Detectability of Hypoattenuating Liver Lesions with Deep Learning CT Reconstruction: A Phantom and Patient Study

Background CT deep learning image reconstruction (DLIR) improves image quality by reducing noise compared with adaptive statistical iterative reconstruction-V (ASIR-V). However, objective assessment of low-contrast lesion detectability is lacking. Purpose To investigate low-contrast detectability of hypoattenuating liver lesions on CT scans reconstructed with DLIR compared with CT scans reconstructed with ASIR-V in a patient and a phantom study. Materials and Methods This single-center retrospective study included patients undergoing portal venous phase abdominal CT between February and May 2021 and a low-contrast-resolution phantom scanned with the same protocol. Four reconstructions (ASIR-V at 40% strength [ASIR-V 40] and DLIR at three strengths) were generated. Five radiologists qualitatively assessed the images using the five-point Likert scale for image quality, lesion diagnostic confidence, conspicuity, and small lesion (≤1 cm) visibility. Up to two key lesions per patient, confirmed at histopathologic testing or at prior or follow-up imaging studies, were included. Lesion-to-background contrast-to-noise ratio was calculated. Interreader variability was analyzed. Intergroup qualitative and quantitative metrics were compared between DLIR and ASIR-V 40 using proportional odds logistic regression models. Results Eighty-six liver lesions (mean size, 15 mm ± 9.5 [SD]) in 50 patients (median age, 62 years [IQR, 57-73 years]; 27 [54%] female patients) were included. Differences were not detected for various qualitative low-contrast detectability metrics between ASIR-V 40 and DLIR (