Comparison of pure and hybrid iterative reconstruction techniques with conventional filtered back projection: image quality assessment in the cervicothoracic region.

OBJECTIVES: To evaluate the impact on image quality of three different image reconstruction techniques in the cervicothoracic region: model-based iterative reconstruction (MBIR), adaptive statistical iterative reconstruction (ASIR), and filtered back projection (FBP). METHODS: Forty-four patients underwent unenhanced standard-of-care clinical computed tomography (CT) examinations which included the cervicothoracic region with a 64-row multidetector CT scanner. Images were reconstructed with FBP, 50% ASIR-FBP blending (ASIR50), and MBIR. Two radiologists assessed the cervicothoracic region in a blinded manner for streak artifacts, pixilated blotchy appearances, critical reproduction of visually sharp anatomical structures (thyroid gland, common carotid artery, and esophagus), and overall diagnostic acceptability. Objective image noise was measured in the internal jugular vein. Data were analyzed using the sign test and pair-wise Student's t-test. RESULTS: MBIR images had significant lower quantitative image noise (8.88 ± 1.32) compared to ASIR images (18.63 ± 4.19, P<0.01) and FBP images (26.52 ± 5.8, P<0.01). Significant improvements in streak artifacts of the cervicothoracic region were observed with the use of MBIR (P<0.001 each for MBIR vs. the other two image data sets for both readers), while no significant difference was observed between ASIR and FBP (P>0.9 for ASIR vs. FBP for both readers). MBIR images were all diagnostically acceptable. Unique features of MBIR images included pixilated blotchy appearances, which did not adversely affect diagnostic acceptability. CONCLUSIONS: MBIR significantly improves image noise and streak artifacts of the cervicothoracic region over ASIR and FBP. MBIR is expected to enhance the value of CT examinations for areas where image noise and streak artifacts are problematic.