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European Radiology

, Volume 26, Issue 12, pp 4380–4389 | Cite as

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

  • 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
Computer Applications

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.

Keywords

CT angiography Dual-energy Virtual monochromatic imaging Stent visualization Diagnostic accuracy 

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

Notes

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.

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Stefanie Mangold
    • 1
    • 2
  • Carlo N. De Cecco
    • 1
  • U. Joseph Schoepf
    • 1
    • 3
  • Ricardo T. Yamada
    • 1
  • Akos Varga-Szemes
    • 1
  • Andrew C. Stubenrauch
    • 1
  • Damiano Caruso
    • 1
    • 4
  • Stephen R. Fuller
    • 1
  • Thomas J. Vogl
    • 1
    • 5
  • Konstantin Nikolaou
    • 2
  • Thomas M. Todoran
    • 3
  • Julian L. Wichmann
    • 1
    • 5
  1. 1.Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Diagnostic and Interventional RadiologyEberhard-Karls University TuebingenTuebingenGermany
  3. 3.Division of Cardiology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  4. 4.Department of Radiological Sciences, Oncology and PathologyUniversity of Rome “Sapienza”RomeItaly
  5. 5.Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany

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