Neointimal formation after carotid artery stenting: phantom and clinical evaluation of model-based iterative reconstruction (MBIR)

• Published in: European radiology Vol. 29; no. 1; pp. 161 - 167
• Main Authors: Yokomachi, Kazushi, Tatsugami, Fuminari, Higaki, Toru, Kume, Shinji, Sakamoto, Shigeyuki, Okazaki, Takahito, Kurisu, Kaoru, Nakamura, Yuko, Baba, Yasutaka, Iida, Makoto, Awai, Kazuo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Algorithms; Carotid arteries; Carotid artery; Carotid Artery, Common - diagnostic imaging; Carotid Artery, Common - surgery; Carotid Stenosis - diagnosis; Carotid Stenosis - surgery; Computed Tomography; Computed Tomography Angiography - methods; Computer simulation; Diagnostic Radiology; Diagnostic systems; Evaluation; Female; Formations; Humans; Image filters; Image reconstruction; Imaging; Imaging, Three-Dimensional; Implants; Internal Medicine; Interventional Radiology; Iterative methods; Male; Mathematical models; Medical imaging; Medicine; Medicine & Public Health; Multidetector Computed Tomography - methods; Neointima - diagnostic imaging; Neuroradiology; Phantoms, Imaging; Quality control; Radiology; ROC Curve; Stents; Surgical implants; Three dimensional imaging; Three dimensional models; Ultrasound; Vascular Surgical Procedures - methods; Visual observation; CT angiography; Image quality enhancement; Carotid artery stenosis; Image reconstruction; Multidetector computed tomography
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-018-5598-5

Objectives The objective of this study was to investigate the usefulness of model-based iterative reconstruction (IR) for detecting neointimal formations after carotid artery stenting. Methods In a cervical phantom harbouring carotid artery stents, we placed simulated neointimal formations measuring 0.40, 0.60, 0.80 and 1.00 mm along the stent wall. The thickness of in-stent neointimal formations was measured on images reconstructed with filtered-back projection (FBP), hybrid IR (AIDR 3D), and model-based IR (FIRST). The clinical study included 43 patients with carotid stents. Cervical computed tomography (CT) images obtained on a 320-slice scanner were reconstructed with AIDR 3D and FIRST. Five blinded observers visually graded the likelihood of neointimal formations on AIDR 3D and AIDR 3D plus FIRST images. Carotid ultrasound images were the reference standard. We analysed results of visual grading by using a Jack-knife type receiver observer characteristics analysis software. Results In the phantom study, the difference between the measured and the true diameter of the neointimal formations was smaller on FIRST than FBP or AIDR 3D images. In the clinical study, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of AIDR 3D were 58%, 88%, 83%, 67% and 73%, respectively. For AIDR 3D plus FIRST images they were 84%, 78%, 80%, 82% and 81%, respectively. The mean area under the curve was significantly higher on AIDR 3D plus FIRST than AIDR 3D images (0.82 vs 0.72; p < 0.01). Conclusions The model-based IR algorithm helped to improve diagnostic performance for the detection of neointimal formations after carotid artery stenting. Key Points • Neointimal formations can be visualised more accurately with model-based IR. • Model-based IR improves the detection of neointimal formations after carotid artery stenting. • Model-based IR is suitable for follow up after carotid artery stenting.