Quantitative evaluation of beam-hardening artefact correction in dual-energy CT myocardial perfusion imaging

To assess quantitatively the impact of a novel reconstruction algorithm ("kernel") with beam-hardening correction (BHC) on beam-hardening artefacts of the myocardium at dual-energy CT myocardial perfusion imaging (DE-CTMPI).

Rest-series of DE-CTMPI examinations from 14 patients were retrospectively analyzed. Six image series were reconstructed for each patient: a) 100 kV, b) 140 kV, and c) linearly blended MIX0.5, each with BHC (D33f kernel) and without (D30f kernel). Seven hundred and fifty-six myocardial regions were assessed. Seven equal regions of interest divided the myocardium in the axial section. Three subdivisions were created within these regions in areas prone to BHA. Reports of SPECT studies performed within 30 days of CT examination were used to confirm the presence and location of true perfusion defects. Paired student t-test was used for statistical evaluation.

Overall mean myocardial attenuation was lower using BHC (D30f: 87.3 ± 24.1 HU; D33f: 85.5 ± 21.5 HU; p = 0.009). Overall relative difference from average myocardial attenuation (RDMA) was more homogeneous using BHC (D30f: -0.3 ± 11.4 %; D33f: 0.1 ± 10.1 %; p < 0.001). Changes in RDMA were greatest in the posterobasal myocardium (D30f: -16.2 ± 10.0 %; D33f: 3.4 ± 10.7 %; p < 0.001).

A dedicated reconstruction algorithm with BHC can significantly reduce beam-hardening artefacts in DE-CTMPI.

• Beam-hardening artefacts (BHA) cause interference with attenuation-based CT myocardial perfusion assessment (CTMPI). • BHA occur mostly in the posterobasal left ventricular wall. • Beam-hardening correction homogenized and decreased mean myocardial attenuation. • BHC can help avoid false-positive findings and increase specificity of static CTMPI.