title: Advanced Modeled Iterative Reconstruction in Low-Tube-Voltage Contrast-Enhanced Neck CT: Evaluation of Objective and Subjective Image Quality.
abstract: OBJECTIVE
  Dose-saving techniques in neck CT cause increased image noise that can be counteracted by iterative reconstruction. Our aim was to evaluate the image quality of advanced modeled iterative reconstruction (ADMIRE) in contrast-enhanced low-tube-voltage neck CT.
  
  
  METHODS
  Sixty-one patients underwent 90-kV(peak) neck CT by using third-generation 192-section dual-source CT. Image series were reconstructed with standard filtered back-projection and ADMIRE strength levels 1, 3, and 5. Attenuation and noise of the sternocleidomastoid muscle, internal jugular vein, submandibular gland, tongue, subscapularis muscle, and cervical fat were measured. Signal-to-noise and contrast-to-noise ratios were calculated. Two radiologists assessed image noise, image contrast, delineation of smaller structures, and overall diagnostic acceptability. Interobserver agreement was calculated.
  
  
  RESULTS
  Image noise was significantly reduced by using ADMIRE compared with filtered back-projection with the lowest noise observed in ADMIRE 5 (filtered back-projection, 9.4 ± 2.4 Hounsfield units [HU]; ADMIRE 1, 8.3 ± 2.8 HU; ADMIRE 3, 6.7 ± 2.0 HU; ADMIRE 5, 5.4 ± 1.7 HU; all, P < .001). Sternocleidomastoid SNR and internal jugular vein-sternocleidomastoid contrast-to-noise ratios were significantly higher for ADMIRE with the best results in ADMIRE 5 (all, P < .001). Subjective image quality and image contrast of ADMIRE 3 and 5 were consistently rated better than those for filtered back-projection and ADMIRE 1 (all, P < .001). Image noise was rated highest for ADMIRE 5 (all, P < .005). Delineation of smaller structures was voted higher in all ADMIRE strength levels compared with filtered back-projection (P < .001). Global interobserver agreement was good (0.75).
  
  
  CONCLUSIONS
  Contrast-enhanced 90-kVp neck CT is feasible, and ADMIRE 5 shows superior objective image quality compared with filtered back-projection. ADMIRE 3 and 5 show the best subjective image quality.
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany janerikscholtz@gmail.com.
authors.forename: J-E
authors.identifier: http://orcid.org/0000-0003-4631-6126
authors.initials: JE
authors.lastname: Scholtz
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-5280-9141
authors.initials: M
authors.lastname: Kaup
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: K
authors.identifier: http://orcid.org/0000-0002-4450-1240
authors.initials: K
authors.lastname: Hüsers
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: M H
authors.identifier: http://orcid.org/0000-0002-4966-6407
authors.initials: MH
authors.lastname: Albrecht
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: B
authors.identifier: http://orcid.org/0000-0002-2409-0528
authors.initials: B
authors.lastname: Bodelle
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: S C
authors.identifier: http://orcid.org/0000-0002-8618-1695
authors.initials: SC
authors.lastname: Metzger
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: J M
authors.identifier: http://orcid.org/0000-0002-7515-3939
authors.initials: JM
authors.lastname: Kerl
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: R W
authors.identifier: http://orcid.org/0000-0002-6804-1832
authors.initials: RW
authors.lastname: Bauer
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: T
authors.identifier: http://orcid.org/0000-0001-7100-7689
authors.initials: T
authors.lastname: Lehnert
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: T J
authors.identifier: http://orcid.org/0000-0002-4590-376X
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany Department of Radiology and Radiological Science (J.L.W.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: J L
authors.identifier: http://orcid.org/0000-0001-5724-7344
authors.initials: JL
authors.lastname: Wichmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media