Loss of mural stratification, peri-appendiceal fat inflammation and an appendicolith are significant predictors of appendicitis in children with otherwise equivocal US exams. While maximum appendiceal diameter is not statistically associated with appendicitis in our study, mean appendiceal diameter of 6.7 mm in those without appendicitis suggests that the customary upper normal limit of 6 mm is too sensitive.

Purpose To qualitatively and quantitatively compare abdominal CT images reconstructed with a new version of model-based iterative reconstruction (Veo 3.0; GE Healthcare) to those created with Veo 2.0. Materials & Methods This retrospective study was approved by our IRB and was HIPPA compliant. The raw data from 29 consecutive patients who had undergone CT abdomen scanning was used to reconstruct 4 sets of 3.75mm axial images: Veo 2.0, Veo 3.0 standard, Veo 3.0 5% resolution preference and Veo 3.0 20% resolution preference. A slice thickness optimization of 3.75 mm and texture feature was selected for Veo 3.0 reconstructions. The images were reviewed by three independent readers in a blinded, randomized fashion using a 5-point Likert scale and 5-point comparative scale. Multiple 2D circular regions of interest were defined for noise and contrast-to-noise ratio (CNR) measurements. Line profiles were drawn across the 7 lp/cm bar pattern of the CatPhan 600 phantom for spatial resolution evaluation. Results The Veo 3.0 standard image set was scored better than Veo 2.0 in terms of artifacts (mean difference 0.43, 95% CI 0.25-0.6, P<0.0001), overall image quality (mean difference 0.87, 95% CI 0.62-1.13, P<0.0001) and qualitative resolution (mean difference 0.9, 95% CI 0.69-1.1, P<0.0001). While the Veo 3.0 standard and RP05 presets were preferred across most categories, the Veo 3.0 RP20 series ranked best for bone detail. Image noise and spatial resolution increased along a spectrum with Veo 2.0 the lowest and RP20 the highest. Conclusion Veo 3.0 enhances imaging evaluation relative to Veo 2.0; readers preferred Veo 3.0 image appearance despite the associated mild increases in image noise. These results provide suggested parameters to be used clinically and as a basis for future evaluations such as focal lesion detection in the oncology setting.

Veo 3.0 clinical presets allow for selection of image noise and spatial resolution balance; for contrast-enhanced CT evaluation of the abdomen, the 5% noise reduction preset with 3.75 mm slice optimization (NR05) was generally ranked superior qualitatively and, relative to other series, was in the middle of the spectrum with reference to image noise and spatial resolution. Advances in knowledge: To our knowledge, this is the first study of Veo 3.0 noise reduction presets and varied slice optimization. This study provides insight into the behaviour of slice optimization and documents the degree of noise reduction and spatial resolution changes that users can expect across various Veo 3.0 clinical presets. These results provide important parameters to guide preset selection for both clinical and research purposes.