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Three-Dimensional Computed Tomographic Angiography of the Liver for Planning Hepatic Surgery: Effect of Low Tube Voltage and the Iterative Reconstruction Algorithm on Image Quality

Honda, Keiichi RT*; Oda, Seitaro MD; Katahira, Kazuhiro MD*; Kajihara, Hiroo MD*; Morishita, Shoji MD*; Honbori, Maki RT*; Kawata, Kenji RT*; Nasu, Jiro MD; Utsunomiya, Daisuke MD; Funama, Yoshinori PhD§; Yamashita, Yasuyuki MD

Journal of Computer Assisted Tomography: January/February 2014 - Volume 38 - Issue 1 - p 131–136
doi: 10.1097/RCT.0b013e3182a9a518
Abdominal Imaging

Objective: The aim of this study was to evaluate the effect of a low tube voltage technique and hybrid iterative reconstruction (HIR) on image quality at 3-dimensional computed tomographic angiography (3D-CTA) of the liver.

Methods: Before hepatic surgery, we randomly assigned 60 patients (17 women, 43 men; mean ± SD age, 68.9 ± 10.1 years) who had undergone 3D-CTA to 1 of 2 protocols; 30 patients underwent scanning under the conventional 120–kilovolt (peak) protocol with filtered back projection (P1); and 30 patients, under an 80–kilovolt (peak) protocol with HIR (P2). The estimated effective radiation dose, computed tomographic attenuation, image noise, contrast-to-noise ratio, and figure of merit were calculated, and the visual image quality of 3D-CTA was scored on a 4-point scale.

Results: The mean effective radiation dose was significantly lower under P2 than P1 (4.8 ± 1.2 vs 7.2 ± 1.5 mSv, P < 0.01). P1 and P2 did not significantly differ with respect to the image noise (10.5 ± 2.3 vs 9.9 ± 1.6 Hounsfield units; P = 0.46). Computed tomographic attenuation, contrast-to-noise ratio, figure of merit, and the visual scores for image quality were higher under P2 than P1 (P < 0.01).

Conclusions: The use of low tube voltage and HIR can yield significantly improved image quality at 3D-CTA of the liver.

From the *Department of Radiology, Kumamoto Chuo Hospital, Kumamoto, Japan ; †Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; ‡Department of Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan; and §Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

Received for publication June 17, 2013; accepted August 19, 2013.

Reprints: Seitaro Oda, MD, Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860–8556, Japan (e-mail:

The authors declare no conflict of interest.

© 2014 by Lippincott Williams & Wilkins