Inter-observer agreement and image quality of model-based algorithm applied to the Coronary Artery Disease-Reporting and Data System score

Davide Ippolito; Cammillo Talei Franzesi; Cecilia Cangiotti; Luca Riva; Andrea De Vito; Davide Gandola; Cesare Maino; Paolo Marra; Giuseppe Muscogiuri; Sandro Sironi

doi:10.1186/s13244-022-01286-5

Inter-observer agreement and image quality of model-based algorithm applied to the Coronary Artery Disease-Reporting and Data System score

Insights Imaging. 2022 Nov 18;13(1):176. doi: 10.1186/s13244-022-01286-5.

Authors

Davide Ippolito^{1

2}, Cammillo Talei Franzesi³, Cecilia Cangiotti³, Luca Riva³, Andrea De Vito³, Davide Gandola^{3

4}, Cesare Maino³, Paolo Marra⁵, Giuseppe Muscogiuri^{4

6}, Sandro Sironi^{4

5}

Affiliations

¹ Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy. davide.ippolito@unimib.it.
² School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. davide.ippolito@unimib.it.
³ Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
⁴ School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
⁵ Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, BG, Italy.
⁶ IRCCS, Istituto Auxologico Italiano, Milan, Italy.

Abstract

Purpose: To evaluate the inter-observer agreement of the CAD-RADS reporting system and compare image quality between model-based iterative reconstruction algorithm (MBIR) and standard iterative reconstruction algorithm (IR) of low-dose cardiac computed tomography angiography (CCTA).

Methods: One-hundred-sixty patients undergone a 256-slice MDCT scanner using low-dose CCTA combined with prospective ECG-gated techniques were enrolled. CCTA protocols were reconstructed with both MBIR and IR. Each study was evaluated by two readers using the CAD-RADS lexicon. Vessels enhancement, image noise, signal-to-noise (SNR), and contrast-to-noise (CNR) were computed in the axial native images, and inter-observer agreement was assessed. Radiation dose exposure as dose-length product (DLP) and effective dose were finally reported.

Results: The reliability analysis between the two readers was almost perfect for all CAD-RADS standard categories. Moreover, a significantly higher value of subjective qualitative analysis, SNR, and CNR in MBIR images compared to IR were found, due to a lower noise level (all p < 0.05). The mean DLP measured was 63.9 mGy*cm, and the mean effective dose was 0.9 mSv.

Conclusion: Inter-observer agreement of CAD-RADS was excellent confirming the importance, the feasibility, and the reproducibility of the CAD-RADS scoring system for CCTA. Moreover, lower noise and higher image quality with MBIR compared to IR were found.

Implications for practice: MBIR, by reducing noise and improving image quality, can help a better assessment of CAD-RADS, in comparison with standard IR algorithm.

Keywords: Cardiac computed tomography angiography; Coronary Artery Disease-Reporting and Data System; Coronary artery disease; Model-based iterative reconstruction algorithm; Radiation exposure.