Objectives: To examine the impact of denoising on ultra-low-dose volume perfusion CT (ULD-VPCT) imaging in acute stroke.
Methods: Simulated ULD-VPCT data sets at 20 % dose rate were generated from perfusion data sets of 20 patients with suspected ischemic stroke acquired at 80 kVp/180 mAs. Four data sets were generated from each ULD-VPCT data set: not-denoised (ND); denoised using spatiotemporal filter (D1); denoised using quanta-stream diffusion technique (D2); combination of both methods (D1 + D2). Signal-to-noise ratio (SNR) was measured in the resulting 100 data sets. Image quality, presence/absence of ischemic lesions, CBV and CBF scores according to a modified ASPECTS score were assessed by two blinded readers.
Results: SNR and qualitative scores were highest for D1 + D2 and lowest for ND (all p ≤ 0.001). In 25 % of the patients, ND maps were not assessable and therefore excluded from further analyses. Compared to original data sets, in D2 and D1 + D2, readers correctly identified all patients with ischemic lesions (sensitivity 1.0, kappa 1.0). Lesion size was most accurately estimated for D1 + D2 with a sensitivity of 1.0 (CBV) and 0.94 (CBF) and an inter-rater agreement of 1.0 and 0.92, respectively.
Conclusion: An appropriate combination of denoising techniques applied in ULD-VPCT produces diagnostically sufficient perfusion maps at substantially reduced dose rates as low as 20 % of the normal scan.
Key points: Perfusion-CT is an accurate tool for the detection of brain ischemias. The high associated radiation doses are a major drawback of brain perfusion CT. Decreasing tube current in perfusion CT increases image noise and deteriorates image quality. Combination of different image-denoising techniques produces sufficient image quality from ultra-low-dose perfusion CT.
Keywords: Brain ischemia; Computed tomography; Perfusion imaging; Radiation dosage; Stroke.