Abstract
Objective: To identify the optimal dual-energy computed tomography (DECT) scanning protocol for peripheral arterial stents while achieving a low radiation dose, while still maintaining diagnostic image quality, as determined by an in vitro phantom study. Methods: Dual-energy scans in monochromatic spectral imaging mode were performed on a peripheral arterial phantom with use of three gemstone spectral imaging (GSI) protocols, three pitch values, and four kiloelectron volts (keV) ranges. A total of 15 stents of different sizes, materials, and designs were deployed in the phantom. Image noise, the signal-to-noise ratio (SNR), different levels of adaptive statistical iterative reconstruction (ASIR), and the four levels of monochromatic energy for DECT imaging of peripheral arterial stents were measured and compared to determine the optimal protocols. Results: A total of 36 scans with 180 datasets were reconstructed from a combination of different protocols. There was a significant reduction of image noise with a higher SNR from monochromatic energy images between 65 and 70 keV in all investigated preset GSI protocols (p < 0.05). In addition, significant effects were found from the main effect analysis for these factors: GSI, pitch, and keV (p = 0.001). In contrast, there was significant interaction on the unstented area between GSI and ASIR (p = 0.015) and a very high significant difference between keV and ASIR (p < 0.001). A radiation dose reduction of 50% was achieved. Conclusions: The optimal scanning protocol and energy level in the phantom study were GSI-48, pitch value 0.984, and 65 keV, which resulted in lower image noise and a lower radiation dose, but with acceptable diagnostic images.
Highlights
The increasing prevalence of peripheral artery disease (PAD) is an important cardiovascular disease risk factor [1,2,3]
A total of 180 series acquired with virtual monochromatic energy images (MEI) imaging at 4-kiloelectron volts and
5-adaptive statistical iterative reconstruction (ASIR) levels were reconstructed to determine the interaction between peripheral arterial stent image quality factors and scanning protocols
Summary
The increasing prevalence of peripheral artery disease (PAD) is an important cardiovascular disease risk factor [1,2,3]. DSA was the standard follow-up procedure for PAD, there are some disadvantages of this modality, which include invasiveness and limited assessment to the vessel structures It has gradually been replaced by less invasive techniques, such as MDCT [8,9], because MDCT is associated with few procedure-related complications, but with shorter procedural time, and fewer motion artifacts [8,9]. Despite these advantages, MDCT has its weaknesses, including a higher rate of contrast medium-induced nephrotoxicity, suffering from blooming artifacts caused by stent struts, and risk of high radiation dose
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