acceptable image quality during whole-pancreas CT perfusion and have no significant impact on the perfusion parameters of normal pancreas compared to the conventional FBP reconstruction using a 256-slice CT scanner.