Skip to main content
SpringerLink
Log in

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

  • Computer Applications
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CNR:

Contrast-to-noise ratio

CTA:

CT angiography

CTDI:

CT dose index

DECT:

Dual-energy CT

DE-CTA:

Dual-energy CT angiography

DLP:

Dose-length product

DSA:

Digital subtraction angiography

DSCT:

Dual-source CT

F_0.5:

Linearly-blended images

HU:

Hounsfield Units

keV:

kilo-electron Volt

NPV:

Negative predictive value

PPV:

Positive predictive value

ROI:

Region of interest

SD:

Standard deviation

SNR:

Signal-to-noise ratio

VMI:

Virtual monochromatic imaging

VMI+:

Noise-optimized virtual monochromatic imaging

References

  1. Heijenbrok-Kal MH, Kock MC, Hunink MG (2007) Lower extremity arterial disease: multidetector CT angiography meta-analysis. Radiology 245:433–439

    Article  PubMed  Google Scholar 

  2. Kock MC, Adriaensen ME, Pattynama PM et al (2005) DSA versus multi-detector row CT angiography in peripheral arterial disease: randomized controlled trial. Radiology 237:727–737

    Article  PubMed  Google Scholar 

  3. Portugaller HR, Schoellnast H, Hausegger KA, Tiesenhausen K, Amann W, Berghold A (2004) Multislice spiral CT angiography in peripheral arterial occlusive disease: a valuable tool in detecting significant arterial lumen narrowing? Eur Radiol 14:1681–1687

    Article  PubMed  Google Scholar 

  4. Schernthaner R, Stadler A, Lomoschitz F et al (2008) Multidetector CT angiography in the assessment of peripheral arterial occlusive disease: accuracy in detecting the severity, number, and length of stenoses. Eur Radiol 18:665–671

    Article  CAS  PubMed  Google Scholar 

  5. Geyer LL, Glenn GR, De Cecco CN et al (2015) CT evaluation of small-diameter coronary artery stents: effect of an integrated circuit detector with iterative reconstruction. Radiology 276:706–714

    Article  PubMed  Google Scholar 

  6. Stehli J, Fuchs TA, Singer A et al (2015) First experience with single-source, dual-energy CCTA for monochromatic stent imaging. Eur Heart J Cardiovasc Imaging 16:507–512

    Article  PubMed  Google Scholar 

  7. Maintz D, Burg MC, Seifarth H et al (2009) Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT. Eur Radiol 19:42–49

    Article  PubMed  Google Scholar 

  8. Gassenmaier T, Petri N, Allmendinger T et al (2014) Next generation coronary CT angiography: in vitro evaluation of 27 coronary stents. Eur Radiol 24:2953–2961

    Article  PubMed  Google Scholar 

  9. Ulrich A, Burg MC, Raupach R et al (2015) Coronary stent imaging with dual-source CT: assessment of lumen visibility using different convolution kernels and postprocessing filters. Acta Radiol 56:42–50

    Article  PubMed  Google Scholar 

  10. von Spiczak J, Morsbach F, Winklhofer S et al (2013) Coronary artery stent imaging with CT using an integrated electronics detector and iterative reconstructions: first in vitro experience. J Cardiovasc Comput Tomogr 7:215–222

    Article  Google Scholar 

  11. Eisentopf J, Achenbach S, Ulzheimer S et al (2013) Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation. JACC Cardiovasc Imaging 6:458–465

    Article  PubMed  Google Scholar 

  12. Zhou Q, Jiang B, Dong F, Huang P, Liu H, Zhang M (2014) Computed tomography coronary stent imaging with iterative reconstruction: a trade-off study between medium kernel and sharp kernel. J Comput Assist Tomogr 38:604–612

    Article  PubMed  Google Scholar 

  13. Ebersberger U, Tricarico F, Schoepf UJ et al (2013) CT evaluation of coronary artery stents with iterative image reconstruction: improvements in image quality and potential for radiation dose reduction. Eur Radiol 23:125–132

    Article  PubMed  Google Scholar 

  14. Almutairi A, Sun Z, Al Safran Z, Poovathumkadavi A, Albader S, Ifdailat H (2015) Optimal scanning protocols for dual-energy CT angiography in peripheral arterial stents: an in vitro phantom study. Int J Mol Sci 16:11531–11549

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cui X, Li T, Li X, Zhou W (2015) High-definition computed tomography for coronary artery stents imaging: initial evaluation of the optimal reconstruction algorithm. Eur J Radiol 84:834–839

    Article  PubMed  Google Scholar 

  16. Renker M, Ramachandra A, Schoepf UJ et al (2011) Iterative image reconstruction techniques: applications for cardiac CT. J Cardiovasc Comput Tomogr 5:225–230

    Article  PubMed  Google Scholar 

  17. Mangold S CP, Schoepf UJ, Wichmann JL, Canstein C, Fuller SR, Muscogiuri G, Varga-Szemes A, Nikolaou K, De Cecco CN (2015) Impact of an advanced image-based monoenergetic reconstruction algorithm on coronary stent visualization using 3rd generation dual-source dual-energy CT: a phantom study. Eur Radiol

  18. Krauss B, Grant KL, Schmidt BT, Flohr TG (2015) The importance of spectral separation: an assessment of dual-energy spectral separation for quantitative ability and dose efficiency. Investig Radiol 50:114–118

    Article  Google Scholar 

  19. Meyer M, Haubenreisser H, Schoepf UJ et al (2014) Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 273:373–382

    Article  PubMed  Google Scholar 

  20. Grant KL, Flohr TG, Krauss B, Sedlmair M, Thomas C, Schmidt B (2014) Assessment of an advanced image-based technique to calculate virtual monoenergetic computed tomographic images from a dual-energy examination to improve contrast-to-noise ratio in examinations using iodinated contrast media. Investig Radiol 49:586–592

    Article  Google Scholar 

  21. Wichmann JL, Arbaciauskaite R, Kerl JM et al (2014) Evaluation of monoenergetic late iodine enhancement dual-energy computed tomography for imaging of chronic myocardial infarction. Eur Radiol 24:1211–1218

    Article  PubMed  Google Scholar 

  22. Beeres M, Trommer J, Frellesen C et al (2015) Evaluation of different keV-settings in dual-energy CT angiography of the aorta using advanced image-based virtual monoenergetic imaging. Int J Cardiovasc Imaging

  23. Sudarski S, Apfaltrer P, Nance JW Jr et al (2013) Optimization of keV-settings in abdominal and lower extremity dual-source dual-energy CT angiography determined with virtual monoenergetic imaging. Eur J Radiol 82:e574–e581

    Article  PubMed  Google Scholar 

  24. Wichmann JL, Gillott MR, De Cecco CN et al (2015) Dual-energy computed tomography angiography of the lower extremity runoff: impact of noise-optimized virtual monochromatic imaging on image quality and diagnostic accuracy. Invest Radiol

  25. Willmann JK, Weishaupt D, Lachat M et al (2002) Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis. Radiology 225:120–128

    Article  PubMed  Google Scholar 

  26. Fuchs TA, Stehli J, Fiechter M et al (2013) First experience with monochromatic coronary computed tomography angiography from a 64-slice CT scanner with Gemstone Spectral Imaging (GSI). J Cardiovasc Comput Tomogr 7:25–31

    Article  PubMed  Google Scholar 

  27. Gilard M, Cornily JC, Pennec PY et al (2006) Assessment of coronary artery stents by 16 slice computed tomography. Heart 92:58–61

    Article  CAS  PubMed  Google Scholar 

  28. Carbone I, Francone M, Algeri E et al (2008) Non-invasive evaluation of coronary artery stent patency with retrospectively ECG-gated 64-slice CT angiography. Eur Radiol 18:234–243

    Article  PubMed  Google Scholar 

  29. Pflederer T, Marwan M, Renz A et al (2009) Noninvasive assessment of coronary in-stent restenosis by dual-source computed tomography. Am J Cardiol 103:812–817

    Article  PubMed  Google Scholar 

  30. Pugliese F, Weustink AC, Van Mieghem C et al (2008) Dual source coronary computed tomography angiography for detecting in-stent restenosis. Heart 94:848–854

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Prof. Dr. U. Joseph Schoepf. The authors of this manuscript declare relationships with the following companies: Dr. Schoepf is a consultant for and receives research support from Astellas, Bayer, Bracco, GE, Medrad, and Siemens. The other authors have no conflicts of interest to disclose. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.

Some study subjects or cohorts have been previously reported in Wichmann et al. (2016) Dual-Energy CT Angiography of the Lower Extremity Run-off: Impact of Noise-Optimized Virtual Monochromatic Imaging on Image Quality and Diagnostic Accuracy. Invest Radiol. 51(2): 139-46. Methodology: retrospective, cross-sectional study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA

    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 & Julian L. Wichmann

  2. Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany

    Stefanie Mangold & Konstantin Nikolaou

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

    U. Joseph Schoepf & Thomas M. Todoran

  4. Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Rome, Italy

    Damiano Caruso

  5. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany

    Thomas J. Vogl & Julian L. Wichmann

Authors
  1. Stefanie Mangold
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo N. De Cecco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Joseph Schoepf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ricardo T. Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akos Varga-Szemes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew C. Stubenrauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Damiano Caruso
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stephen R. Fuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Thomas J. Vogl
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Konstantin Nikolaou
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas M. Todoran
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Julian L. Wichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Joseph Schoepf.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mangold, S., De Cecco, C.N., Schoepf, U.J. et al. 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. Eur Radiol 26, 4380–4389 (2016). https://doi.org/10.1007/s00330-016-4304-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4304-8

Keywords

Search

Navigation