The effect of iterative reconstruction on quantitative computed tomography assessment of coronary plaque composition

To compare coronary plaque size and composition as well as degree of coronary artery stenosis on coronary Computed Tomography angiography (CCTA) using three levels of iterative reconstruction (IR) with standard filtered back projection (FBP). In 63 consecutive patients with a clinical indication for CCTA 55 coronary plaques were analysed. Raw data were reconstructed using standard FBP and levels 2, 4 and 6 of a commercially available IR algorithm (iDose(4)). CT attenuation and noise were measured in the aorta and two coronary arteries. Both signal-to-noise-ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The amount of lipid, fibrous and calcified plaque components and mean cross-sectional luminal area were analysed using dedicated software. Image noise was reduced by 41.6% (p < 0.0001) and SNR and CNR in the aorta were improved by 73.4% (p < 0.0001) and 72.9% (p < 0.0001) at IR level 6, respectively. IR improved objective image quality measures more in the aorta than in the coronary arteries. Furthermore, IR had no significant effect on measurements of plaque volume and cross-sectional luminal area. The application of IR significantly improves objective image quality, and does not alter quantitative analysis of coronary plaque volume, composition and luminal area.