Performance of high‐resolution CT for detection and discrimination tasks related to stenotic lesions – A phantom study using model observers

Abstract

Background Accurate detection and grading of atheromatous stenotic lesions within the cardiac, renal, and intracranial vasculature is imperative for early recognition of disease and guiding treatment strategies. Purpose In this work, a stenotic lesion phantom was used to compare high resolution and normal resolution modes on the same CT scanner in terms of detection and size discrimination performance. Materials and Methods The phantom is comprised of three acrylic cylinders (each 15.0 cm in diameter and 1.3 cm thick) with a matching array of holes in each module. The outer two modules contain holes that are slightly larger than the corresponding hole in the central module to simulate stenotic narrowing in vasculature. The stack of modules was submerged in an iodine solution simulating contrast‐enhanced stenotic lesions with a range of lumen diameters (1.32–10.08 mm) and stenosis severity (0%, 50%, 60%, 70%, and 80%). The phantom was imaged on the Canon Aquilion Precision high‐resolution CT scanner in high‐resolution (HR) mode (0.25 mm × 0.50 mm detector element size) and normal‐resolution (NR) mode (0.50 mm × 0.50 mm) using 120 kV and two dose levels (14 and 21 mGy SSDE) with 30 repeat scans acquired for each combination. Filtered back‐projection (FBP) and a hybrid‐iterative reconstruction (AIDR) were used with the FC18 kernel, as well as a deep learning algorithm (AiCE) which is only available for HR. A non‐prewhitening model observer with an eye filter was implemented to quantify performance for detection and size discrimination tasks in the axial plane. Results Detection performance improved with increasing diameter, dose, and for AIDR in comparison to FBP for a fixed resolution mode. Performance in the HR mode was generally higher than NR for the smaller lumen diameters (1–5 mm) with decreasing differences as the diameter increased. Performance in NR mode surpassed HR mode for lumen diameters greater than ∼4 mm and ∼5 mm for 14 mGy and 21 mGy, respectively. AiCE provided consistently higher detection performance compared with AIDR‐FC18 (48% higher for a 6 mm lumen diameter). Discrimination performance increased with increasing nominal diameter, dose, and for larger differences in stenosis severity. When comparing discrimination performance in HR to NR modes, the largest relative differences occur at the smallest nominal diameters and smallest differences in stenosis severity. The AiCE reconstruction algorithm produced the highest overall discrimination performance values, and these were significantly higher than AIDR‐FC18 for nominal diameters of 7.14 and 10.08 mm. Conclusions HR mode outperforms NR for detection up to a specific diameter and the results improve with AiCE and for higher dose levels. For the task of size discrimination, HR mode consistently outperforms NR if AIDR‐FC18 is used for dose levels of at least 21 mGy, and the results improve with AiCE and for the smallest differences in stenosis severity investigated (50% vs. 60%). High‐resolution CT appears to be beneficial for detecting s...

Computed Tomography 2.0

“…Detectability of simulated lung lesions was best with the smoothest level in DLR; a dose reduction potential of 81% to 94% was assumed. An overview of recently published articles on deep learning–based image reconstruction 5,9,47–87 is given in Table 5.…”

Possible improvements in effective fill factor using X‐ray fluorescent interpixel reflectors

“…As it stands, the highresolution scanner appears to improve dose efficiency for high-resolution tasks but decrease dose efficiency for low-resolution tasks. 5 While the pixel pitch of scintillator-photodiode detectors has generally remained at 1 mm for most CT systems, other X-ray detectors have seen improvement. In flat-panel detectors, the pixel pitch is small and interpixel reflectors are not practical.…”

“…While the dimensions of the high‐resolution design are not known to us, and it is possible that improvements in fill factor were obtained in the engineering of this high‐resolution scanner, the observed radiation dose increase appears consistent with a model where the reflector dimensions are fixed at 0.1 mm wide: such a model would predict a dose increase proportional to the fill factors, $$\frac{{{{0.9}^2}}}{{{{0.8}^2}}} - 1\; = \;27\% $$. As it stands, the high‐resolution scanner appears to improve dose efficiency for high‐resolution tasks but decrease dose efficiency for low‐resolution tasks 5 …”