Noise Reduction to Decrease Radiation Dose and Improve Conspicuity of Hepatic Lesions at Contrast-Enhanced 80-kV Hepatic CT Using Projection Space Denoising

Abstract

The purpose of this study was to investigate the combined potential of 80-kV CT and noise reduction using a projection space denoising algorithm to reduce radiation dose reduction or to improve the image quality of hepatic CT. Twenty patients with 56 liver lesions underwent dual-energy (80 and 140 kV) contrast-enhanced hepatic CT. Low-dose 80-kV-only images (comprising 26-54% of the total radiation dose), low-dose 80-kV projection space denoising images (routine and sharper reconstruction kernel), and full-dose mixed-kilovoltage with projection space denoising images were evaluated by three radiologists for lesion conspicuity, image noise, and sharpness. Lesions were compared with full-dose images using 5-point scales (0 = no change, +2 = markedly better, and -2 = markedly worse). Quantitative conspicuity in the form of lesion-to-liver contrast-to-noise ratio (CNR), image noise, and image sharpness were measured. For all readers, the mean conspicuity rating of low-dose 80-kV projection space denoising images was better than that for full-dose images (mean conspicuity, 0.36-0.57; p < 0.001), with only 1.2% of lesions less conspicuous on 80-kV projection space denoising images. Eighty-kilovolt projection space denoising images reconstructed with a sharper kernel were subjectively similar to full-dose mixed-kilovoltage images comparing image noise (-0.054 to 0.018; p < 0.001 to p = 0.058) and sharpness (-0.64 to -0.09; p < 0.001 to p = 0.057). For 80-kV projection space denoising images with a sharper kernel, lesion-to-liver CNR was slightly higher than that for full-dose mixed-kilovoltage images (p < 0.001), whereas image sharpness and noise were unchanged (p = 0.74 and p = 0.02). Eighty-kilovolt imaging with noise reduction can simultaneously increase lesion conspicuity and facilitate radiation dose reduction and image quality improvement at contrast-enhanced hepatic CT.