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First experience of evaluation of the impact of high-matrix size reconstruction in image quality in arterial CT runoff studies of the lower extremities

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine whether image reconstruction with a higher matrix size improves image quality for lower extremity CTA studies.

Methods

Raw data from 50 consecutive lower extremity CTA studies acquired on two MDCT scanners (SOMATOM Flash, Force) in patients evaluated for peripheral arterial disease (PAD) were retrospectively collected and reconstructed with standard (512 × 512) and higher resolution (768 × 768, 1024 × 1024) matrix sizes. Five blinded readers reviewed representative transverse images in randomized order (150 total). Readers graded image quality (0 (worst)–100 (best)) for vascular wall definition, image noise, and confidence in stenosis grading. Ten patients’ stenosis scores on CTA images were compared to invasive angiography. Scores were compared using mixed effects linear regression.

Results

Reconstructions with 1024 × 1024 matrix were ranked significantly better for wall definition (mean score 72, 95% CI = 61–84), noise (74, CI = 59–88), and confidence (70, CI = 59–80) compared to 512 × 512 (wall = 65, CI = 53 × 77; noise = 67, CI = 52 × 81; confidence = 62, CI = 52 × 73; p = 0.003, p = 0.01, and p = 0.004, respectively).

Compared to 512 × 512, the 768 × 768 and 1024 × 1024 matrix improved image quality in the tibial arteries (wall = 51 vs 57 and 59, p < 0.05; noise = 65 vs 69 and 68, p = 0.06; confidence = 48 vs 57 and 55, p < 0.05) to a greater degree than the femoral-popliteal arteries (wall = 78 vs 78 and 85; noise = 81 vs 81 and 84; confidence = 76 vs 77 and 81, all p > 0.05), though for the 10 patients with angiography accuracy of stenosis grading was not significantly different. Inter-reader agreement was moderate (rho = 0.5).

Conclusion

Higher matrix reconstructions of 768 × 768 and 1024 × 1024 improved image quality and may enable more confident assessment of PAD.

Clinical relevance statement

Higher matrix reconstructions of the vessels in the lower extremities can improve perceived image quality and reader confidence in making diagnostic decisions based on CTA imaging.

Key Points

• Higher than standard matrix sizes improve perceived image quality of the arteries in the lower extremities.

• Image noise is not perceived as increased even at a matrix size of 1024 × 1024 pixels.

• Gains from higher matrix reconstructions are higher in smaller, more distal tibial and peroneal vessels than in femoropopliteal vessels.

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Abbreviations

AIC:

Akaike’s Information Criteria

BIC:

Bayesian Information Criteria

CI:

Confidence interval

CTA:

Computed tomographic angiography

HU:

Houndsfield unit

ICC:

Intraclass correlation

MDCT:

Multi-detector CT

PACS:

Picture Archiving and Communication System

PAD:

Peripheral arterial disease

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Acknowledgements

We would like to acknowledge the work of Brittney Stone, BSRT in collecting the raw data from the scanners during the complicated period of COVID restrictions in 2020. In addition, we would like to acknowledge the support of Dr. Olanrewaju Akande, who validated the statistical methods chosen for exploratory data analysis and for statistical model selection and evaluation of results. This project was made possible by a collaborative research agreement with Siemens Healthineers (Erlangen, Germany).

Funding

This study has received funding from the Duke Radiology Department.

Author information

Authors and Affiliations

  1. Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA

    Fides R. Schwartz, James S. Ronald, Kevin R. Kalisz, Wanyi Fu, Lynne M. Hurwitz Koweek, Susan Churchill & Daniele Marin

  2. Siemens Healthineers, Malvern, PA, USA

    Juan Carlos Ramirez-Giraldo

  3. Department of Vascular Surgery, Duke University Health System, Durham, NC, USA

    Kevin W. Southerland

  4. Department of Surgery, Duke University Health System, 2301 Erwin Road, Box 3704, Durham, NC, 27110, USA

    Kevin W. Southerland

Authors
  1. Fides R. Schwartz
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  2. James S. Ronald
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  3. Kevin R. Kalisz
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  4. Wanyi Fu
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  6. Lynne M. Hurwitz Koweek
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  7. Susan Churchill
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  8. Kevin W. Southerland
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  9. Daniele Marin
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Corresponding author

Correspondence to Fides R. Schwartz.

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Guarantor

The scientific guarantor of this publication is Daniele Marin.

Conflict of interest

Fides R. Schwartz — is a member of European Radiology Scientific Editorial Board and has therefore not taken any part in review or selection of this article.

James S. Ronald — nothing to disclose

Francesca Rigiroli — nothing to disclose

Kevin R. Kalisz — nothing to disclose

Wanyi Fu — nothing to disclose

Juan Carlos Ramirez-Giraldo — employee Siemens Healthineers

Lynne M. Hurwitz Koweek — nothing to disclose

Susan Churchill — nothing to disclose

Kevin W. Southerland — nothing to disclose

Daniele Marin — nothing to disclose

Statistics and biometry

A statistician (Dr. Olanrewaju Akande) was consulted for the generation of the statistical models and their output.

Informed consent

This was a retrospective study and the IRB waived the need for informed consent from individual patients. No animal subjects were studied.

Ethical approval

Institutional Review Board approval was obtained prior to the start of the study.

Study subjects or cohorts overlap

N/A

Methodology

• retrospective

• observational

• performed at one institution

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Schwartz, F.R., Ronald, J.S., Kalisz, K.R. et al. First experience of evaluation of the impact of high-matrix size reconstruction in image quality in arterial CT runoff studies of the lower extremities. Eur Radiol 33, 8745–8753 (2023). https://doi.org/10.1007/s00330-023-09841-4

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  • DOI: https://doi.org/10.1007/s00330-023-09841-4

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