Iterative Reconstruction Improves Both Objective and Subjective Image Quality in Acute Stroke CTP
Standard
Iterative Reconstruction Improves Both Objective and Subjective Image Quality in Acute Stroke CTP. / Flottmann, Fabian; Kabath, Jan; Illies, Till; Schneider, Tanja; Buhk, Jan-Hendrik; Fiehler, Jens; Kemmling, André.
In: PLOS ONE, Vol. 11, No. 3, 2016, p. e0150103.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Iterative Reconstruction Improves Both Objective and Subjective Image Quality in Acute Stroke CTP
AU - Flottmann, Fabian
AU - Kabath, Jan
AU - Illies, Till
AU - Schneider, Tanja
AU - Buhk, Jan-Hendrik
AU - Fiehler, Jens
AU - Kemmling, André
PY - 2016
Y1 - 2016
N2 - PURPOSE: Computed tomography perfusion (CTP) imaging in acute ischemic stroke (AIS) suffers from measurement errors due to image noise. The purpose of this study was to investigate if iterative reconstruction (IR) algorithms can be used to improve the diagnostic value of standard-dose CTP in AIS.METHODS: Twenty-three patients with AIS underwent CTP with standardized protocol and dose. Raw data were reconstructed with filtered back projection (FBP) and IR with intensity levels 3, 4, 5. Image quality was objectively (quantitative perfusion values, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)) and subjectively (overall image quality) assessed. Ischemic core and perfusion mismatch were visually rated. Discriminative power for tissue outcome prediction was determined by the area under the receiver operating characteristic curve (AUC) resulting from the overlap between follow-up infarct lesions and stepwise thresholded CTP maps.RESULTS: With increasing levels of IR, objective image quality (SNR and CNR in white matter and gray matter, elimination of error voxels) and subjective image quality improved. Using IR, mean transit time (MTT) was higher in ischemic lesions, while there was no significant change of cerebral blood volume (CBV) and cerebral blood flow (CBF). Visual assessments of perfusion mismatch changed in 4 patients, while the ischemic core remained constant in all cases. Discriminative power for infarct prediction as represented by AUC was not significantly changed in CBV, but increased in CBF and MTT (mean (95% CI)): 0.72 (0.67-0.76) vs. 0.74 (0.70-0.78) and 0.65 (0.62-0.67) vs 0.67 (0.64-0.70).CONCLUSION: In acute stroke patients, IR improves objective and subjective image quality when applied to standard-dose CTP. This adds to the overall confidence of CTP in acute stroke triage.
AB - PURPOSE: Computed tomography perfusion (CTP) imaging in acute ischemic stroke (AIS) suffers from measurement errors due to image noise. The purpose of this study was to investigate if iterative reconstruction (IR) algorithms can be used to improve the diagnostic value of standard-dose CTP in AIS.METHODS: Twenty-three patients with AIS underwent CTP with standardized protocol and dose. Raw data were reconstructed with filtered back projection (FBP) and IR with intensity levels 3, 4, 5. Image quality was objectively (quantitative perfusion values, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)) and subjectively (overall image quality) assessed. Ischemic core and perfusion mismatch were visually rated. Discriminative power for tissue outcome prediction was determined by the area under the receiver operating characteristic curve (AUC) resulting from the overlap between follow-up infarct lesions and stepwise thresholded CTP maps.RESULTS: With increasing levels of IR, objective image quality (SNR and CNR in white matter and gray matter, elimination of error voxels) and subjective image quality improved. Using IR, mean transit time (MTT) was higher in ischemic lesions, while there was no significant change of cerebral blood volume (CBV) and cerebral blood flow (CBF). Visual assessments of perfusion mismatch changed in 4 patients, while the ischemic core remained constant in all cases. Discriminative power for infarct prediction as represented by AUC was not significantly changed in CBV, but increased in CBF and MTT (mean (95% CI)): 0.72 (0.67-0.76) vs. 0.74 (0.70-0.78) and 0.65 (0.62-0.67) vs 0.67 (0.64-0.70).CONCLUSION: In acute stroke patients, IR improves objective and subjective image quality when applied to standard-dose CTP. This adds to the overall confidence of CTP in acute stroke triage.
KW - Aged
KW - Aged, 80 and over
KW - Algorithms
KW - Brain
KW - Brain Ischemia
KW - Cerebrovascular Circulation
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Radiographic Image Enhancement
KW - Radiographic Image Interpretation, Computer-Assisted
KW - Signal-To-Noise Ratio
KW - Stroke
KW - Journal Article
U2 - 10.1371/journal.pone.0150103
DO - 10.1371/journal.pone.0150103
M3 - SCORING: Journal article
C2 - 26930290
VL - 11
SP - e0150103
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 3
ER -