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Diagnostic Accuracy of Coronary CT Angiography: Comparison of Filtered Back Projection and Iterative Reconstruction With Different Strengths

Wang, Rui MD, PhD*; Schoepf, U. Joseph MD; Wu, Runze MD; Nance, John W. Jr MD§; Lv, Biao MD*; Yang, Hua MD; Li, Fang MD*; Lu, Dongxu*; Zhang, Zhaoqi MD*

Journal of Computer Assisted Tomography: March/April 2014 - Volume 38 - Issue 2 - p 179–184
doi: 10.1097/RCT.0000000000000005
Cardiovascular & Thoracic Imaging

Purpose: To investigate the diagnostic accuracy of coronary computed tomographic (CT) angiography (CCTA) using filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) of different strength factors with invasive coronary angiography as the reference standard.

Materials and Methods: Fifty consecutive patients (32 men and 18 women) prospectively underwent electrocardiogram-triggered CCTA on a dual-source CT system. The acquisition window was set depending on the heart rate (HR): HR of less than 60 beats per minute (bpm) at the 70% RR interval, 61 to 80 bpm at 30% to 80% RR interval, and greater than 80 bpm at 30% to 50% RR interval; 100 kV and 359 to 377 mA s for patients with a body mass index of less than 24 kg/m2, and 410 to 438 mA s at 120 kV for patients with a body mass index of 24 kg/m2 or greater. Image data were reconstructed using both FBP and SAFIRE. Sinogram-affirmed iterative reconstruction series were reconstructed using 3 different strength factors. Two blinded observers independently assessed the image quality and image impression of each coronary segment using a 4-point scale (1, non-diagnostic; and 4, excellent). Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured. Filtered back projection and all SAFIRE series were independently evaluated for coronary artery stenosis (>50%), and their diagnostic accuracy was compared with invasive coronary angiography.

Results: Statistically significant increases in SNR and CNR were obtained when higher strength factors were used. The highest SNR and CNR were found with the highest SAFIRE strength factor of 5; however, this strength also resulted in a more unfamiliar, “plasticlike” image appearance. Imaging quality scores of FBP and different SAFIRE strengths were 3.37 ± 0.49, 3.41 ± 0.47, 3.52 ± 0.30, and 3.48 ± 0.35, respectively (P < 0.001). The diagnostic accuracies were 92.91%, 93.76%, 95.28%, and 94.94% on per-segment level, respectively (P = 0.993). A tendency toward higher diagnostic performance was observed with SAFIRE strength factor 3 on per-segment analysis, albeit without reaching statistical significance. The effective radiation dose equivalent was 5.7 ± 1.6 mSv.

Conclusion: Sinogram-affirmed iterative reconstruction provides significant improvements in image noise, SNR, and CNR compared with FBP, which are progressive with increasing SAFIRE strength factors. Sinogram-affirmed iterative reconstruction strength factor 3 or 5 is recommended for use with CCTA.

From the *Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; †Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC; ‡Siemens Healthcare China, Beijing, China; §The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD; and ∥Affiliated Hospital, Hebei United University, Hebei, China.

Received for publication May 22, 2013; accepted August 30, 2013.

Reprints: Zhaoqi Zhang, MD, Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China (e-mail:

Conflict of interest statement: UJS is a consultant for and receives research support from Bayer, Bracco, GE, Medrad, and Siemens; and Runze Wu is an employee of Siemens Healthcare. The other authors declare no conflict of interest.

© 2014 by Lippincott Williams & Wilkins