Improving head and neck CTA with hybrid and model-based iterative reconstruction techniques

Aim: To compare image quality of head and neck computed tomography angiography (CTA) reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR) and model-based iterative reconstruction (MIR) algorithms. Materials and methods: The raw data of 34 studies were simultaneously reconstructed with FBP, HIR (iDose⁴, Philips Healthcare, Best, the Netherlands), and with a prototype version of a MIR algorithm (IMR, Philips Healthcare). Objective (contrast-to-noise ratio [CNR], vascular contrast, automatic vessel analysis [AVA], stenosis grade) and subjective image quality (ranking at level of the circle of Willis, carotid bifurcation, and shoulder) of the five reconstructions were compared using repeated-measures analysis of variance (ANOVA) and post-hoc analysis. Results: Vascular contrast was significantly higher in both the circle of Willis and carotid bifurcation with both levels of MIR compared to the other reconstruction methods (all p<0.0001). The CNR was highest for high MIR, followed by low MIR, high HIR, mid HIR and FBP (p<0.001 except low MIR versus high HIR; p>0.33). AVA showed most complete carotids in both MIR-levels, followed by high HIR (p>0.08), mid HIR (p<0.023) and FBP (p<0.010), vertebral arteries completeness was similar (p=0.40 and p=0.06). Stenosis grade showed no significant differences (p=0.16). High HIR showed the best subjective image quality at the circle of Willis and carotid bifurcation level, followed by mid HIR. At shoulder level, low MIR and high HIR were ranked best, followed by high MIR. Conclusion: Objectively, MIR significantly improved the overall image quality, reduced image noise, and improved automated vessel analysis, whereas FBP showed the lowest objective image quality. Subjectively, the highest level of HIR was considered superior at the level of the circle of Willis and the carotid bifurcation, and along with the lowest level of MIR for the origins of the neck arteries at shoulder level. - Highlights: • The most commonly used reconstruction method for CTA is filtered back projection (FBP). • Recently, hybrid iterative reconstruction (HIR) and model-based IR algorithms (MIR) have also become available. • We compared the image quality of head and neck CTA reconstructed with FBP, HIR and MIR. • Objectively, MIR significantly improved the overall image quality, reduced image noise and improved automated vessel analysis. • Subjectively, HIR was considered superior in most of the different levels of CTA.