Optimization of contrast-enhanced breast imaging: Analysis using a cascaded linear system model.

Purpose Contrast-enhanced (CE) breast imaging involves the injection contrast agents (i.e., iodine) to increase conspicuity of malignant lesions. CE imaging may be used in conjunction with digital mammography (DM) or digital breast tomosynthesis (DBT) and has shown promise in improving diagnostic specificity. Both CE-DM and CE-DBT techniques require optimization as clinical diagnostic tools. Physical factors including x-ray spectra, subtraction technique, and the signal from iodine contrast, must be considered to provide the greatest object detectability and image quality. We developed a cascaded linear system model (CLSM) for the optimization of CE-DM and CE-DBT employing dual energy (DE) subtraction or temporal (TE) subtraction. Methods We have previously developed a CLSM for DBT implemented with an a-Se flat panel imager (FPI) and filtered backprojection (FBP) reconstruction algorithm. The model is used to track image quality metrics — modulation transfer function (MTF) and noise power spectrum (NPS) — at each stage of the imaging chain. In this study, the CLSM is extended for CE breast imaging. The effect of x-ray spectrum (varied by changing tube potential and the filter) and DE and TE subtraction techniques on breast structural noise was measured was studied and included as a deterministic source of noise in the CLSM. From the two-dimensional (2D) and three-dimensional (3D) MTF and NPS, the ideal observer signal-to-noise ratio (SNR), also known as the detectability index (d′), may be calculated. Using d′ as a FOM, we discuss the optimization of CE imaging for the task of iodinated contrast object detection within structured backgrounds. Results Increasing x-ray energy was determined to decrease the magnitude of structural noise and not its correlation. By performing DE subtraction, the magnitude of the structural noise was further reduced at the expense of increased stochastic (quantum and electronic) noise. TE subtraction exhibited essentially no residual structural noise at the expense of increased quantum noise, even over that of the DE case. For DE subtraction, optimization of dose weighting to the HE view (fh) results in the minimization of quantum noise. Both subtraction weighting factor (wSub) and the iodine contrast signal were dependent on the LE and HE x-ray spectra. To best detect a 5 mm Gaussian lesion with 5 mg/ml of iodine within a 4 cm thick breast, it was found that the high energy (HE) view should be acquired with a tube potential of 47 kVp (W/Ti spectrum) and the low energy (LE) view with a potential of 23 kVp (W/Rh spectrum). Due to the complete removal of structural noise, TE subtraction produced much higher d′ than DE subtraction both as a function of mean glandular dose and iodine concentration. Conclusions We have shown the effect of increasing x-ray energy as well as projection domain subtraction on breast structural noise. Further, we have exhibited the utility of the CLSM for DE and TE subtraction CE imaging in the optimization of imaging parameters such as x-ray energy, fh, and wSub as well as guiding the understanding of their effects on image contrast and noise.