title: Use of Model-based Iterative Reconstruction to Improve Detection of Congenital Cardiovascular Anomalies in Infants Undergoing Free-breathing Computed Tomographic Angiography.
abstract: OBJECTIVE
  The aim of the study was to assess the detection of congenital cardiovascular anomalies (congenital heart disease) in neonates and infants using model-based iterative reconstruction (MBIR) algorithm compared with hybrid iterative reconstruction (HIR) and filtered back projection (FBP) reconstructions on axial computed tomography (CT) performed at minimum scanner dose.
  
  
  METHODS
  Over 1 year, all CT angiographies performed in infants below 3 months of age with congenital heart disease were assessed retrospectively. All were scanned on a 256-slice CT (Brilliance iCT) using single axial rotation at minimum allowable scanner dose (80 kV/10 mAs), with patients free-breathing. Intravenous contrast was 1 mL/kg. Scan reconstruction was 0.9 mm/0.45 mm overlap, reconstructed with FBP, HIR (iDose5), and MBIR (IMR2). The 3 reconstructions per study were anonymized and randomized. Four cardiac radiologists (23, 9, 7, and 6 y experience) evaluated each reconstruction on a workstation for presence of an atrial septal defect, a ventricular septal defect, patent ductus arteriosus, and surgical shunt or anomalies of the aorta, pulmonary arteries, and pulmonary veins. Unevaluable structures were classified as nondiagnostic. Gold standard was surgery or both echocardiogram and cardiac catheterization. The sensitivity, specificity, and accuracy were determined for each reconstruction.
  
  
  RESULTS
  Fifteen scans in 14 infants met the inclusion criteria, with a total of 48 anomalies. Pooled sensitivity for MBIR of 0.82 (range, 0.75 to 0.9) was significantly better than those for FBP (0.58; range, 0.54 to 0.6; P<0.001) and HIR (0.67; range, 0.60 to 0.79; P<0.001). Pooled accuracy of MBIR, HIR, and FBP was 0.91, 0.84, and 0.81, respectively. Readers deemed 39 and 15 structures nondiagnostic with FBP and HIR, respectively, versus 2 with MBIR (MBIR-FBP, MBIR-HIR, P<0.0001). The CTDIvol, DLP, and estimated dose for all cases was 0.52 mGy, 4.2 mGy×cm, and 0.16 mSv.
  
  
  CONCLUSIONS
  MBIR significantly improves the detection of congenital anomalies in neonates and infants undergoing CT angiography at minimum allowable dose.
authors.affiliation: *Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD †Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
authors.forename: Seth
authors.initials: S
authors.lastname: Kligerman
authors.forename: Ferdia
authors.initials: F
authors.lastname: Bolster
authors.forename: Jason
authors.initials: J
authors.lastname: Mitchell
authors.forename: Travis
authors.initials: T
authors.lastname: Henry
authors.forename: Jean
authors.initials: J
authors.lastname: Jeudy
authors.forename: Charles S
authors.initials: CS
authors.lastname: White
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012119:Respiration; D012680:Sensitivity and Specificity