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High pitch, low voltage dual source CT pulmonary angiography: assessment of image quality and diagnostic acceptability with hybrid iterative reconstruction

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Abstract

Increased use of CT Pulmonary angiography in suspected pulmonary embolism (PE) has driven research to minimize radiation dose while maintaining image quality and diagnostic accuracy. Following institutional review board approval, we performed a retrospective comparison study in patients with suspected PE. Patients were scanned using an ultra high pitch dual source technique (pitch = 2.6) using 120 kV (SVCTPA) (n = 54) or 100 kV (RV-CTPA) (n = 52). SV-CTPA images were reconstructed using filtered back projection (SV-wFBP) and RV-CTPA images were reconstructed using both FBP (RV-wFBP) and Iterative Reconstruction (RV-IR). Comparison of radiation dose, diagnostic ability, subjective image noise, quality, and sharpness, diagnostic agreement, signal to noise (SNR) and contrast to noise ratios (CNR) were performed. Mean effective dose was 2.56 ± 0.19 mSv for the RV protocol compared to 5.36 ± 0.60 mSv for the SV. The RV-CTPA protocol resulted in a mean DLP reduction of 52 % and mean CTDI reduction of 51 %. Pulmonary artery SNR and CNR were significantly higher on RV-IR images than SV-wFBP (p = 0.007, p = 0.003). Mean subjective image noise, quality and sharpness scores did not differ significantly between the SV-wFBP and RVIR images (p > 0.05). Subjective quality scores were significantly better for the RV-IR group compared to the RV-wFBP group (p < 0.001). Agreement between readers for presence or absence of pulmonary emboli on RV-IR images was almost perfect (κ = 0.891, p < 0.001). Iterative reconstruction complements ultra high pitch dual source CTPA examinations acquired using a reduced voltage resulting in higher mean pulmonary artery SNR and CNR when compared to both RV-wFBP and SV-CTPA.

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References

  1. Tapson VF (2008) Acute pulmonary embolism. N Engl J Med 358(10):1037–52

    Article  CAS  PubMed  Google Scholar 

  2. Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353(9162):1386–9

    Article  CAS  PubMed  Google Scholar 

  3. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e419S–94S

    PubMed Central  CAS  PubMed  Google Scholar 

  4. Lucassen W, Geersing G-J, Erkens PMG, Reitsma JB, Moons KGM, Büller H et al (2011) Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 155(7):448–60

    Article  PubMed  Google Scholar 

  5. Costa AF, Basseri H, Sheikh A, Stiell I, Dennie C (2014) The yield of CT pulmonary angiograms to exclude acute pulmonary embolism. Emerg Radiol 21(2):133–41

  6. Komissarova M, Chong S, Frey K, Sundaram B (2013) Imaging of acute pulmonary embolism. Emerg Radiol 20(2):89–101

  7. Bettmann MA, Boxt LM, Gomes AS, Grollman J (2000) Acute chest pain—suspected pulmonary embolism. American College of Radiology. ACR Appropriateness Criteria. Radiology

  8. Hou DJ, Tso DK, Davison C, Inacio J, Louis LJ, Nicolaou S, et al (2013) Clinical utility of ultra high pitch dual source thoracic CT imaging of acute pulmonary embolism in the emergency department: are we one step closer towards a non-gated triple rule out? Eur J Radiol 82(10):1793–8

  9. Sodickson A, Weiss M (2012) Effects of patient size on radiation dose reduction and image quality in low-kVp CT pulmonary angiography performed with reduced IV contrast dose. Emerg Radiol 19(5):437–45

  10. Heyer CM, Mohr PS, Lemburg SP, Peters SA, Nicolas V (2007) Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Radiology 245(2):577–83

  11. Fanous R, Kashani H, Jimenez L, Murphy G, Paul NS (2012) Image quality and radiation dose of pulmonary CT angiography performed using 100 and 120 kVp. Am J Roentgenol 199(5):990–6

  12. Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M, Herold CJ, Prokop M (2006) CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 241(3):899–907

  13. Leipsic J, Nguyen G, Brown J, Sin D, Mayo JR (2010) A prospective evaluation of dose reduction and image quality in chest CT using adaptive statistical iterative reconstruction. Am J Roentgenol 195(5):1095–9

  14. Singh S, Kalra MK, Gilman MD, Hsieh J, Pien HH, Digumarthy SR et al (2011) Adaptive statistical iterative reconstruction technique for radiation dose reduction in chest CT: a pilot study. Radiology 259(2):565–73

  15. Baumueller S, Winklehner A, Karlo C, Goetti R, Flohr T, Russi EW et al (2012) Low-dose CT of the lung: potential value of iterative reconstructions. Eur Radiol

  16. Cornfeld D, Israel G, Detroy E, Bokhari J, Mojibian H (2011) Impact of Adaptive Statistical Iterative Reconstruction (ASIR) on radiation dose and image quality in aortic dissection studies: a qualitative and quantitative analysis. Am J Roentgenol 196(3):W336–40

  17. Wang R, Schoepf UJ, Wu R, Gibbs KP, Yu W, Li M et al (2012) CT coronary angiography: image quality with sinogram-affirmed iterative reconstruction compared with filtered back-projection. Clin Radiol

  18. Han BK, Grant KLR, Garberich R, Sedlmair M, Lindberg J, Lesser JR (2012) Assessment of an iterative reconstruction algorithm (SAFIRE) on image quality in pediatric cardiac CT datasets. J Cardiovasc Comput Tomogr 6(3):200–4

  19. Paul J, Krauss B, Banckwitz R, Maentele W, Bauer RW, Vogl TJ (2012) Relationships of clinical protocols and reconstruction kernels with image quality and radiation dose in a 128-slice CT scanner: study with an anthropomorphic and water phantom. Eur J Radiol 81(5):e699–703

  20. Co SJ, Mayo J, Liang T, Krzymyk K, Yousefi M, Nicolaou S (2013) Iterative reconstructed ultra high pitch CT pulmonary angiography with cardiac bowtie-shaped filter in the acute setting: effect on dose and image quality. Eur J Radiol 82(9):1571–6

  21. Bongartz G, Golding S, Jurik A, Leonardi M, Van Meerten E, Geleijns J et al (1999) European guidelines on quality criteria for computed tomography. European Commission

  22. Schulz B, Jacobi V, Beeres M, Bodelle B, Gruber T, Lee C et al (2012) Quantitative analysis of motion artifacts in high-pitch dual-source computed tomography of the thorax. J Thorac Imaging 27(6):382–6

  23. Flohr TG, Leng S, Yu L, Aiimendinger T, Bruder H, Petersilka M et al (2009) Dual-source spiral CT with pitch up to 3.2 and 75 ms temporal resolution: image reconstruction and assessment of image quality. Med Phys 36(12):5641–53

  24. Nelson RC, Feuerlein S, Boll DT (2011) New iterative reconstruction techniques for cardiovascular computed tomography: how do they work, and what are the advantages and disadvantages? J Cardiovasc Comput Tomogr 5(5):286–92

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Conflict of interest

A single author in this study (KK) is a research collaborations advisor with Siemens Healthcare. This author was involved in protocol optimization but was not involved in data collection, analysis or manuscript editing. All other authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada, V5Z 1M9

    Patrick D. McLaughlin, T. Liang, M. Homiedan, L. J. Louis, T. W. O’Connell, S. Nicolaou & J. R. Mayo

  2. CT Research Collaborations, Siemens Healthcare, Forchheim, Germany

    Karl Krzymyk

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  1. Patrick D. McLaughlin
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  2. T. Liang
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  3. M. Homiedan
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  4. L. J. Louis
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  5. T. W. O’Connell
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  6. Karl Krzymyk
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  7. S. Nicolaou
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  8. J. R. Mayo
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Correspondence to Patrick D. McLaughlin.

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McLaughlin, P.D., Liang, T., Homiedan, M. et al. High pitch, low voltage dual source CT pulmonary angiography: assessment of image quality and diagnostic acceptability with hybrid iterative reconstruction. Emerg Radiol 22, 117–123 (2015). https://doi.org/10.1007/s10140-014-1230-4

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  • DOI: https://doi.org/10.1007/s10140-014-1230-4

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