131 Reduced-Dose Dual-Source Coronary Computed Tomography Angiography (CCTA): Is Raw-Data-Based Iterative Reconstruction able to Maintain Diagnostic Confidence?

Purpose To evaluate image quality and diagnostic confidence of a raw-data-based iterative reconstruction technique (SAFIRE) in reduced-dose CCTA images in comparison with standard-dose filtered back projection (FBP) images. Materials and methods 107 consecutive patients (72 males; 35 females), referred for a CCTA were prospectively included using a dual-source CT system in a high pitch (n = 51) or a sequential mode (n = 56) according to heart rate (mean DLP = 204.6 mGy.cm). From each acquisition, three series of images were reconstructed: standard-dose images reconstructed with FBP and considered as the reference standard (Group 1); and two series of reduced-dose images obtained with prototype software simulating a 30% dose reduction, and reconstructed with FBP (Group 2) or SAFIRE (Group 3). Two readers blindly evaluated each series for (a) objective noise and CNR; (b) coronary border sharpness, lesion severity; and (c) diagnostic confidence level using a 5-point scale. Results In Group 2, there was a significant increase in noise compared to Group 1 (36.8 HU ±6.73 vs 30.4 HU ±5.20; p Conclusion Raw-data-based iterative reconstruction allowed significant noise reduction but may be associated with blurring of the coronary luminal borders, which can decrease diagnostic confidence. When reporting reduced-dose CCTA with iterative reconstruction, false smooth plaque artefacts must be considered in diagnostic assessment and subsequent patient management.