Low dose dynamic myocardial CT perfusion using advanced iterative reconstruction

Brendan L. Eck; Rachid Fahmi; Christopher Fuqua; Mani Vembar; Amar Dhanantwari; Hiram G. Bezerra; David L. Wilson

doi:10.1117/12.2081418

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19 March 2015 Low dose dynamic myocardial CT perfusion using advanced iterative reconstruction

Brendan L. Eck; Rachid Fahmi; Christopher Fuqua; Mani Vembar; Amar Dhanantwari; Hiram G. Bezerra; David L. Wilson

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Proceedings Volume 9417, Medical Imaging 2015: Biomedical Applications in Molecular, Structural, and Functional Imaging; 94170Z (2015) https://doi.org/10.1117/12.2081418
Event: SPIE Medical Imaging, 2015, Orlando, Florida, United States

Abstract

Dynamic myocardial CT perfusion (CTP) can provide quantitative functional information for the assessment of coronary artery disease. However, x-ray dose in dynamic CTP is high, typically from 10mSv to >20mSv. We compared the dose reduction potential of advanced iterative reconstruction, Iterative Model Reconstruction (IMR, Philips Healthcare, Cleveland, Ohio) to hybrid iterative reconstruction (iDose⁴) and filtered back projection (FBP). Dynamic CTP scans were obtained using a porcine model with balloon-induced ischemia in the left anterior descending coronary artery to prescribed fractional flow reserve values. High dose dynamic CTP scans were acquired at 100kVp/100mAs with effective dose of 23mSv. Low dose scans at 75mAs, 50mAs, and 25mAs were simulated by adding x-ray quantum noise and detector electronic noise to the projection space data. Images were reconstructed with FBP, iDose⁴, and IMR at each dose level. Image quality in static CTP images was assessed by SNR and CNR. Blood flow was obtained using a dynamic CTP analysis pipeline and blood flow image quality was assessed using flow-SNR and flow-CNR. IMR showed highest static image quality according to SNR and CNR. Blood flow in FBP was increasingly over-estimated at reduced dose. Flow was more consistent for iDose⁴ from 100mAs to 50mAs, but was over-estimated at 25mAs. IMR was most consistent from 100mAs to 25mAs. Static images and flow maps for 100mAs FBP, 50mAs iDose⁴, and 25mAs IMR showed comparable, clear ischemia, CNR, and flow-CNR values. These results suggest that IMR can enable dynamic CTP at significantly reduced dose, at 5.8mSv or 25% of the comparable 23mSv FBP protocol.

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Brendan L. Eck, Rachid Fahmi, Christopher Fuqua, Mani Vembar, Amar Dhanantwari, Hiram G. Bezerra, and David L. Wilson "Low dose dynamic myocardial CT perfusion using advanced iterative reconstruction", Proc. SPIE 9417, Medical Imaging 2015: Biomedical Applications in Molecular, Structural, and Functional Imaging, 94170Z (19 March 2015); https://doi.org/10.1117/12.2081418

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