PurposeWe aimed to compare the efficacy of the double contrast enhancement (CE)-boost technique with that of conventional methods to improve vascular contrast attenuation in lower-extremity computed tomography (CT) angiography. ApproachThis retrospective study enrolled 45 patients (mean age, 70 years; range, 26 to 90 years; 30 males). To generate the CE-boost image, the degree of CE was determined by subtracting the post-contrast CT images from the pre-contrast CT images. The double CE–boost technique involves the application of this CE process twice. Both objective assessments (CT attenuation, noise level, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR], and image sharpness) and subjective quality evaluations were conducted on three types of images (conventional, CE-boost, and double CE–boost images). ResultsDouble CE–boost images demonstrated significantly reduced noise in Hounsfield units (HUs) compared with conventional and CE-boost images (p<0.001). CT attenuation values (HUs) were substantially higher in all different locations of the lower extremity with double CE–boost images (834.49±140.73), as opposed to conventional (399.63±62.01) and CE-boost images (572.66±93.61). The SNR and CNR were notably improved in the double CE–boost image compared with both conventional and CE-boost images. Image sharpness analysis of the popliteal artery (p=0.828), anterior tibial artery (p=0.671), and dorsalis pedis artery (p=0.281) revealed consistency across conventional, CE-boost, and double CE–boost images. Subjective image analysis indicated superior ratings for the double CE–boost compared with other types. ConclusionsThe implementation of the double CE–boost technique improves image quality by decreasing image noise, increasing CT attenuation, and improving SNR, CNR, and subjective assessment compared with CE-boost and conventional imaging.
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