A Systematic Review of Image Quality, Diagnostic Value and Radiation Dose of Coronary CT Angiography Using Iterative Reconstruction Compared to Filtered Back Projection in the Diagnosis of Coronary Artery Disease

The purpose of this study was to perform a systematic review of the image quality, diagnostic value and radiation dose of coronary CT angiography performed with iterative reconstruction (IR) when compared to the standard filtered back-projection (FBP) techniques. A search of Pubmed/Medline and Science direct databases for English literature was performed to identify studies comparing IR and FBP techniques used in coronary CT angiography in the diagnosis of patients with suspected coronary artery disease. Qualitative and quantitative assessment of image quality and effective radiation dose associated with coronary CT angiography were analyzed and compared between the two reconstruction algorithms to determine if there are any significant differences. Twenty-nine studies met selection criteria and were included in the analysis. In comparison with FBP; coronary CT angiography with IR showed improvement in image quality in terms of qualitative and quantitative image analysis. Furthermore, the IR technique results in higher segment assessability (89.5% vs. 85.8%) and high sensitivity, specificity and diagnostic accuracy (95.2%, 96.5% and 96.3% and 94.2%, and 94.3%) (although no significant difference between IR and FBP reconstructions) but with significantly lower radiation dose than that with use of FBP (3.1 mSv vs. 5.8 mSv). Iterative reconstruction technique leads to noise reduction and subsequently improvement in image quality in coronary CT angiography with significantly lower radiation dose. It could be used as a feasible alternative to the standard filtered back projection in coronary CT angiography, although further studies are needed to confirm its diagnostic value.