Non-inferior low-dose coronary computed tomography angiography image quality with knowledge-based iterative model reconstruction for overweight patients

In Kyung Park, Jeffrey Park, Tae Hoon Kim, Joohee Lee, Kyunghwa Han, Chisuk Oh, Chul Hwan Park, In Kyung Park, Jeffrey Park, Tae Hoon Kim, Joohee Lee, Kyunghwa Han, Chisuk Oh, Chul Hwan Park

Abstract

We investigated the feasibility of low-dose coronary computed tomography angiography (CCTA), using a prospective electrocardiogram (ECG)-triggered axial scan protocol, knowledge-based iterative model reconstruction (IMR), and fixed tube current, in overweight subjects. Forty non-overweight (group A; body-mass index [BMI] < 25 kg/m2) and 40 overweight individuals (group B; BMI = 25-30 kg/m2), who underwent CCTA for coronary artery disease screening, were retrospectively and consecutively enrolled. A 64-slice CT scanner was used at 100-kVp tube voltage and 150-mA tube current, and images were reconstructed using IMR techniques. Image noise, attenuation at the aorta, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) at the proximal right and left main coronary arteries (pRCA and LMCA) were calculated. CCTA images were qualitatively evaluated using a four-point scale (1, poor; 4, excellent) and analyzed using a non-inferiority test with a pre-defined non-inferiority margin of -0.2. The mean CCTA radiation dose (Group A: 1.33 ± 0.02 mSv; Group B: 1.35 ± 0.10 mSv; p = 0.151) and mean aortic root CT attenuation values (Group A: 447.9 ± 81.6 HU; Group B: 439.5 ± 63.6 HU; p = 0.571) did not differ significantly between the two groups. The mean noise in groups A and B was 26.0 ± 4.8 HU and 29.2 ± 4.4 HU, respectively (p = 0.005). The noise reduction ratio in the groups, compared to filtered back projection, was 65.0% and 68.1%, respectively. The mean grade of image quality did not differ significantly (3.75 ± 0.04 vs. 3.71 ± 0.04, p = 0.478). Group B CCTA image quality was non-inferior (mean difference = -0.043, 95% CI = -0.162-0.077) to that of Group A. We concluded that low-dose CCTA with prospective ECG-triggering and IMR might be applied to overweight subjects, as well as to normal-weight subjects, by using a fixed tube current without an increase in tube current based on the patient's body size.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Image noise in CCTA with…
Fig 1. Image noise in CCTA with FBP reconstruction and IMR reconstruction.
Image noise was calculated as the standard deviation of attenuation at the ascending aorta. The mean noise of 80 CCTA images were 82.5 ± 17.7 with FBP reconstruction, and 27.6 ± 4.8 with IMR reconstruction. The mean noise reduction ratio of IMR compared to FBP in 80 patients was 65.0% in Group A (non-overweight; BMI 2) and 68.1% in Group B (overweight; BMI 25–30 kg/m2). BMI: body mass index. CCTA: coronary computed tomography angiography. IMR: iterative model reconstruction. FBP: filtered back projection.
Fig 2. Representative CCTA Images with Different…
Fig 2. Representative CCTA Images with Different Image Reconstruction.
Curved multiplanar images of the right coronary artery taken at 100 kVp, 150 mAs, with prospective ECG-triggering, and IMR reconstruction in subjects with BMI of (a) 22.1 kg/m2, (b) 27.5 kg/m2, and (c) 29.4 kg/m2. The images show good image quality with similar image noise and attenuation, irrespective of BMI. BMI: Body mass index. CCTA: coronary computed tomography angiography. ECG: electrocardiogram. FBP: filtered back projection. IMR: iterative model reconstruction.

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