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Research ArticlePatient Safety

Can Iterative Reconstruction Improve Imaging Quality for Lower Radiation CT Perfusion? Initial Experience

C.J. Lin, T.H. Wu, C.H. Lin, S.C. Hung, C.F. Chiu, M.-J. Liu, M.M.H. Teng, F.C. Chang, W.Y. Guo and C.Y. Chang
American Journal of Neuroradiology August 2013, 34 (8) 1516-1521; DOI: https://doi.org/10.3174/ajnr.A3436
C.J. Lin
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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T.H. Wu
cDepartment of Biomedical Imaging and Radiological Sciences (T.H.W.), National Yang-Ming University, Taipei, Taiwan
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C.H. Lin
dGraduate Institute of Epidemiology and Preventive Medicine (C.H.L.), National Taiwan University, Taipei, Taiwan.
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S.C. Hung
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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C.F. Chiu
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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M.-J. Liu
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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M.M.H. Teng
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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F.C. Chang
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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W.Y. Guo
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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C.Y. Chang
aFrom the Department of Radiology (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
bSchool of Medicine (C.J.L., S.C.H., C.F.C., M.-J.L., M.M.H.T., F.C.C., W.Y.G., C.Y.C.)
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    Fig 1.

    The imaging plane for 5 ROIs: frontal white matter (ROI1), caudate nucleus (ROI2), lentiform nucleus (ROI3), thalamus (ROI4), and occipital white matter (ROI5).

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    Fig 2.

    CBV (A), CBF (B), and MTT (C) of lower dose CTP (tube current is 80 mAs, group B) in a 61-year-old man, 6 months after receiving a right carotid artery stent.

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    Fig 3.

    The mean SNR of individual ROIs in axial-enhanced imaging at Tmax reconstructed by IR and FBP in groups A and B (group A: 100 mAs with FBP; group A: 100 mAs with IR; group B: 80 mAs with FBP; group B: 80 mAs with IR. Asterisk indicates P value < .001).

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    Fig 4.

    The mean values of individual ROIs in CBV (A), CBF (B), and MTT (C) reconstructed by IR and FBP (x-axis: mean value of IR; y-axis: mean value of FBP).

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    Fig 5.

    The correlation SNR of individual regions of interest in CBV (A), CBF(B), and MTT (C) reconstructed by IR and FBP (x-axis: SNR of IR; y-axis: SNR of FBP).

Tables

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    Table 1:

    Patient characteristics and radiation dose in CT protocols with standard and low tube currents

    Subject CharacteristicGroup A (Tube Current = 100 mAs)Group B (Tube Current = 80 mAs)P Value
    Age74.974.2.48
    Sex (M/F)14/614/61
    Tmax (second)12.5 + 2.3412.3 + 2.83..53
    Maximium HU of A2a159.84177.6.13
    CTDI (mGy)153.56 + 0.03128.17 + 0.03<.001
    DLP (mGy/cm)1229 + 0.26985 + 0.6<.001
    Effective dose (mSv)2.56 mSv2.06 mSv<.001
    • Note:— Tmax indicates the time point of maximal enhancement of anterior cerebral artery; DLP, dose-length product.

    • ↵a A2 indicates second portion of anterior cerebral artery.

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    Table 2:

    General linear regression of SNR in CBV, CBF, and MTT values among different tube currents, locations, reconstructive algorithms, and peak arterial and venous enhancement

    SNR of CBFSNR of CBVSNR of MTT
    Standardized EstimateP ValueStandardized EstimateP ValueStandardized EstimateP Value
    80 mAsa0.043.4120.016.747−0.121.031d
    IR reconstructionb−0.008.8720.002.6550.007.887
    Gray matterc0.443<.001d0.515<.001d−0.203<.001d
    Peak enhancement of arterial ROI0.055.2860.064.195−.178.001d
    Peak enhancement of venous ROI0.017.7540.043.408−0.163.005d
    • ↵a The control group has a tube current of 100 mAs.

    • ↵b The control group is processed by FBP.

    • ↵c The control group is ROI white matter, including ROI1 and ROI5; the experimental group is ROI gray matter including ROI2, ROI3, and ROI4.

    • ↵d Statistically significant (P < .05).

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    Table 3:

    Mean imaging score of CBV, CBF, and MTT reconstructed by IR and FBP in groups A and B

    CBV ScoreCBF ScoreMTT Score
    IR
        Group A (100 mAs)5.5 ± 1.74.2 + 2.03.5 ± 1.4
        Group B (80 mAs)5.5 ± 1.94.1 ± 2.13.5 ± 1.5
    FBP
        Group A (100 mAs)5.3 ± 1.83.6 ± 2.13.4 ± 1.5
        Group B (80 mAs)5.2 ± 1.93.6 ± 2.03.5 ± 1.4
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American Journal of Neuroradiology: 34 (8)
American Journal of Neuroradiology
Vol. 34, Issue 8
1 Aug 2013
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C.J. Lin, T.H. Wu, C.H. Lin, S.C. Hung, C.F. Chiu, M.-J. Liu, M.M.H. Teng, F.C. Chang, W.Y. Guo, C.Y. Chang
Can Iterative Reconstruction Improve Imaging Quality for Lower Radiation CT Perfusion? Initial Experience
American Journal of Neuroradiology Aug 2013, 34 (8) 1516-1521; DOI: 10.3174/ajnr.A3436

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Can Iterative Reconstruction Improve Imaging Quality for Lower Radiation CT Perfusion? Initial Experience
C.J. Lin, T.H. Wu, C.H. Lin, S.C. Hung, C.F. Chiu, M.-J. Liu, M.M.H. Teng, F.C. Chang, W.Y. Guo, C.Y. Chang
American Journal of Neuroradiology Aug 2013, 34 (8) 1516-1521; DOI: 10.3174/ajnr.A3436
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