Optimal Adaptive Statistical Iterative Reconstruction Percentage in Dual-energy Monochromatic CT Portal Venography

Rationale and Objectives: The aim of this article was to study the influence of different adaptive statistical iterative reconstruction (ASIR) percentages on the image quality of dual-energy computed tomography (DECT) portal venography in portal hypertension patients. Materials and Methods: DECT scans of 40 patients with cirrhosis (mean age, 56 years) at the portal venous phase were retrospectively analyzed. Monochromatic images at 60 and 70 keV were reconstructed with four ASIR percentages: 0%, 30%, 50%, and 70%. Computed tomography (CT) numbers of the portal veins (PVs), liver parenchyma, and subcutaneous fat tissue in the abdomen were measured. The standard deviation from the region of interest of the liver parenchyma was interpreted as the objective image noise (IN). The contrast-noise ratio (CNR) between PV and liver parenchyma was calculated. The diagnostic acceptability (DA) and sharpness of PV margins were obtained using a 5-point score. The IN, CNR, DA, and sharpness of PV were compared among the eight groups with different keV + ASIR level combinations. Results: The IN, CNR, DA, and sharpness of PV of different keV + ASIR groups were all statistically different (P < 0.05). In the eight groups, the best and worst CNR were obtained in the 60 keV + 70% ASIR and 70 keV + 0% ASIR (filtered back-projection [FBP]) combination, respectively, whereas the largest and smallest objective IN were obtained in the 60 keV + 0% ASIR (FBP) and 70 keV + 70% combination. The highest DA and sharpness values of PV were obtained at 50% ASIR for 60 keV. Conclusions: An optimal ASIR percentage (50%) combined with an appropriate monochromatic energy level (60 keV) provides the highest DA in portal venography imaging, whereas for the higher monochromatic energy (70 keV) images, 30% ASIR provides the highest image quality, with less IN than 60 keV with 50% ASIR.