Deep learning–based reconstruction may improve non-contrast cerebral CT imaging compared to other current reconstruction algorithms

OBJECTIVES: To evaluate image quality and reconstruction times of a commercial deep learning reconstruction algorithm (DLR) compared to hybrid-iterative reconstruction (Hybrid-IR) and model-based iterative reconstruction (MBIR) algorithms for cerebral non-contrast CT (NCCT). METHODS: Cerebral NCCT acquisitions of 50 consecutive patients were reconstructed using DLR, Hybrid-IR and MBIR with a clinical CT system. Image quality, in terms of six subjective characteristics (noise, sharpness, grey-white matter differentiation, artefacts, natural appearance and overall image quality), was scored by five observers. As objective metrics of image quality, the noise magnitude and signal-difference-to-noise ratio (SDNR) of the grey and white matter were calculated. Mean values for the image quality characteristics scored by the observers were estimated using a general linear model to account for multiple readers. The estimated means for the reconstruction methods were pairwise compared. Calculated measures were compared using paired t tests. RESULTS: For all image quality characteristics, DLR images were scored significantly higher than MBIR images. Compared to Hybrid-IR, perceived noise and grey-white matter differentiation were better with DLR, while no difference was detected for other image quality characteristics. Noise magnitude was lower for DLR compared to Hybrid-IR and MBIR (5.6, 6.4 and 6.2, respectively) and SDNR higher (2.4, 1.9 and 2.0, respectively). Reconstruction times were 27 s, 44 s and 176 s for Hybrid-IR, DLR and MBIR respectively. CONCLUSIONS: With a slight increase in reconstruction time, DLR results in lower noise and improved tissue differentiation compared to Hybrid-IR. Image quality of MBIR is significantly lower compared to DLR with much longer reconstruction times. KEY POINTS: • Deep learning reconstruction of cerebral non-contrast CT results in lower noise and improved tissue differentiation compared to hybrid-iterative reconstruction. • Deep learning reconstruction of cerebral non-contrast CT results in better image quality in all aspects evaluated compared to model-based iterative reconstruction. • Deep learning reconstruction only needs a slight increase in reconstruction time compared to hybrid-iterative reconstruction, while model-based iterative reconstruction requires considerably longer processing time. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-020-07668-x.