title: Dynamic contrast-enhanced CT for prostate cancer: relationship between image noise, voxel size, and repeatability.
abstract: OBJECTIVE
  To evaluate the relationship between image noise, voxel size, and voxel-wise repeatability of a dynamic contrast agent-enhanced (DCE) computed tomographic (CT) examination for prostate cancer.
  
  
  METHODS
  This prospective study was approved by the local research ethics committee, and all patients gave written informed consent. Twenty-nine patients (mean age, 69.1 years; range, 56-80 years) with biopsy-proved prostate cancer underwent two DCE CT examinations within 1 week prior to radiation therapy. Parameter maps of transfer constant (K(trans)), the fraction of blood plasma (v(p)), the fraction of extravascular extracellular space (v(e)), and the flux rate constant between the extravascular extracellular space and plasma (k(ep)) were calculated at 15 different image resolutions, with kernel sizes ranging from 0.002 to 2.57 cm(3). Statistical analysis to quantify the voxel-wise repeatability was performed by using a Bland-Altman analysis on all tracer kinetic model parameter maps of each patient. From this analysis, the within-voxel standard deviation (wSD) was calculated as a function of spatial resolution.
  
  
  RESULTS
  A kernel size in the range of 0.1-0.3 cm(3) yields reliable information. At 0.15 cm(3), the median wSDs of K(trans), k(ep), v(p), and v(e) are 0.047 min(-1), 0.144 min(-1), 0.011, and 0.104, respectively. With increasing kernel size, these values reach stable levels of approximately 0.02 min(-1), 0.05 min(-1), 0.005, and 0.05, respectively.
  
  
  CONCLUSIONS
  There is a high voxel-wise repeatability of the DCE CT imaging technique for prostate cancer for kernel sizes as small as 0.1 cm(3). With the relationship between kernel size, image noise and voxel-wise repeatability, it becomes possible to estimate for alternative DCE CT protocols (eg, those with a reduced radiation dose) at what kernel size a sufficient repeatability can be obtained.
authors.affiliation: Department of Radiotherapy and Radiology, University Medical Center Utrecht, GA Utrecht, The Netherlands. J.Korporaal-2@umcutrecht.nl
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Korporaal
authors.forename: Cornelis A T
authors.initials: CA
authors.lastname: van den Berg
authors.forename: Cécile R L P N
authors.initials: CR
authors.lastname: Jeukens
authors.forename: Greetje
authors.initials: G
authors.lastname: Groenendaal
authors.forename: Maaike R
authors.initials: MR
authors.lastname: Moman
authors.forename: Peter
authors.initials: P
authors.lastname: Luijten
authors.forename: Marco
authors.initials: M
authors.lastname: van Vulpen
authors.forename: Uulke A
authors.initials: UA
authors.lastname: van der Heide
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media