Control of whole-body FDG-positron emission tomography image quality by adjusting the acquisition time: A new physical image quality index and patientdependent parameters for clinical imaging

Objective: This study aimed to establish a methodology for obtaining visually equivalent image quality regardless of patient size by controlling the acquisition time of positron emission tomography (PET) studies. Methods: In Part 1, we determined the physical image quality index with the highest correlation with visual assessment in 30 patients. In Part 2, 100 patients were scanned to identify the patient-dependent parameters that were most correlated with the physical image quality index. These parameters were calculated from the combination of the administered activity of 18F-FDG and weight. We drew an approximate curve from these parameters and prepared a scatter plot of the physical image quality index. In Part 3, we checked whether the image quality was constant by controlling the acquisition time in 189 patients. The approximation formula we obtained under (2) was used to control the acquisition time. The physical image quality index was a constant value, and the patient-dependent parameter was calculated from the patient’s physique. Results: The physical image quality index with the highest correlation with visual evaluation was the noise equivalent count weight (NECweight) (correlation coefficient: 0.90). The patient-dependent index most correlated with NECweight was activity/weight3 (A/W3) (coefficient of determination: 0.978). The verification of the acquisition time to obtain a certain image quality showed an average of 0.60 ± 0.034 Mcounts/m∙kg, and a similar image quality was obtained independent of the individual physiques. Conclusions: Calculating NECweight and A/W3 enable the determination of the appropriate acquisition time for stable image quality before the PET study

Body physique and heart rate variability determine the occurrence of stair-step artefacts in 64-slice CT coronary angiography with prospective ECG-triggering

The purpose of this study was to describe and characterize the frequency and extent of stair-step artefacts in computed tomography coronary angiography (CTCA) with prospective electrocardiogram (ECG)-triggering and to identify their determinants. One hundred and forty three consecutive patients (55 women, mean age 57 ± 13years) underwent 64-slice CTCA using prospective ECG-triggering. Occurrence of stair-step artefacts in CTCA of the thoracic wall and the coronary arteries was determined and maximum offset was measured. If stair-step artefacts occurred in both cases, a difference between thoracic wall and coronary artery offset of 0.6mm or greater was attributed to additional motion of the heart. Mean effective radiation dose was 2.1 ± 0.7mSv (range 1.0-3.5mSv). Eighty-nine patients (62%) had stair-step artefacts in CTCA of the coronary arteries (mean offset of 1.7 ± 1.1mm), while only 77 patients had thoracic wall stair-step artefacts (mean offset of 1.0 ± 0.3mm; significantly different, P < 0.001). Stair-step artefacts in CTCA of the thoracic wall were determined by BMI and weight (P < 0.01), while artefacts in CTCA of the coronary arteries were associated with heart rate variability (P < 0.05). Stair-step artefacts in CTCA with prospective ECG-triggering are determined by (a) motion of the entire patient during table travel, particularly in large patients and (b) by motion of the heart, particularly when heart rates are variabl

Improved Detectability of Hyper-Dense Nodules Using Dual-Energy Computed Tomography Scanning: Phantom Study Using Simulated Liver Harboring Nodules

The purpose of this study was to evaluate the detectability of hyper-dense nodules using dual-energy computed tomography (DECT) in a phantom. Arterial-phase hepatic dynamic computed tomography (CT) was conducted on small, medium, and large liver-simulating phantoms harboring simulated hypervascular tumors. We acquired 150 single-energy CT (SECT) and 150 DECT scans and measured the contrast-to-noise ratio (CNR) of the nodules. Alternative free response receiver observer characteristic (AFROC) curves of five radiologists’ readings of the SECT and DECT scans were compared to assess detectability of the hyper-dense nodules. For all phantoms, the CNR of nodules measured using DECT was significantly higher than that by using SECT (p < 0.001, all). In the AFROC study, DECT showed a significantly larger area under the curve than that with SECT (0.778 vs 0.499, p = 0.012). Detectability of high-density nodules was better with DECT scans than with SECT scans

Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating

Aims To determine diagnostic accuracy, effective radiation dose, and potential value of computed tomography coronary angiography (CTCA) for hybrid imaging with single-photon emission computed tomography (SPECT) comparing prospective electrocardiogram (ECG)-triggering vs. retrospective ECG-gating. Methods and results Two hundred patients underwent standard myocardial stress/rest- SPECT perfusion imaging, which served as standard of reference. One hundred consecutive patients underwent 64-slice CTCA using prospective ECG-gating, and were compared with 100 patients who had previously undergone CTCA using retrospective ECG-gating. For predicting ischaemia, CTCA with prospective ECG-triggering and a stenosis cut-off >50% had a per-vessel sensitivity, specificity, negative, and positive predictive value of 100, 84, 100, and 30%; respective values for CTCA with retrospective ECG-gating were similar (P = n.s.): 86, 83, 98, and 33%. Combining CTCA with stress-only SPECT revealed 100% clinical agreement with regard to perfusion defects, and provided additional information in half the patients on preclinical coronary findings. Effective radiation dose was 2.2 ± 0.7 mSv for CTCA with prospective ECG-triggering, and 19.7 ± 4.2 mSv with retrospective ECG-gating (P < 0.001) (5.4 ± 0.8 vs. 24.1 ± 4.3 mSv for hybrid imaging). Conclusion Prospective ECG-triggering for CTCA reduces radiation dose by almost 90% without affecting diagnostic performance. Combined imaging with stress-only SPECT is an attractive alternative to standard stress/rest-SPECT for evaluation of coronary artery disease, offering additional information on preclinical atherosclerosi

Prevalence of noncardiac findings on low dose 64-slice computed tomography used for attenuation correction in myocardial perfusion imaging with SPECT

Electrocardiogram (ECG)-triggered, low dose computed tomography (CT) is increasingly used for attenuation correction in myocardial perfusion imaging (MPI) with SPECT. The purpose of the study was to assess the prevalence of relevant noncardiac findings in the field-of-view of such attenuation correction CT scans. Five hundred and eighty-two consecutive patients (211 female, 371 male; mean age: 64±11years; BMI: 27.7±5.3kg/m2) underwent 64-slice, ECG-triggered CT scanning for attenuation correction of MPI with SPECT. Relevant findings were defined as abnormalities that required clinical or radiological follow-up. Noncardiac findings were detected in 400 patients (68.7%). In 196 patients (33.7%) 226 relevant findings were detected. Findings included noncalcified pulmonary nodules (n=156), interstitial lung disease (n=6), pleural effusion (n=20), pneumonia (n=1), aortic aneurysm (n=5), aortic dissection (n=4), enlarged mediastinal lymph nodes (n=5), mediastinal tumor (n=3), breast abnormalities (n=3), liver cirrhosis (n=5), liver mass (n=5), ascites (n=5), splenomegaly (n=2), renal mass (n=1), hydronephrosis (n=1), adrenal mass (n=3), and bone metastasis (n=1). As low dose 64-slice CT scans used for attenuation correction in MPI with SPECT reveal a high prevalence of noncardiac pathologic findings with potential clinical relevance, a systematic review of the CT scans appears mandator

Super resolution deep learning reconstruction for coronary CT angiography: A structured phantom study

Purpose: Super-resolution deep-learning-based reconstruction: SR-DLR is a newly developed and clinically available deep-learning-based image reconstruction method that can improve the spatial resolution of CT images. The image quality of the output from non-linear image reconstructions, such as DLR, is known to vary depending on the structure of the object being scanned, and a simple phantom cannot explicitly evaluate the clinical performance of SR-DLR. This study aims to accurately investigate the quality of the images reconstructed by SR-DLR by utilizing a structured phantom that simulates the human anatomy in coronary CT angiography. Methods: The structural phantom had ribs and vertebrae made of plaster, a left ventricle filled with dilute contrast medium, a coronary artery with simulated stenosis, and an implanted stent graft. By scanning the structured phantom, we evaluated noise and spatial resolution on the images reconstructed with SR-DLR and conventional reconstructions. Results: The spatial resolution of SR-DLR was higher than conventional reconstructions; the 10 % modulation transfer function of hybrid IR (HIR), DLR, and SR-DLR were 0.792-, 0.976-, and 1.379 cycle/mm, respectively. At the same time, image noise was lowest (HIR: 21.1-, DLR: 19.0-, and SR-DLR: 13.1 HU). SR-DLR could accurately assess coronary artery stenosis and the lumen of the implanted stent graft. Conclusions: SR-DLR can obtain CT images with high spatial resolution and lower noise without special CT equipments, and will help diagnose coronary artery disease in CCTA and other CT examinations that require high spatial resolution