Advanced virtual monoenergetic imaging algorithm for lower extremity computed tomography angiography: effects on...

Area of Science:

• Radiology
• Medical Imaging
• Cardiovascular Imaging

Background:

• Peripheral arterial disease (PAD) diagnosis relies on imaging techniques.
• Computed tomography angiography (CTA) is a key modality for evaluating PAD.
• Optimizing image quality in LE-CTA is crucial for accurate PAD assessment.

Purpose of the Study:

• To investigate the impact of monoenergetic images (MEIs) at various kiloelectron volt (keV) levels on lower extremity computed tomography angiography (LE-CTA) image quality.
• To determine the optimal keV level for evaluating peripheral arterial disease (PAD) using LE-CTA with MEIs.
• To assess the effect of MEI reconstruction on venous contamination and metal artifacts in LE-CTA.

Main Methods:

• 146 patients undergoing LE-CTA on a dual-energy scanner were included.
• Monoenergetic images (MEIs) were reconstructed at 40, 50, 60, 70, and 80 keV.
• Image quality was evaluated based on overall quality, segmental quality, venous contamination, and metal artifacts.

Main Results:

• Overall and segmental image quality significantly improved with increasing keV levels, peaking at 70-80 keV.
• Unsatisfactory image quality due to calcification indistinguishability was noted at lower keV levels (40-50 keV).
• Venous contamination and metal artifacts were reduced at 70-80 keV compared to 40 keV.

Conclusions:

• LE-CTA using MEIs reconstructed at 70-80 keV enhances image quality for PAD evaluation.
• This approach effectively mitigates venous contamination and metal artifacts, improving diagnostic confidence.
• Optimized MEI reconstruction in LE-CTA offers superior visualization of lower extremity vasculature in PAD patients.