Multireader image quality evaluation of dynamic myocardial computed tomography perfusion imaging with a novel four-dimensional noise reduction filter

Olga Sliwicka, Zaneta Swiderska-Chadaj, Miranda Snoeren, Monique Brink, Khibar Salah, Liesbeth Peters-Bax, Tip Stille, Martinus Johannes van Amerongen, Ioannis Sechopoulos*, Jesse Habets

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Dynamic myocardial computed tomography perfusion (CTP) is a novel technique able to depict cardiac ischemia. Purpose: To evaluate the impact of a four-dimensional noise reduction filter (similarity filter [4D-SF]) on image quality in dynamic CTP imaging, allowing for substantial radiation dose reduction. Material and Methods: Dynamic CTP datasets of 30 patients (16 women) with suspected coronary artery disease, acquired with a 320-slice CT system, were retrieved, reconstructed with the deep learning-based algorithm of the system (DLR), and filtered with the 4D-SF. For each case, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in six regions of interest (33–38mm2) were calculated before and after filtering, in four-chamber and short-axis views, and t-tested. Furthermore, six radiologists of different expertise evaluated subjective image preference by answering five visual grading analysis-type questions (regarding acceptable level of noise, absence of artifacts, natural appearance, cardiac contour sharpness, diagnostic acceptability) using a 5-point scale. The results were analyzed using visual grade characteristics (VGC) and intraclass correlation coefficient (ICC). Results: Mean SNR in four-chamber view (unfiltered vs. filtered) were: septum=4.1 ± 2.1 versus 7.6 ± 5.6; lateral wall=4.5 ± 2.0 versus 8.0 ± 4.9; CNRseptum=16.6 ± 8.9 versus 31.7 ± 28; lateral wall=16.2 ± 8.9 versus 31.3 ± 28.9. Similar results were obtained in short-axis view. The perceived filtered image quality indicated decreased noise (VGCAUC=0.96) and artifacts (0.65), improved natural appearance (0.59), cardiac contour sharpness (0.74), and diagnostic acceptability (0.78). The inter-observer variability was excellent (ICC=0.79). All results were statistically significant (P < 0.05). Conclusion: Similarity filtering after DLR improves image quality, possibly enabling dose reduction in dynamic CTP imaging in patient with suspected chronic coronary syndrome.

Original languageEnglish
Pages (from-to)999-1006
JournalActa Radiologica
Issue number3
Early online date28 Jun 2022
Publication statusPublished - 2023
Externally publishedYes


  • Computed tomography
  • dynamic myocardial computed tomography perfusion imaging
  • image quality
  • noise reduction filter
  • n/a OA procedure
  • NLA


Dive into the research topics of 'Multireader image quality evaluation of dynamic myocardial computed tomography perfusion imaging with a novel four-dimensional noise reduction filter'. Together they form a unique fingerprint.

Cite this