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Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques

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Abstract

Objectives

To evaluate image quality (IQ) of low-radiation-dose paediatric cardiovascular CT angiography (CTA), comparing iterative reconstruction in image space (IRIS) and sinogram-affirmed iterative reconstruction (SAFIRE) with filtered back-projection (FBP) and estimate the potential for further dose reductions.

Methods

Forty neonates and children underwent low radiation CTA with or without ECG synchronisation. Data were reconstructed with FBP, IRIS and SAFIRE. For ECG-synchronised studies, half-dose image acquisitions were simulated. Signal noise was measured and IQ graded. Effective dose (ED) was estimated.

Results

Mean absolute and relative image noise with IRIS and full-dose SAFIRE was lower than with FBP (P < 0.001), while SNR and CNR were higher (P < 0.001). Image noise was also lower and SNR and CNR higher in half-dose SAFIRE studies compared with full-and half-dose FBP studies (P < 0.001). IQ scores were higher for IRIS, full-dose SAFIRE and half-dose SAFIRE than for full-dose FBP and higher for half-dose SAFIRE than for half-dose FBP (P < 0.05). Median weight-specific ED was 0.3 mSv without and 1.36 mSv with ECG synchronisation. The estimated ED of half-dose SAFIRE studies was 0.68 mSv.

Conclusions

IR improves image noise, SNR, CNR and subjective IQ compared with FBP in low-radiation-dose paediatric CTA and allows further dose reductions without compromising diagnostic IQ.

Key Points

• Iterative reconstruction techniques significantly improve non-invasive cardiovascular CT in children.

• Using half traditional radiation dose image quality is higher with iterative reconstruction.

• Iterative reconstruction techniques may allow further radiation reductions in paediatric cardiovascular CT.

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Abbreviations

CNR:

Contrast/Noise Ratio

CTA:

CT angiography

ECG:

Electrocardiogram

ED:

Effective radiation dose equivalent

FBP:

Filtered back projection

HU:

Hounsfield units

IQ:

Image quality

IRIS:

Iterative reconstruction in image space

ROI:

Region of interest

SAFIRE:

Sinogram affirmed iterative reconstruction

SD:

Standard deviation

SNR:

Signal-to-noise ratio

VRT:

Volume-rendered technique

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Acknowledgements

UJS is a consultant for and receives research support from Bayer, Bracco, GE, Medrad and Siemens. The other authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC, 29401, USA

    Francesco Tricarico, Anthony M. Hlavacek, U. Joseph Schoepf, Ullrich Ebersberger, John W. Nance Jr., Rozemarijn Vliegenthart, Young Jun Cho, J. Reid Spears, Francesco Secchi & Paul Apfaltrer

  2. Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, “A. Gemelli” Hospital, Rome, Italy

    Francesco Tricarico, Giancarlo Savino, Riccardo Marano & Lorenzo Bonomo

  3. Division of Pediatric Cardiology, Children’s Hospital, Medical University of South Carolina, Charleston, SC, USA

    Anthony M. Hlavacek & U. Joseph Schoepf

  4. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    U. Joseph Schoepf

  5. Department of Cardiology and Intensive Care Medicine, Heart Centre Munich-Bogenhausen, Munich, Germany

    Ullrich Ebersberger

  6. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA

    John W. Nance Jr.

  7. Centre for Medical Imaging—North East Netherlands, Department of Radiology, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands

    Rozemarijn Vliegenthart

  8. Department of Radiology, Konyang University School of Medicine, Daejeon, Republic of Korea

    Young Jun Cho

  9. Department of Medical and Surgical Sciences, Radiology Unit, University of Milan School of Medicine IRCCS Policlinico San Donato, Milan, Italy

    Francesco Secchi

  10. Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim—Heidelberg University, Mannheim, Germany

    Stefan O. Schoenberg & Paul Apfaltrer

Authors
  1. Francesco Tricarico
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  2. Anthony M. Hlavacek
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  3. U. Joseph Schoepf
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  7. Young Jun Cho
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  9. Francesco Secchi
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  13. Lorenzo Bonomo
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  14. Paul Apfaltrer
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Corresponding author

Correspondence to U. Joseph Schoepf.

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Tricarico, F., Hlavacek, A.M., Schoepf, U.J. et al. Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques. Eur Radiol 23, 1306–1315 (2013). https://doi.org/10.1007/s00330-012-2734-5

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  • DOI: https://doi.org/10.1007/s00330-012-2734-5

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