Comparison of different iterative reconstruction algorithms with contrast-enhancement boost technique on the image quality of CT pulmonary angiography for obese patients.

Objective: To evaluate the effect of the contrast-enhancement-boost (CE-boost) postprocessing technique on improving the image quality of obese patients in computed tomography pulmonary angiography (CTPA) compared to hybrid iterative reconstruction (HIR) and model-based iterative reconstruction (MBIR) algorithms.

Methods: This prospective study was conducted on 100 patients who underwent CTPA for suspected pulmonary embolism. Non-obese patients with a body mass index (BMI) under 25 were designated as group 1, while obese patients (group 2) had a BMI exceeding 25. The CE-boost images were generated by subtracting non-contrast HIR images from contrast-enhanced HIR images to improve the visibility of pulmonary arteries further. The CT value, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantitatively assessed. Two chest radiologists independently reviewed the CT images (5, best; 1, worst) across three subjective characteristics including diagnostic confidence, subjective image noise, and vascular contrast. The Friedman test and Dunn-Bonferroni correction were used for statistical analysis.

Results: The CE-boost had significantly higher CT values than HIR and MBIR in both groups (all p < 0.001). The MBIR yielded the lowest image noise compared with HIR and CE-boost (all p < 0.001). The SNR and CNR of main pulmonary artery (MPA) were significantly higher in CE-boost than in MBIR (all p < 0.05), with HIR showing the lowest values (all p < 0.001). Group 2 MBIR received significantly better subjective image noise scores, while the diagnostic confidence and vascular contrast scored highest with the group 2 CE-boost (all p < 0.05).

Conclusion: Compared to the HIR algorithm, both the CE-boost technique and the MBIR algorithm can improve the image quality of CTPA in obese patients. CE-boost had the greatest potential in increasing the visualization of pulmonary artery and its branches.