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Research ArticleHead and Neck Imaging

Advanced Modeled Iterative Reconstruction in Low-Tube-Voltage Contrast-Enhanced Neck CT: Evaluation of Objective and Subjective Image Quality

J.-E. Scholtz, M. Kaup, K. Hüsers, M.H. Albrecht, B. Bodelle, S.C. Metzger, J.M. Kerl, R.W. Bauer, T. Lehnert, T.J. Vogl and J.L. Wichmann
American Journal of Neuroradiology January 2016, 37 (1) 143-150; DOI: https://doi.org/10.3174/ajnr.A4502
J.-E. Scholtz
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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M. Kaup
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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K. Hüsers
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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M.H. Albrecht
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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B. Bodelle
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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S.C. Metzger
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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J.M. Kerl
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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R.W. Bauer
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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T. Lehnert
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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T.J. Vogl
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
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J.L. Wichmann
aFrom the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
bDepartment of Radiology and Radiological Science (J.L.W.), Medical University of South Carolina, Charleston, South Carolina.
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    Fig 1.

    Boxplot graph shows comparison of image noise of the sternocleidomastoid and subscapularis muscles between the different image reconstruction settings. Image noise of the sternocleidomastoid muscle and subscapularis muscle was significantly lower with all ADMIRE levels, with the best results for ADMIRE 5 (all, P < .001). Noise in the lower part of the neck, represented by the subscapularis muscle, was significantly increased within each reconstruction mode compared with the upper part of the neck, represented by the sternocleidomastoid muscle (all, P < .001).

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    Fig 2.

    Boxplot graphs show comparison of signal-to-noise ratios of the sternocleidomastoid muscle. SNR was significantly higher for ADMIRE compared with FBP with the highest results observed for ADMIRE strength level 5 (all, P < .001). Significant differences were also shown within ADMIRE strength levels (all, P < .001).

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    Fig 3.

    Boxplot graphs show contrast-to-noise ratios of sternocleidomastoid muscle-to-fat (A) with significantly higher results in ADMIRE strength levels 3 and 5 compared with FBP and ADMIRE 1 (P < .001), while internal jugular vein–sternocleidomastoid muscle CNR (B) is significantly increased in all ADMIRE strength levels compared with FBP (all, P < .001).

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    Fig 4.

    Images of a 46-year-old male patient examined with a low tube voltage of 90 kV on 192-section DSCT (window settings: width, 400 HU; level, 80 HU). Images were reconstructed by using filtered back-projection (A) and advanced modeled iterative reconstruction with strength levels 1 (B), 3 (C), and 5 (D). Axial images show histologically proved bilateral T2 squamous cell carcinoma of the glottic larynx (arrows). Image noise was highest by using FBP (A). The higher ADMIRE strength levels show consistently lower image noise (B–D). The internal jugular vein–sternocleidomastoid muscle CNR is highest by using ADMIRE 5 (D). Delineation of smaller structures was considered good by both observers in all images.

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    Fig 5.

    A 58-year-old male patient with sudden dyspnea. CT was performed with a tube voltage of 90 kV (window settings: width, 400 HU; level, 80 HU). Images were reconstructed by using filtered back-projection (A) and advanced modeled iterative reconstruction with strength levels 1 (B), 3 (C), and 5 (D). Images show histologically proved bilateral T4 laryngeal squamous cell carcinoma (arrows). The tumor reaches to the left thyroid cartilage but is separated from the right thyroid cartilage by a thin fat line. Image noise was lower in ADMIRE compared with FBP with the lowest image noise in ADMIRE 5 (D). Streak artifacts in the sternocleidomastoid muscle on both sides are visible in all images due to the shoulder region in the lower part of the neck.

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    Table 1:

    Results of objective image analysisa

    FBPADMIRE 1ADMIRE 3ADMIRE 5
    Attenuation (HU)
        Sternocleidomastoid muscle79.4 ± 13.280.1 ± 13.479.9 ± 13.679.2 ± 13.7
        Internal jugular vein288.5 ± 71.4290.5 ± 72.6289.0 ± 71.6287.3 ± 72.2
        Submandibular gland131.4 ± 47.1131.2 ± 48.2131.6 ± 47.8131.1 ± 47.2
        Tongue97.4 ± 14.197.5 ± 13.996.2 ± 13.595.7 ± 13.5
    Subscapularis muscle69.8 ± 12.969.9 ± 12.868.8 ± 12.669.0 ± 12.4
        Fat−105.7 ± 9.3−106.4 ± 11.3−107.2 ± 10.9−106.0 ± 11.3
    Image noise (HU)
        Sternocleidomastoid muscle9.4 ± 2.48.3 ± 2.86.7 ± 2.05.4 ± 1.7
        Internal jugular vein12.6 ± 6.311.2 ± 5.910.3 ± 7.18.5 ± 5.5
    Submandibular gland11.9 ± 2.611.2 ± 2.59.4 ± 2.97.5 ± 3.0
        Tongue10.3 ± 2.49.8 ± 2.68.6 ± 2.86.9 ± 3.2
        Subscapularis muscle15.3 ± 2.813.7 ± 2.711.8 ± 2.68.6 ± 2.8
        Fat15.1 ± 5.114.9 ± 4.512.6 ± 4.89.8 ± 4.0
    • ↵a Data are means.

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    Table 2:

    Signal-to-noise ratio and contrast-to-noise ratio calculationsa

    FBPADMIRE 1ADMIRE 3ADMIRE 5
    Signal-to-noise ratio
        Sternocleidomastoid muscle9.0 ± 2.510.8 ± 4.113.0 ± 4.416.4 ± 6.2
        Submandibular gland11.6 ± 4.612.3 ± 4.715.3 ± 6.819.6 ± 8.2
    Contrast-to-noise ratio
        Sternocleidomastoid muscle–fat14.5 ± 8.113.8 ± 4.917.3 ± 7.722.6 ± 11.4
        Submandibular gland–fat19.1 ± 11.617.9 ± 8.222.6 ± 11.728.6 ± 17.1
        IJV–sternocleidomastoid muscle24.1 ± 10.128.7 ± 13.534.8 ± 16.341.2 ± 22.1
    • Note:—IJV indicates internal jugular vein.

    • ↵a Data are means.

    • View popup
    Table 3:

    Subjective image-quality assessmenta

    FBPADMIRE 1ADMIRE 3ADMIRE 5
    Overall image quality3.2 ± 0.5 (0.58)3.3 ± 0.6 (0.57)4.4 ± 0.9 (0.12)4.7 ± 0.5 (0.67)
    Image noise3.4 ± 0.5 (0.79)3.8 ± 0.4 (0.83)4.6 ± 0.5 (0.52)4.9 ± 0.3 (0.32)
    Delineation of smaller structures3.3 ± 0.4 (0.74)3.7 ± 0.5 (0.78)3.8 ± 0.4 (0.50)3.8 ± 0.4 (0.74)
    Image contrast3.5 ± 0.5 (0.80)3.4 ± 0.5 (0.78)4.8 ± 0.4 (0.34)4.8 ± 0.4 (0.47)
    • ↵a Data are means ± SD. Interobserver agreement (slight [κ < 0.3], moderate [κ = 0.3–0.7], good [κ > 0.7]).

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American Journal of Neuroradiology: 37 (1)
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J.-E. Scholtz, M. Kaup, K. Hüsers, M.H. Albrecht, B. Bodelle, S.C. Metzger, J.M. Kerl, R.W. Bauer, T. Lehnert, T.J. Vogl, J.L. Wichmann
Advanced Modeled Iterative Reconstruction in Low-Tube-Voltage Contrast-Enhanced Neck CT: Evaluation of Objective and Subjective Image Quality
American Journal of Neuroradiology Jan 2016, 37 (1) 143-150; DOI: 10.3174/ajnr.A4502

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Advanced Modeled Iterative Reconstruction in Low-Tube-Voltage Contrast-Enhanced Neck CT: Evaluation of Objective and Subjective Image Quality
J.-E. Scholtz, M. Kaup, K. Hüsers, M.H. Albrecht, B. Bodelle, S.C. Metzger, J.M. Kerl, R.W. Bauer, T. Lehnert, T.J. Vogl, J.L. Wichmann
American Journal of Neuroradiology Jan 2016, 37 (1) 143-150; DOI: 10.3174/ajnr.A4502
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