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01-12-2016 | Computer Applications

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: Stefanie Mangold, Carlo N. De Cecco, U. Joseph Schoepf, Ricardo T. Yamada, Akos Varga-Szemes, Andrew C. Stubenrauch, Damiano Caruso, Stephen R. Fuller, Thomas J. Vogl, Konstantin Nikolaou, Thomas M. Todoran, Julian L. Wichmann

Published in: European Radiology | Issue 12/2016

Abstract

Purpose

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).

Material and methods

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.

Results

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 %).

Conclusion

80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA.

Key Points

• 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.

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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: Stefanie Mangold
Carlo N. De Cecco
U. Joseph Schoepf
Ricardo T. Yamada
Akos Varga-Szemes
Andrew C. Stubenrauch
Damiano Caruso
Stephen R. Fuller
Thomas J. Vogl
Konstantin Nikolaou
Thomas M. Todoran
Julian L. Wichmann
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 12/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4304-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Material and methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Material and methods

Results

Conclusion

Key Points

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