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Comparison of Iterative Model–Based Reconstruction Versus Conventional Filtered Back Projection and Hybrid Iterative Reconstruction Techniques: Lesion Conspicuity and Influence of Body Size in Anthropomorphic Liver Phantoms

Purpose This study aimed to determine whether an iterative model–based reconstruction (IMR) can improve lesion conspicuity and depiction on computed tomography (CT) compared with filtered back projection (FBP) and hybrid iterative reconstruction (iDose4) using anthropomorphic phantoms. Materials and Methods One small and one large anthropomorphic body phantoms, each containing 8 simulated focal liver lesions (FLLs), were scanned using a 256-channel CT scanner at 120 kVp with variable tube current-time products (10-200 mAs). Scans were divided into 3 groups based on radiation dose (RD) as follows: (a) full dose (FD), (b) low dose (FD50), and (c) ultralow dose (FD25 for the large phantom, FD15 for the small phantom). All images were reconstructed using FBP, iDose4, and IMR. Image noise and lesion-to-liver contrast were assessed quantitatively and qualitatively. Thereafter, 6 radiologists independently evaluated conspicuity of FLLs, and then, compared the number of invisible FLLs on 3 image sets of each RD group. Results Image noise was significantly lower with IMR than with FBP and iDose4 at the same RD. Iterative model–based reconstruction improved conspicuity of low-contrast FLLs in all RD groups compared to the others (P < 0.001). Furthermore, compared to FBP and iDose4, the number of visible FLLs significantly increased on IMR images in the FD15 group of the small phantom 52.8% [38/72], 68.1% [49/72], and 84.8% [61/72], respectively; P < 0.001) and in the FD 25, FD50 groups of the large phantom (FD50: 56.9% [41/72], 76.4% [55/72], and 84.7% [61/72], respectively; P < 0.05). Conclusions Iterative model–based reconstruction reduced image noise and improved low-contrast FLL conspicuity, compared to FBP and iDose4. Therefore, depiction of low-contrast FLLs on FBP could be improved using IMR.