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- Title
A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography.
- Authors
Mangold, Stefanie; Schoepf, U.; Caruso, Damiano; Vogl, Thomas; Wichmann, Julian; De Cecco, Carlo; Yamada, Ricardo; Varga-Szemes, Akos; Stubenrauch, Andrew; Fuller, Stephen; Nikolaou, Konstantin; Todoran, Thomas; De Cecco, Carlo N; Schoepf, U Joseph; Yamada, Ricardo T; Stubenrauch, Andrew C; Fuller, Stephen R; Vogl, Thomas J; Todoran, Thomas M; Wichmann, Julian L
- Abstract
<bold>Purpose: </bold>To evaluate the impact of noise-optimized virtual monochromatic imaging (VMI+) on stent visualization and accuracy for in-stent re-stenosis at lower extremity dual-energy CT angiography (DE-CTA).<bold>Material and Methods: </bold>We evaluated third-generation dual-source DE-CTA studies in 31 patients with prior stent placement. Images were reconstructed with linear blending (F_0.5) and VMI+ at 40-150 keV. In-stent luminal diameter was measured and contrast-to-noise ratio (CNR) calculated. Diagnostic confidence was determined using a five-point scale. In 21 patients with invasive catheter angiography, accuracy for significant re-stenosis (≥50 %) was assessed at F_0.5 and 80 keV-VMI+ chosen as the optimal energy level based on image-quality analysis.<bold>Results: </bold>At CTA, 45 stents were present. DSA was available for 28 stents whereas 12 stents showed significant re-stenosis. CNR was significantly higher with ≤80 keV-VMI+ (17.9 ± 6.4-33.7 ± 12.3) compared to F_0.5 (16.9 ± 4.8; all p < 0.0463); luminal stent diameters were increased at ≥70 keV (5.41 ± 1.8-5.92 ± 1.7 vs. 5.27 ± 1.8, all p < 0.001) and diagnostic confidence was highest at 70-80 keV-VMI+ (4.90 ± 0.48-4.88 ± 0.63 vs. 4.60 ± 0.66, p = 0.001, 0.0042). Sensitivity, negative predictive value and accuracy for re-stenosis were higher with 80 keV-VMI+ (100, 100, 96.4 %) than F_0.5 (90.9, 94.1, 89.3 %).<bold>Conclusion: </bold>80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA.<bold>Key Points: </bold>• The impact of noise-optimized virtual monochromatic imaging on stent visualization was assessed. • Virtual monochromatic imaging significantly improves stent lumen visualization and diagnostic confidence. • At 80 keV diagnostic performance for detection of in-stent restenosis was increased. • 80 keV virtual monochromatic images are recommended for stent evaluation of lower extremity vasculature.
- Subjects
ANGIOGRAPHY; DUAL-energy X-ray absorptiometry; IMAGE reconstruction; DIAGNOSTIC imaging; SURGICAL stents; ISCHEMIA treatment; ALGORITHMS; ISCHEMIA; LEG; COMPUTERS in medicine; RESEARCH evaluation; SURGICAL complications; VASCULAR grafts
- Publication
European Radiology, 2016, Vol 26, Issue 12, p4380
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-016-4304-8