Knowledge-based iterative model reconstruction in coronary computed tomography angiography: comparison with hybrid iterative reconstruction and filtered back projection

Background Knowledge-based iterative model reconstruction (IMR) is known to allow radiation dose reduction while preserving image quality. Purpose To investigate the effect of IMR on coronary computed tomography angiography (CCTA) by comparing it with filtered back projection (FBP) and hybrid iterative reconstruction (HIR). Material and Methods Forty-five patients (group A) who underwent CCTA with prospective electrocardiogram (ECG) triggering at 80kVp were included. All images were reconstructed using three algorithms: FBP, HIR, and IMR. The control group comprised 45 patients (group B) who underwent CCTA at 100kVp; their images were reconstructed with HIR alone. Objective and subjective image quality was assessed by two radiologists. Results In group A, the signal-to-noise and contrast-to-noise ratios were significantly higher for images reconstructed with IMR than with HIR or FBP (P<0.001). IMR was also superior to HIR and FBP in subjective image quality analyses, including image noise, vessel sharpness, beam-hardening artifact, and overall quality (P<0.001). Moreover, the images reconstructed using IMR in group A had superior image quality with less radiation exposure than those reconstructed using HIR in group B on both objective and subjective analyses (P<0.001). The mean attenuation values were also significantly higher in group A than in group B (P<0.001) Conclusion Compared with HIR and FBP, IMR provided higher quality images with less radiation exposure in CCTA, using low kilovoltage and prospective ECG triggering.