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Validation of deep-learning image reconstruction for coronary computed tomography angiography: Impact on noise, image quality and diagnostic accuracy

Published:January 13, 2020DOI:https://doi.org/10.1016/j.jcct.2020.01.002

      Abstract

      Background

      Advances in image reconstruction are necessary to decrease radiation exposure from coronary CT angiography (CCTA) further, but iterative reconstruction has been shown to degrade image quality at high levels. Deep-learning image reconstruction (DLIR) offers unique opportunities to overcome these limitations. The present study compared the impact of DLIR and adaptive statistical iterative reconstruction-Veo (ASiR-V) on quantitative and qualitative image parameters and the diagnostic accuracy of CCTA using invasive coronary angiography (ICA) as the standard of reference.

      Methods

      This retrospective study includes 43 patients who underwent clinically indicated CCTA and ICA. Datasets were reconstructed with ASiR-V 70% (using standard [SD] and high-definition [HD] kernels) and with DLIR at different levels (i.e., medium [M] and high [H]). Image noise, image quality, and coronary luminal narrowing were evaluated by three blinded readers. Diagnostic accuracy was compared against ICA.

      Results

      Noise did not significantly differ between ASiR-V SD and DLIR-M (37 vs. 37 HU, p = 1.000), but was significantly lower in DLIR-H (30 HU, p < 0.001) and higher in ASiR-V HD (53 HU, p < 0.001). Image quality was higher for DLIR-M and DLIR-H (3.4–3.8 and 4.2–4.6) compared to ASiR-V SD and HD (2.1–2.7 and 1.8–2.2; p < 0.001), with DLIR-H yielding the highest image quality. Consistently across readers, no significant differences in sensitivity (88% vs. 92%; p = 0.453), specificity (73% vs. 73%; p = 0.583) and diagnostic accuracy (80% vs. 82%; p = 0.366) were found between ASiR-V HD and DLIR-H.

      Conclusion

      DLIR significantly reduces noise in CCTA compared to ASiR-V, while yielding superior image quality at equal diagnostic accuracy.

      Keywords

      Abbreviations:

      CCTA (Coronary Computed Tomography Angiography), ASiR-V (Adaptive Statistical Iterative Reconstruction-Veo), ASiR-V SD (ASiR-V With Standard Definition Kernel), ASiR-V HD (ASiR-V With High Definition Kernel), DLIR (Deep-Learning Image Reconstruction), DLIR-M (DLIR at Medium Level), DLIR-H (DLIR at High Level), ICA (Invasive Coronary Angiography)
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