European Radiology

, Volume 23, Issue 1, pp 125–132 | Cite as

CT evaluation of coronary artery stents with iterative image reconstruction: improvements in image quality and potential for radiation dose reduction

  • Ullrich Ebersberger
  • Francesco Tricarico
  • U. Joseph SchoepfEmail author
  • Philipp Blanke
  • J. Reid Spears
  • Garrett W. Rowe
  • William T. Halligan
  • Thomas Henzler
  • Fabian Bamberg
  • Alexander W. Leber
  • Ellen Hoffmann
  • Paul Apfaltrer



Comparison of coronary artery stent assessment with cardiac CT angiography (cCTA) using traditional filtered back projection (FBP) and sinogram affirmed iterative reconstruction (SAFIRE), in both full- and half-radiation dose image data.


Dual-source cCTA studies of 37 implanted stents were reconstructed at full- and half-radiation dose with FBP and SAFIRE. Half-dose data were based on projections from one DSCT detector. In-stent noise, signal-to-noise ratio (SNR), and stent-lumen attenuation increase ratio (SAIR) were measured and image quality graded. Stent volumes were measured to gauge severity of beam hardening artefacts.


Full-dose SAFIRE reconstructions were superior to full-dose FBP vis-à-vis in-stent noise (21.2 ± 6.6 vs. 35.7 ± 17.5; P < 0.05), SNR (22.1 ± 8.6 vs. 14.3 ± 6.7; P < 0.05), SAIR (19.6 ± 17.6 vs. 33.4 ± 20.4%; P < 0.05), and image quality (4.2 ± 0.86 vs. 3.5 ± 1.0; P < 0.05). Stent volumes were lower measured with SAFIRE (119.9 ± 53.7 vs. 129.8 ± 65.0 mm3; P > 0.05). Comparing half-dose SAFIRE with full-dose FBP, in-stent noise (26.7 ± 13.0 vs. 35.7 ± 17.5; P < 0.05) and SNR (18.2 ± 6.9 vs. 14.3 ± 6.7; P < 0.05) improved significantly. SAIR (31.6 ± 24.3 vs. 33.4 ± 20.4%; P > 0.05), stent volume (129.6 ± 57.3 vs. 129.8 ± 65.0 mm3; P > 0.05), and image quality (3.5 ± 1.0 vs. 3.7 ± 1.1; P > 0.05) did not differ. Radiation dose decreased from 8.7 ± 5.2 to 4.3 ± 2.6 mSv.


Iterative reconstruction significantly improves imaging of coronary artery stents by CT compared with FBP, even with half-radiation-dose data.

Key Points

Computed tomography (CT) is becoming an increasingly important investigation for cardiac problems.

Iterative CT reconstruction techniques significantly improve coronary artery stent evaluation.

Iterative reconstruction has the potential to reduce radiation dose requirements.

Improved stent visualisation detects complications better, further reducing the need for catheterisation.


Iterative reconstruction SAFIRE Dual-source CT Coronary artery stents Coronary CT angiography 



U.J.S. is a consultant for and receives research support from Bayer-Schering, Bracco, General Electric, Medrad, and Siemens. T.A., S.V., and B.S. are employees of Siemens Healthcare. The other authors have no conflict of interest to disclose.


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Ullrich Ebersberger
    • 1
    • 2
  • Francesco Tricarico
    • 3
  • U. Joseph Schoepf
    • 1
    • 8
    Email author
  • Philipp Blanke
    • 1
    • 4
  • J. Reid Spears
    • 1
  • Garrett W. Rowe
    • 1
  • William T. Halligan
    • 1
  • Thomas Henzler
    • 1
    • 5
  • Fabian Bamberg
    • 6
  • Alexander W. Leber
    • 7
  • Ellen Hoffmann
    • 2
  • Paul Apfaltrer
    • 1
    • 5
  1. 1.Department of Radiology and Radiological Science and Division of Cardiology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Cardiology and Intensive Care MedicineHeart Centre Munich-BogenhausenMunichGermany
  3. 3.Department of Bioimaging and Radiological SciencesCatholic University of the Sacred Heart, “A. Gemelli” HospitalRomeItaly
  4. 4.Department of Diagnostic RadiologyUniversity Hospital FreiburgFreiburgGermany
  5. 5.Institute of Clinical Radiology and Nuclear MedicineUniversity Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg UniversityHeidelbergGermany
  6. 6.Institute of Clinical RadiologyUniversity of Munich – Grosshadern CampusMunichGermany
  7. 7.Institute for Cardiovascular Intervention and Imaging, Schulich Heart Center, Sunnybrook Health Science CentreUniversity of TorontoTorontoCanada
  8. 8.Heart and Vascular CenterMedical University of South CarolinaCharlestonUSA

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