Rationale and Objectives
This study aims to compare the image quality of coronary artery stent scans on computed tomography images reconstructed with forward projected model-based iterative reconstruction solution (FIRST) and adaptive iterative dose reduction 3D (AIDR 3D).
Materials and Methods
Coronary computed tomography angiography scans of 23 patients with 32 coronary stents were used. The images were reconstructed with AIDR 3D and FIRST. We generated computed tomography attenuation profiles across the stents and measured the width of the edge rise distance and the edge rise slope (ERS). We also calculated the stent lumen attenuation increase ratio (SAIR) and measured visible stent lumen diameters. Two radiologists visually evaluated the image quality of the stents using a 4-point scale (1 = poor, 4 = excellent).
Results
There was no significant difference in the edge rise distance between the two reconstruction methods ( P = 0.36). The ERS on FIRST images was greater than the ERS on AIDR 3D images (325.2 HU/mm vs 224.4 HU/mm; P < 0.01). The rate of the visible stent lumen diameter compared to the true diameter on FIRST images was higher than that on AIDR 3D images (51.4% vs 47.3%, P < 0.01). The SAIR on FIRST images was lower than the SAIR on AIDR 3D images (0.19 vs 0.30, P < 0.01). The mean image quality scores for AIDR 3D and FIRST images were 3.18 and 3.63, respectively; the difference was also significant ( P < 0.01).
Conclusion
The image quality of coronary artery stent scans is better on FIRST than on AIDR 3D images.
Introduction
Coronary computed tomography angiography (CTA) is a suitable noninvasive imaging modality for patient follow-up after coronary artery stent implantation . However, blooming artifacts from stent struts limit the evaluation of stent lumens . These artifacts primarily arise from partial volume averaging and beam hardening; stent struts appear thicker than they are and often overlap the vessel lumen , which complicates assessment of coronary artery stent patency.
Advances in computer processing hardware have made it possible to use the iterative reconstruction (IR) algorithm in the clinical setting for computed tomography (CT) studies. Hybrid IR, which applies noise reduction techniques to the raw data and image domains, has been shown to be superior to conventional filtered back projection (FBP) because it reduces blooming artifacts and improves the image quality of coronary artery stent scans . Model-based IR has been introduced as a new reconstruction algorithm. The advantage of model-based IR is higher spatial resolution compared to images reconstructed with conventional FBP or hybrid IR , and its sophisticated modeling is expected to reduce blooming artifacts and improve the image quality compared to hybrid IR.
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Materials and Methods
Patients
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CT Scanning
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Quantitative Analysis
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Sharpness of the Stent Struts
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Attenuation Effects of the Stent Struts
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Image Noise
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Qualitative Analysis
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Statistical Analyses
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Results
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TABLE 1
Stent Characteristics
Name Manufacturer Material Nominal Stent Diameter (mm) 2.5 2.75 3.0 3.5 4.0 Xience Abbott Vascular Stainless steel 1 2 2 3 3 Cypher Cordis Stainless steel 1 0 3 1 0 Integrity Medtronic Cobalt-chromium alloy 0 1 2 1 1 Nobori Terumo Stainless steel 1 0 1 2 0 Driver Medtronic Cobalt-chromium alloy 0 1 0 2 1 Multi-Link 8 Abbott Cobalt-chromium alloy 0 0 0 2 0 Taxus Boston Scientific Stainless steel 0 0 0 1 0 Total 3 4 8 12 5
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TABLE 2
Overall Quantitative Image Quality Parameters
AIDR 3D FIRST_P_ ERD mean (mm) 0.67 (0.30–1.64) 0.69 (0.45–1.64) 0.36 ERS mean (HU/mm) 224.4 (46.4–477.1) 325.2 (61.9–876.4) <0.01 SAIR 0.30 (0.04–1.08) 0.19 (0.01–0.55) <0.01 Visible diameter (%) 47.3 (31.4–76.4) 51.4 (36.0–80.0) <0.01 Image noise (HU) 24.6 (19.2–31.9) 23.4 (19.9–28.3) 0.17
AIDR 3D, adaptive iterative dose reduction 3D; ERD, edge rise distance; ERS, edge rise slope; FIRST, forward projected model-based iterative reconstruction solution; SAIR, stent lumen attenuation increase ratio.
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Discussion
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