Virtual Noncontrast Abdominal Imaging with Photon-counting Detector CT.

Background Accurate CT attenuation and diagnostic quality of virtual noncontrast (VNC) images acquired with photon-counting detector (PCD) CT are needed to replace true noncontrast (TNC) scans. Purpose To assess the attenuation errors and image quality of VNC images from abdominal PCD CT compared with TNC images. Materials and Methods In this retrospective study, consecutive adult patients who underwent a triphasic examination with PCD CT from July 2021 to October 2021 were included. VNC images were reconstructed from arterial and portal venous phase CT. The absolute attenuation error of VNC compared with TNC images was measured in multiple structures by two readers. Then, two readers blinded to image reconstruction assessed the overall image quality, image noise, noise texture, and delineation of small structures using five-point discrete visual scales (5 = excellent, 1 = nondiagnostic). Overall image quality greater than or equal to 3 was deemed diagnostic. In a phantom, noise texture, spatial resolution, and detectability index were assessed. A detectability index greater than or equal to 5 indicated high diagnostic accuracy. Interreader agreement was evaluated using the Krippendorff α coefficient. The paired t test and Friedman test were applied to compare objective and subjective results. Results Overall, 100 patients (mean age, 72 years ± 10 [SD]; 81 men) were included. In patients, VNC image attenuation values were consistent between readers (α = .60), with errors less than 5 HU in 76% and less than 10 HU in 95% of measurements. There was no evidence of a difference in error of VNC images from arterial or portal venous phase CT (3.3 HU vs 3.5 HU, P = .16). Subjective image quality was rated lower in VNC images for all categories (all, P < .001). Diagnostic quality of VNC images was reached in 99% and 100% of patients for readers 1 and 2, respectively. In the phantom, VNC images exhibited 33% higher noise, blotchier noise texture, similar spatial resolution, and inferior but overall good image quality (detectability index >20) compared with TNC images. Conclusion Abdominal virtual noncontrast images from the arterial and portal venous phase of photon-counting detector CT yielded accurate CT attenuation and good image quality compared with true noncontrast images. © RSNA, 2022 Online supplemental material is available for this article See also the editorial by Sosna in this issue

Iterative Reconstructions in Reduced-Dose CT: Which Type Ensures Diagnostic Image Quality in Young Oncology Patients?

To compare adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) algorithms for reduced-dose computed tomography (CT). Forty-four young oncology patients (mean age 30 ± 9 years) were included. After routine thoraco-abdominal CT (dose 100%, average CTDI javax.xml.bind.JAXBElement@e7f585f 9.1 ± 2.4 mGy, range 4.4-16.9 mGy), follow-up CT was acquired at 50% (average CTDI javax.xml.bind.JAXBElement@2e35610f 4.5 ± 1.2 mGy, range 2.2-8.4 mGy) in 29 patients additionally at 20% dose (average CTDI javax.xml.bind.JAXBElement@37ad3473 1.9 ± 0.5 mGy, range 0.9-3.4 mGy). Each reduced-dose CT was reconstructed using both ASIR and MBIR. Four radiologists (two juniors and two seniors) blinded to dose and technique read each set of CT images regarding objective and subjective image qualities (high- or low-contrast structures), subjective noise or pixilated appearance, diagnostic confidence, and lesion detection. At all dose levels, objective image noise was significantly lower with MBIR than with ASIR (P < 0.001). The subjective image quality for low-contrast structures was significantly higher with MBIR than with ASIR (P < 0.001). Reduced-dose abdominal CT images of patients with higher body mass index (BMI) were read with significantly higher diagnostic confidence than images of slimmer patients (P < 0.001) and had higher subjective image quality, regardless of technique. Although MBIR images appeared significantly more pixilated than ASIR images, they were read with higher diagnostic confidence, especially by juniors (P < 0.001). Reduced-dose CT during the follow-up of young oncology patients should be reconstructed with MBIR to ensure diagnostic quality. Elevated body mass index does not hamper the quality of reduced-dose CT

Prospective randomized comparison of high-pitch CT at 80 kVp under free breathing with standard-pitch CT at 100 kVp under breath-hold for detection of pulmonary embolism

RATIONALE AND OBJECTIVES To prospectively compare high-pitch computed tomography (HPCT) under free breathing (FB) with standard-pitch CT (SPCT) under breath-hold (BH) for detection of pulmonary embolism (PE). MATERIALS AND METHODS One hundred consecutive patients (47 females; mean age 58.7 ± 16.6) randomly underwent HPCT-FB (n = 50) or SPCT-BH (n = 50). Radiation doses were documented. One reader measured pulmonary artery attenuation and noise; mean signal-to-noise ratio (SNR) was calculated. Two readers assessed image quality, diagnostic confidence for detection of PE, motion artifacts, assessability of anatomical structures, and presence of transient interruption of contrast as sign of Valsalva maneuver. Inter-reader agreement was calculated. RESULTS Radiation dose was significantly lower in HPCT compared to SPCT (2.68 ± 0.60 mGy vs 6.01 ± 2.26 mGy; P < .001). Mean pulmonary artery attenuation and image noise were significantly higher in HPCT (attenuation: 479 Hounsfield unit (HU) vs 343HU; P < .001; noise: 16 HU vs 10 HU; P < .001) whereas SNR was similar between groups (34 HU vs 38 HU; P = .258). HPCT had significantly higher diagnostic confidence for PE detection (P = .048), less cardiac and breathing artifacts (P < .001), better assessability of anatomical structures, and fewer cases of transient interruption of contrast (P < .001) compared to the SPCT. CONCLUSIONS HPCT-FB allows for a significant reduction of breathing and motion artifacts compared to SPCT-BH. Diagnostic confidence, assessability of vascular and bronchial structures, as well as SNR are maintained

Automatic radiation dose monitoring for CT of trauma patients with different protocols: feasibility and accuracy

AIM: To demonstrate the feasibility and accuracy of automatic radiation dose monitoring software for computed tomography (CT) of trauma patients in a clinical setting over time, and to evaluate the potential of radiation dose reduction using iterative reconstruction (IR). MATERIALS AND METHODS: In a time period of 18 months, data from 378 consecutive thoraco-abdominal CT examinations of trauma patients were extracted using automatic radiation dose monitoring software, and patients were split into three cohorts: cohort 1, 64-section CT with filtered back projection, 200 mAs tube current-time product; cohort 2, 128-section CT with IR and identical imaging protocol; cohort 3, 128-section CT with IR, 150 mAs tube current-time product. Radiation dose parameters from the software were compared with the individual patient protocols. Image noise was measured and image quality was semi-quantitatively determined. RESULTS: Automatic extraction of radiation dose metrics was feasible and accurate in all (100%) patients. All CT examinations were of diagnostic quality. There were no differences between cohorts 1 and 2 regarding volume CT dose index (CTDIvol; p=0.62), dose-length product (DLP), and effective dose (ED, both p=0.95), while noise was significantly lower (chest and abdomen, both -38%, p<0.017). Compared to cohort 1, CTDIvol, DLP, and ED in cohort 3 were significantly lower (all -25%, p<0.017), similar to the noise in the chest (-32%) and abdomen (-27%, both p<0.017). Compared to cohort 2, CTDIvol (-28%), DLP, and ED (both -26%) in cohort 3 was significantly lower (all, p<0.017), while noise in the chest (+9%) and abdomen (+18%) was significantly higher (all, p<0.017). CONCLUSION: Automatic radiation dose monitoring software is feasible and accurate, and can be implemented in a clinical setting for evaluating the effects of lowering radiation doses of CT protocols over time

Ultralow-Dose CT with Tin-Filtration for Detection of Solid and Sub-solid Pulmonary Nodules: A phantom study

PURPOSE To investigate diagnostic performance of advanced modelled iterative reconstruction (ADMIRE) to filtered back projection (FBP) when using an ultra-low dose protocol for the detection of solid and sub-solid pulmonary-nodules. METHODS Single-energy CT was performed at 100kVp with tin-filtration in an anthropomorphic chest-phantom with solid and sub-solid pulmonary-nodules (2-10mm, attenuation, 20HU to -800HU at 120 kVp). CTDIvol of the standard chest protocol was 2.2 mGy. Subsequent scans were obtained at 1/8 (0.28 mGy), 1/20 (0.10 mGy), and 1/70 (0.03 mGy) dose levels by lowering tube-voltage and -current. Images were reconstructed with FBP and ADMIRE. One reader measured image noise; two readers determined image quality and assessed nodule localization. RESULTS Image noise was significantly reduced using ADMIRE compared to FBP (ADMIRE at a strength-level of 5: 70.4% for 1/20; 71.6% for 1/8;p<0.001). Inter-observer agreement for image-quality was excellent (k=0.88). Image-quality was considered diagnostic for all images at 1/20 dose using ADMIRE. Sensitivity of nodule detection was 97.14% (100% for solid, 93.8% for sub-solid nodules) at 1/20 dose and 100% for both nodule entities at 1/8 dose using ADMIRE5. Images obtained with 1/70 dose had moderate sensitivity (overall85.71%; solid 94%; sub-solid 73.3%). CONCLUSION Our study suggests that with a combination of tin-filtration and ADMIRE the mean volume CT dose index (CTDIvol) of chest CT can be lowered considerably, while sensitivity for nodule-detection remains high. For solid nodules CTDIvol was 0.10 mGy, while sub-solid nodules required a slightly higher CTDIvol of 0.28 mGy. Advances in knowledge: Detection of sub-solid nodules is feasible with ultralow-dose protocols

Dose-optimized computed tomography for screening and follow-up of solid pulmonary nodules in obesity: a phantom study

To determine the lowest CT radiation dose-level at maintained image-quality and high sensitivity for detection of pulmonary-nodules in obesity. Single-energy CT with tin-filtration was performed in a chest-phantom with solid pulmonary-nodules simulating over-weight and obesity. CTDIvol of the standard-protocol was 0.41 mGy, subsequent scans were obtained at 1/2 and 1/4 dose-levels. Images were reconstructed using FBP and advanced-modeled iterative reconstruction (ADMIRE). Noise, image-quality, and sensitivity for nodule-detection were assessed. Noise was significantly reduced with ADMIRE (standard-dose: 73%; 1/2 dose: 73%; 1/4 dose: 71.2%; p < 0.001) compared to FBP. Image-quality was diagnostic for all images reconstructed with ADMIRE5. Sensitivity for nodule-detection was 100% at 1/2 and 1/4 dose-level for the phantom simulating over-weight and 97.37% (1/2 dose-level) and 81.58% (1/4 dose-level) for the phantom simulating obesity using ADMIRE5. In conclusion, single-energy CT with tin-filtration and ADMIRE shows potential for dose reduction in a phantom experiment down to 0.1 mGy in over-weight and 0.21 mGy obese subjects, while image quality and sensitivity for detection of solid pulmonary nodules remains high

Tube voltage-independent coronary calcium scoring on a first-generation dual-source photon-counting CT-a proof-of-principle phantom study

To evaluate the accuracy of coronary artery calcium (CAC) scoring at various tube voltages and different monoenergetic image reconstructions on a first-generation dual-source photon-counting detector CT (PCD-CT). A commercially available anthropomorphic chest phantom with calcium inserts was scanned at different tube voltages (90 kV, Sn100kV, 120 kV, and Sn140kV) on a first-generation dual-source PCD-CT system with quantum technology using automatic exposure control with an image quality (IQ) level of 20. The same phantom was also scanned on a conventional energy-integrating detector CT (120 kV; weighted filtered back projection) for reference. Extension rings were used to emulate different patient sizes. Virtual monoenergetic images at 65 keV and 70 keV applying different levels of quantum iterative reconstruction (QIR) were reconstructed from the PCD-CT data sets. CAC scores were determined and compared to the reference. Radiation doses were noted. At an IQ level of 20, radiation doses ranged between 1.18 mGy and 4.64 mGy, depending on the tube voltage and phantom size. Imaging at 90 kV or Sn100kV was associated with a size-dependent radiation dose reduction between 23% and 48% compared to 120 kV. Tube voltage adapted image reconstructions with 65 keV and QIR 3 at 90 kV and with 70 keV and QIR 1 at Sn100kV allowed to calculate CAC scores comparable to conventional EID-CT scans with a percentage deviation of ≤ 5% for all phantom sizes. Our phantom study indicates that CAC scoring with dual-source PCD-CT is accurate at various tube voltages, offering the possibility of substantial radiation dose reduction

Comprehensive morphologic and functional imaging of heart transplant patients: first experience with dynamic perfusion CT

OBJECTIVES We aimed to assess the diagnostic performance of a combined protocol with coronary computed tomography angiography (CCTA) and stress CT perfusion imaging (CTP) in heart transplant patients for comprehensive morphological and functional imaging. METHODS In this prospective study, 13 patients undergoing routine follow-up 8±6 years after heart transplantation underwent CCTA and dynamic adenosine stress CTP using a third-generation dual-source CT scanner, cardiac magnetic resonance (MR) adenosine stress perfusion imaging at 1.5 T, and catheter coronary angiography. In CCTA stenoses >50% luminal diameter narrowing were noted. Myocardial perfusion deficits were documented in CTP and MR. Quantitative myocardial blood flow (MBF) was calculated with CTP. Left ventricular ejection fraction was determined on cardiac MR cine images. Radiation doses of CT were determined. RESULTS One of the 13 patients had to be excluded because of severe motion artifacts. CCTA identified three patients with stenosis >50%, which were confirmed with catheter coronary angiography. CTP showed four patients with stress-induced myocardial hypoperfusion, which were confirmed by MR stress perfusion imaging. Quantitative analysis of global MBF showed lower mean values as compared to known reference values (MBF under stress 125.5 ± 34.5 ml/100 ml/min). Average left ventricular ejection fraction was preserved (56 ± 5%). CONCLUSIONS In heart transplant patients, a comprehensive CT protocol for the assessment of morphology and function including CCTA and CTP showed good concordance to results from MR perfusion imaging and catheter coronary angiography. KEY POINTS • Stress CT perfusion imaging enables the detection of myocardial ischemia • CT myocardial perfusion imaging can be combined with coronary computed tomography angiography • Combining perfusion and coronary CT imaging is accurate in heart transplant patients • CT myocardial perfusion imaging can be performed at a reasonable radiation dose