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Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction.

Purpose: To prospectively compare traditional filtered back projection (FBP) and iterative image reconstruction for the evaluation of heavily calcified arteries with coronary computed tomography (CT) angiography. Materials and Methods: The study had institutional review board approval and was HIPAA...

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Published in:Radiology Vol. 260; no. 2; pp. 390 - 400
Main Authors: Renker M, Nance JW Jr, Schoepf UJ, O'Brien TX, Zwerner PL, Meyer M, Kerl JM, Bauer RW, Fink C, Vogl TJ, Henzler T, Renker, Matthias, Nance, John W Jr, Schoepf, U Joseph, O'Brien, Terrence X, Zwerner, Peter L, Meyer, Mathias, Kerl, J Matthias, Bauer, Ralf W, Fink, Christian
Format: research Journal Article
Published: Wolters Kluwer Health 2011 Aug
Online Access:View this record in EBSCOhost
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      dt: 2011 Aug
      vid: 260
      iid: 2
      pid: 79357
      pub: Wolters Kluwer Health
      place: New York, New York
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        108243055
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        atl: Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction.
      aug:
        au:
          Renker M
          Nance JW Jr
          Schoepf UJ
          O'Brien TX
          Zwerner PL
          Meyer M
          Kerl JM
          Bauer RW
          Fink C
          Vogl TJ
          Henzler T
          Renker, Matthias
          Nance, John W Jr
          Schoepf, U Joseph
          O'Brien, Terrence X
          Zwerner, Peter L
          Meyer, Mathias
          Kerl, J Matthias
          Bauer, Ralf W
          Fink, Christian
        affil: Heart and Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260, USA
      sug:
        subj:
          Calcinosis Radiography
          Coronary Angiography Methods
          Coronary Stenosis Radiography
          Radiographic Image Interpretation, Computer-Assisted Methods
          Tomography, X-Ray Computed
          Analysis of Variance
          Artifacts
          Chi Square Test
          Contrast Media Diagnostic Use
          Electrocardiography
          Female
          Contrast Media
          Male
          Middle Age
          Prospective Studies
          Sensitivity and Specificity
          Middle Aged: 45-64 years
          Female
          Male
      ab: Purpose: To prospectively compare traditional filtered back projection (FBP) and iterative image reconstruction for the evaluation of heavily calcified arteries with coronary computed tomography (CT) angiography. Materials and Methods: The study had institutional review board approval and was HIPAA compliant. Written informed consent was obtained from all patients. Fifty-five consecutive patients (35 men, 20 women; mean age, 58 years ± 12 [standard deviation]) with Agatston scores of at least 400 underwent coronary CT angiography and cardiac catheterization. Image data were reconstructed with both FBP and iterative reconstruction techniques with corresponding cardiac algorithms. Image noise and subjective image quality were compared. To objectively assess the effect of FBP and iterative reconstruction on blooming artifacts, volumes of circumscribed calcifications were measured with dedicated volume analysis software. FBP and iterative reconstruction series were independently evaluated for coronary artery stenosis greater than 50%, and their diagnostic accuracy was compared, with cardiac catheterization as the reference standard. Statistical analyses included paired t tests, Kruskal-Wallis analysis of variance, and a modified McNemar test. Results: Image noise measured significantly lower (P = .011-.035) with iterative reconstruction instead of FBP. Image quality was rated significantly higher (P = .031 and .042) with iterative reconstruction series than with FBP. Calcification volumes measured significantly lower (P = .019 and .026) with iterative reconstruction (44.3 mm(3) ± 64.7 and 46.2 mm(3) ± 68.8) than with FBP (54.5 mm(3) ± 69.5 and 56.3 mm(3) ± 72.5). Iterative reconstruction significantly improved some measures of per-segment diagnostic accuracy of coronary CT angiography for the detection of significant stenosis compared with FBP (accuracy: 95.9% vs 91.8%, P = .0001; specificity: 95.8% vs 91.2%, P = .0001; positive predictive value: 76.9% vs 61.1%, P = .0001). Conclusion: Iterative reconstruction reduces image noise and blooming artifacts from calcifications, leading to improved diagnostic accuracy of coronary CT angiography in patients with heavily calcified coronary arteries.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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