Model-based vs hybrid iterative reconstruction technique in ultralow-dose submillisievert CT colonography

Objective: To compare image quality of different reconstruction techniques in submillisievert ultralow-dose CT colonography (CTC) and to correlate colonic findings with subsequent optical colonoscopy. Methods: 58 patients underwent ultralow-dose CTC. The images were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR) or model-based iterative reconstruction (MBIR) techniques. In each segment, endoluminal noise (expressed as standard deviation of endoluminal density) was measured and image quality was rated on a five-point Likert scale by two independent readers. Colonic lesions were evaluated in consensus and correlated with subsequent optical colonoscopy where possible. Results: The estimated radiation dose was 0.41 +/- 0.05mSv for the supine and 0.42 +/- 0.04mSv for the prone acquisitions. In the endoluminal view, the image quality was rated better in HIR, whereas better scores were obtained in MBIR in the cross-sectional view, where the endoluminal noise was the lowest (p < 0.0001). Five (26%) polyps were not identified using both computer-aided detection and endoluminal inspection in FBP images vs only one (5%) in MBIR and none in HIR images. Conclusion: This study showed that in submillisievert ultralow-dose CTC, the image quality for the endoluminal view is better when HIR is used, whereas MBIR yields superior images for the cross-sectional view. The inferior quality of images reconstructed with FBP may result in decreased detection of colonic lesions. Advances in knowledge: Radiation dose from CTC can be safely reduced <1mSv for both positions when iterative reconstruction is used. MBIR provides better image quality in the cross-sectional view and HIR in the endoluminal view.