4D Dynamic contrast-enhanced breast CT: Phantom-based reconstruction parameter optimization for iodine quantification.

Background: Four-dimensional dynamic contrast-enhanced breast CT (4D DCE-bCT) offers promising high-resolution spatial and temporal imaging capabilities for the characterization and monitoring of breast tumors. However, the optimal combination of parameters for iodine quantification in image space remains to be determined.

Purpose: This study aims to optimize a dedicated bCT system to perform long dynamic contrast-enhanced scans with high spatio-temporal resolution while maintaining a reasonable radiation dose.

Methods: Our protocol includes the acquisition of a high-quality prior image that is reconstructed with a polychromatic iterative algorithm (IMPACT). The acquisition of the post-contrast sequence is continuous but sparse and these images are reconstructed using prior image constrained compressed sensing (PICCS). A four-step optimization process is performed using images of a physical phantom. First, the optimal tube current is selected by taking the noise level into account. Second, the optimal number of angles is selected based on the absence of streak artifacts. Third, the number of iterations in IMPACT is specified at the lowest value that achieves the highest spatial resolution. Finally, the number of iterations in PICCS is determined based on the quantitative accuracy of a range of iodine concentrations.

Results: When a high-quality prior image is available, the imaging of post-contrast images can be performed using just 40 projection angles with a tube current of 32 mA. The noise level in the post-contrast images is inherited from the prior image and no streak artifacts are visible. Mean difference between the linear attenuation coefficients of samples containing iodine reconstructed with IMPACT using all 360 projections and PICCS using 40 projections is 0.0004 at most. The spatial resolution of images reconstructed with PICCS is lower than the one of IMPACT images and is concentration dependent. The cut-off frequency at 10% modulation transfer function drops from 1.55 in the prior image to 0.9 when the target with the largest concentration is evaluated. The total mean glandular dose of the protocol does not exceed 22.5 mGy.

Conclusions: This study found the optimal acquisition and reconstruction parameters for a low-dose dynamic contrast-enhanced bCT protocol. The numerical accuracy of the proposed protocol was ensured by performing a physical phantom study.