Iterative Reconstruction Leads to Increased Subjective and Objective Image Quality in Cranial CT in Patients With Stroke

OBJECTIVE. The purpose of this study was to determine whether iterative reconstruction improves the quality of cranial CT (CCT) images of stroke patients. MATERIALS AND METHODS. Fifty-one CCT studies of patients with infarction performed with either a low (260 mAs; n = 21) or standard (340 mAs; n = 30) dose were reconstructed with both filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) with five strength levels (S1-S5). The resulting six image sets (one FBP and one each for SAFIRE levels S1-S5) were rated separately by two blinded radiologists in terms of conspicuity of infarcted areas on a 5-point scale. Noise and infarct-to-normal brain as well as medullary-to-cortical contrast-to-noise ratios (CNRs) were measured. Ratings, noise, and CNRs were intraindividually compared within the same dose group (Fisher exact test) and interindividually between the different dose groups (Wilcoxon-Mann-Whitney U test). RESULTS. The strength level S4 showed the best conspicuity of infarcted areas. Compared with FBP, SAFIRE S4 statistically significantly (p < 0.01) reduced noise and improved CNRs without statistically significant differences in all subjective and objective criteria (p > 0.01) when the dose was reduced. Patients examined with a 260-mAs low-dose were exposed to a statistically significantly lower dose (1.77 vs 2.33 mSv; p < 0.01). CONCLUSION. Iterative reconstruction (SAFIRE at strength level S4) leads to increased subjective and objective image quality in CCT and allows dose reduction (-24%) without losses in the demarcation of ischemic lesions.