Improving the image quality of pediatric chest CT angiography with low radiation dose and contrast volume using deep learning image reconstruction

Abstract

Background: Chest CT angiography (CTA) is a common clinical examination technique for children. Iterative reconstruction algorithms are often used to reduce image noise but encounter limitations under low dose conditions. Deep learning-based image reconstruction algorithms have been developed to overcome these limitations. We assessed the quantitative and qualitative image quality of thin-slice chest CTA in children acquired with low radiation dose and contrast volume by using a deep learning image reconstruction (DLIR) algorithm. Methods: A total of 33 children underwent chest CTA with 70 kVp and automatic tube current modulation for noise indices of 11-15 based on their age and contrast volume of 0.8-1.2 mL/kg. Images were reconstructed with 50% and 100% adaptive statistical iterative reconstruction-V (ASIR-V) and high-setting DLIR (DLIR-H) at 0.625 mm slice thickness. Two radiologists evaluated images in consensus for overall image noise, artery margin, and artery contrast separately on a 5-point scale (5, excellent; 4, good; 3, acceptable; 2, sub-acceptable, and 1, not acceptable). The CT value and image noise of the descending aorta and back muscle were measured. Radiation dose and contrast volume was recorded. Results: The volume CT dose index, dose length product, and contrast volume were 1.37±0.29 mGy, 35.43±10.59 mGy cm, and 25.43±13.32 mL, respectively. The image noises (in HU) of the aorta with DLIR-H (19.24±5.77) and 100% ASIR-V (20.45±6.93) were not significantly different (P>0.05) and were substantially lower than 50% ASIR-V (29.45±7.59) (P<0.001). The 100% ASIR-V images had over-smoothed artery margins, but only the DLIR-H images provided acceptable scores on all 3 aspects of the qualitative image quality evaluation. Conclusions: It is feasible to improve the image quality of a low radiation dose and contrast volume chest CTA in children using the high-setting DLIR algorithm.