Diagnostic Performance in Low- and High-Contrast Tasks of an Image-Based Denoising Algorithm Applied to Radiation Dose–Reduced Multiphase Abdominal CT Examinations

Akitoshi Inoue, Benjamin A. Voss, Nam Ju Lee, Hiroaki Takahashi, Kazuto Kozaka, Jay P. Heiken, Eric C. Ehman, Rogerio Vasconcelos, Jeff L. Fidler, Yong S. Lee, Achille Mileto, Matthew P. Johnson, Matthias Baer-Beck, Nikkole M. Weber, Gregory J. Michalak, Ahmed Halaweish, Rickey E. Carter, Cynthia H. McCollough, Joel G. Fletcher

Research output: Contribution to journalArticlepeer-review


BACKGROUND. Anatomic redundancy between phases can be used to achieve denoising of multiphase CT examinations. A limitation of iterative reconstruction (IR) techniques is that they generally require use of CT projection data. A frequency-split multiband-filtration algorithm applies denoising to the multiphase CT images themselves. This method does not require knowledge of the acquisition process or integration into the reconstruction system of the scanner, and it can be implemented as a supplement to commercially available IR algorithms. OBJECTIVE. The purpose of the present study is to compare radiologists’ performance for low-contrast and high-contrast diagnostic tasks (i.e., tasks for which differences in CT attenuation between the imaging target and its anatomic background are subtle or large, respectively) evaluated on multiphase abdominal CT between routine-dose images and radiation dose–reduced images processed by a frequency-split multiband-filtration denoising algorithm. METHODS. This retrospective single-center study included 47 patients who underwent multiphase contrast-enhanced CT for known or suspected liver metastases (a low-contrast task) and 45 patients who underwent multiphase contrast-enhanced CT for pancreatic cancer staging (a high-contrast task). Radiation dose–reduced images corresponding to dose reduction of 50% or more were created using a validated noise insertion technique and then underwent denoising using the frequency-split multiband-filtration algorithm. Images were independently evaluated in multiple sessions by different groups of abdominal radiologists for each task (three readers in the low-contrast arm and four readers in the high-contrast arm). The noninferiority of denoised radiation dose–reduced images to routine-dose images was assessed using the jackknife alternative free-response ROC (JAFROC) figure-of-merit (FOM; limit of noninferiority, -0.10) for liver metastases detection and using the Cohen kappa statistic and reader confidence scores (100-point scale) for pancreatic cancer vascular invasion. RESULTS. For liver metastases detection, the JAFROC FOM for denoised radiation dose–reduced images was 0.644 (95% CI, 0.510–0.778), and that for routine-dose images was 0.668 (95% CI, 0.543–0.792; estimated difference, -0.024 [95% CI, -0.084 to 0.037]). Intraobserver agreement for pancreatic cancer vascular invasion was substantial to near perfect when the two image sets were compared (κ = 0.53–1.00); the 95% CIs of all differences in confidence scores between image sets contained zero. CONCLUSION. Multiphase contrast-enhanced abdominal CT images with a radiation dose reduction of 50% or greater that undergo denoising by a frequency-split multiband-filtration algorithm yield performance similar to that of routine-dose images for detection of liver metastases and vascular staging of pancreatic cancer. CLINICAL IMPACT. The image-based denoising algorithm facilitates radiation dose reduction of multiphase examinations for both low- and high-contrast diagnostic tasks without requiring manufacturer-specific hardware or software.

Original languageEnglish (US)
Pages (from-to)73-85
Number of pages13
JournalAmerican Journal of Roentgenology
Issue number1
StatePublished - Jan 2023


  • MDCT
  • image quality enhancements
  • image reconstructions
  • metastasis
  • pancreatic cancer
  • radiation dosage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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