D-CTA D-CTA three dimensional CT angiography CT 3D-CTA D-CTA Optimization of setting conditions for head 3D-CTA using iterati

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1 3D-CTA D-CTA three dimensional CT angiography CT 3D-CTA D-CTA Optimization of setting conditions for head 3D-CTA using iterative reconstruction Investigating setting conditions using simulated vessel phantoms Abstract FUKUYA Yasukazu and KATSUMATAI Kenichirou When we perform head 3D-CTA (three dimensional CT angiography) for the purpose of diagnosing ruptured cerebral aneurysms, minimizing the image noise is vitally important. Increasing the exposure dose used to be necessary to reduce the image noise. Recently iterative reconstruction has been developed to reduce the image noise without increasing the exposure dose. However, some reports point out that the use of iterative reconstruction may lower the resolution in areas where CT value differences are small. It means some degradations of vessel visibility are concerned when iterative reconstruction is used for head 3D-CTA. So the author investigated the optimal setups for iterative reconstruction that would be able to most reduce the exposure dose without the degradation of vessel visibility. The author changed the scan conditions and iterative reconstruction settings in a variety of ways, and scanned the self-making simulated blood vessel phantom. With using these scanned images, vessel visibility was visually evaluated by 10 neurosurgeons. As a result, the settings that can most reduce the exposure dose with maintaining vessel visibility were confirmed. By using iterative reconstruction, the exposure dose can be reduced approximately 30%. Keywords 3D-CTA, iterative reconstruction, vessel visibility, subarachnoid hemorrhage Division of Radiological Sciences, Doctoral Program in Health Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare 2 Seirei Memorial Hospital fukuya@seirei-memorial.com 3 Division of Radiological Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare 27

2 1 CT-AEC CT-AEC 3 Patient size AEC z-axis AEC Z Rotational AEC Axial XY AEC DSA Digital Subtraction Angiography 3D-CTA 3 dimensional CT angiography 5 3D-CTA DSA 7,8 DSA 7,8 DSA 9 3D-CTA 10 3D-CTA D-CTA CT CT-auto exposure control CT-AEC: 1 12 CT-AEC 28

3 2 3 Radiosurgery Head Phantom 4 CT X X CT PET SPECT X CT CT 15 3D-CTA Filtered back projection FBP 1 3D-CTA 29

4 :120 kv : NI Noise Index 6 9 : 1 s/rotation pitch factor: detector configuration: mm 64 SFOV: Head bowtie filter 32 cm NI NI CT-AEC CT SD SD NI NI NI mm 3 3 mm mm 2 CT 50 HU 16 3D-CTA CT CT 250 HU CT DFOV: 9.6 cm : Full IQ Enhance : mm : mm : Standard FBP ASiR Adaptive Statistical Iterative Reconstruction ASiR ASiR 6 ASiR ASiR 120 HU CT 120 HU 250 HU 370 HU CT 380 HU 2 Radiosurgery Head Phantom CIRS Radiosurgery Head Phantom CT 40 HU 1,000 HU 2 CT GE Healthcare Light Speed VCT VISION mm 64 5 NI Noise Index SD NI Noise Index SD NI 9 SD SD 9.96 NI 30

5 6 ASiR FBP X CT GE Healthcare ASiR ASiR PET SPECT FBP IT innavi.net technote/100119/index.html: D-CTA CT-AEC CT-AEC NI NI 1 NI 9 2 mm 2 NI mm FBP CT-AEC NI 6 anterior choroidal artery DSA mm Villablanca mm Villablanca 0.4 mm 0.4 mm 3 NI mm NI 4 NI ASiR Axial 31

6 0.4 mm mm Axial 0.4 mm 0.4 mm ROI SD NI 6 FBP SD NI ASiR NI 6 FBP ma s mas NI 6 FBP Axial GE Healthcare Advantage Workstation Volume Share2 Volume rendering VR 0.4 mm FOV1.6 cm VR SD NI 6 FBP Axial 0.4 mm Image J 0.4 mm ROI 8 full CT 600 HU NI 6 FBP 0.4 mm VR 2 1 TOTOKU 2.0 CCL254i2/AR 0.4 mm 5 A B A B 2 A width at half maximum FWHM 7 ROI Axial 0.4 mm ROI 8 ROI 0.4 mm

7 B 1 A B 0 A B 1 A B 2 A B B A B A 2.5 SD 2 FBP SD NI 7 ASiR NI 8 ASiR CT NI 8 ASiR 1 NI NI ASiR SD 100 CT NI 6 FBP 1.71 NI 7 ASiR NI 8 ASiR NI 6 FBP NI 7 ASiR NI 8 ASiR SD 1 ASiR NI 6 FBP SD 10 NI 7 ASiR 30 NI 8 ASiR 100 NI 9 ASiR NI 6 FBP 3 3 FBP VR NI 6 FBP NI 7 ASiR 1 NI ASiR SD NI 6 NI 7 NI 8 NI 9 ASiR 0 FBP ASiR ASiR ASiR ASiR ASiR ASiR ASiR ASiR ASiR ASiR ma s FBP SD NI 6 FBP NI 7 ASiR 30 NI 8 ASiR 100 SD mas

8 30 5 (p>0.05) NI 8 ASiR 100 (p<0.05) NI 7 ASiR 30 NI 8 ASiR (p<0.05) 12 9 FBP 3D-CTA FBP FBP CT FBP FBP ASiR 3 n 10 NI 8 ASiR *** 38 NI 6 FBP NI 7 ASiR 30 NI 8 ASiR 100 NI 6 FBP *** NI 7 ASiR 30 1 *** *** 11 FBP VR 0.4 mm 34

9 CT 50 HU 10 NI 8 ASiR 100 CT 17.5 NI 7 ASiR FBP NI 6 FBP 0.62 NI 7 ASiR NI 8 ASiR NI 6 FBP 2 NI 7 ASiR 30 3 NI 8 ASiR 100 CT 1.5 NI 6 FBP NI 6 FBP NI 7 ASiR 30 (p>0.05) NI 7 ASiR 30 NI 8 ASiR 100 (p<0.05) NI 7 ASiR FBP NI 6 NI 7 ASiR 30 NI 8 ASiR 100 NI 7 ASiR NI 8 ASiR Singh 19 MTF FBP MTF Niu 14 CT FBP 50 CT CT HU CT X CT CT 0.4 mm 30 NI 6 FBP NI 8 ASiR 100 NI 6 FBP X CT Radiosurgery Head Phantom SD CT 1 2 3D-CTA DSA DSA 35

10 10 3D-CTA DSA DSA 20, CT-AEC NI 7 ASiR 30 3D-CTA 30 X CT ; hw/jinkou/kakutei12/dl/10_h6.pdf: k-tyosa10/4-2.html: ; 64 7 : Edner G, Kagstrom E, Wallstedt L. Total overall management and surgical outcome after aneurysmal subarachnoid haemorrhage in a defined population. Br. J. Neurosurg. 1992; 6: Mayberg MR, Batjer HH, Dacey R, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1994; 25: : 2009: Matsumoto M, Sato M, Nakano M, et al. Three-dimensional computerized tomography angiography-guided surgery of acutely ruptured cerebral aneurysms. J. Neurosurg. 2001; 94: Three-dimensional CT angiography 2001; 10: Ajid R, Andersson T, Almqvist H, et al. Negative CT angiography findings in patients with spontaneous subarachnoid hemorrhage: when is digital subtraction angiography still needed? AJNR Am. J. Neuroradiol. 2010; 31: CT Angiography 2007; 35: MSCT 2006; 62(3) : D-CTA CT-AEC 2010; 66: Thibault JB, Sauer KD, Bouman CA, et al. A threedimensional statistical approach to improved image quality for multislice helical CT. Med. Phys. 2007; 34: Niu YT, Mehta D, Zhanget.ZR, et al. Radiation dose reduction in temporal bone CT with iterative reconstruction technique. AJNR Am. J. Neuroradiol. 2012; 33: ; 68: Ohkawa M, Tanabe M, Toyama Y, et al. CT angiography with helical CT in the assessment of acute stage of subarachnoid hemorrhage. Radiat. Med. 1998; 16: Villablanca JP, Rodriguez FJ, Stockman T, et al. MDCT angiography for detection and quantification of small intracranial arteries: comparison with conventional catheter angiography. AJR Am. J. Roentgenol. 2007; 188: Scheffe 2010; 66: Singh S, Kalra MK, Hsieh J, et al. Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology 2010; 257: Heiserman JE, Dean BL, Hodak JA, et al. Neurologic complications of cerebral angiography. AJNR Am. J. Neuroradiol. 1994; 15: Bendszus M, Koltzenberg M, Burger R, et al. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures:a prospective study. Lancet 1999; 354:

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