Noise reduction and motion elimination in low-dose 4D myocardial computed tomography perfusion (CTP): preliminary clinical evaluation of the ASTRA4D algorithm
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To propose and evaluate a four-dimensional (4D) algorithm for joint motion elimination and spatiotemporal noise reduction in low-dose dynamic myocardial computed tomography perfusion (CTP).
Thirty patients with suspected or confirmed coronary artery disease were prospectively included and underwent dynamic contrast-enhanced 320-row CTP. A novel deformable image registration method based on the principal component analysis (PCA) of the ante hoc temporally smoothed voxel-wise time-attenuation curves (ASTRA4D) is presented. Quantitative (standard deviation, signal-to-noise ratio (SNR), temporal variation, volumetric deformation) and qualitative (motion, contrast, contour sharpness [1, poor; 5, excellent]) measures of CTP quality were assessed for the original and motion-compensated sequences (without and with temporal filtering, PCA/ASTRA4D). Following myocardial perfusion deficit detection by two readers, diagnostic accuracy was evaluated using magnetic resonance myocardial perfusion imaging (MR-MPI) as the reference standard in 15 patients.
Registration using ASTRA4D was successful in all 30 patients and resulted in comparison with the benchmark PCA in significantly (p < 0.001) reduced noise over time (− 83%, 178.5 vs 29.9) and spatially (− 34%, 21.4 vs 14.1) as well as improved SNR (+ 47%, 3.6 vs 5.3) and subjective image quality (motion, contrast, contour sharpness [+ 1.0, + 1.0, + 0.5]). ASTRA4D had significantly improved per-segment sensitivity of 91% (58/64) and similar specificity of 96% (429/446) compared with PCA (52%, 33/64; 98%, 435/446; p = 0.011) in the visual detection of perfusion deficits.
The ASTRA4D registration algorithm improved the spatiotemporal noise profile and CTP sequence image quality, resulting in significantly improved sensitivity of 4D CTP in the detection of myocardial ischemia.
• ASTRA4D combines local temporal regression and deformable image registration.
• Quantitative and qualitative measures of CTP quality are improved compared to PCA.
• Improved spatiotemporal differentiation of ischemic regions leads to an excellent perfusion deficit concordance of ASTRA4D with MRI.
KeywordsCoronary artery disease Computed tomography myocardial perfusion imaging Temporal averaging Motion artifacts Deformable registration
Coronary artery disease
Computed tomography perfusion
Myocardial perfusion imaging
Principal component analysis
Region of interest
The abstract for this paper was submitted to and accepted for the European Congress of Radiology in Vienna 2018. The presentation with the title Motion elimination in low-dose 4D myocardial computed tomography perfusion (CTP) using the automated smooth temporal registration for analysis of 4D image data (ASTRA) algorithm (B-0762) was held in the session New CT protocols to assess coronary artery and myocardium (SS 703) on the 1st of March 2018.
Prof. Dewey has received grant support for this study from the Heisenberg Program of the DFG (DE 1361/14-1).
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Dr. Marc Dewey.
Conflict of interest
The authors of this manuscript declare relationships with the following companies:
Prof. Dewey has received grant support from the Heisenberg Program of the DFG for a professorship (DE 1361/14-1) and the FP7 Program of the European Commission for the randomized multicenter DISCHARGE trial (603266-2, HEALTH-2012.2.4.-2).
Prof. Dewey has received lecture fees from Toshiba Medical Systems, Guerbet, Cardiac MR Academy Berlin, and Bayer (Schering-Berlex).
Prof. Dewey is the editor of the Cardiac Section of European Radiology.
Institutional master research agreements exist with Siemens Medical Solutions, Philips Medical Systems, and Toshiba Medical Systems. The terms of these arrangements are managed by the legal department of Charité – Universitätsmedizin Berlin.
Other authors declared no conflicts of interest.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all patients included in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Study subjects have been previously reported in Feger et al .
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