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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.

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