# Usefulness of four-dimensional noise reduction filtering using a similarity algorithm in low-dose dynamic computed tomography for the evaluation of breast cancer: a preliminary study

## TL;DR

A new noise reduction technique improves image quality and tumor visibility in low-dose CT scans for breast cancer evaluation.

## Contribution

This study demonstrates that 4D-SF filtering enhances low-dose dynamic CT for breast cancer assessment.

## Key findings

- 4D-SF significantly improves signal-to-noise and contrast-to-noise ratios in breast CT images.
- 4D-SF increases overall image quality and tumor margin sharpness according to observer evaluations.
- 4D-SF improves correlation between tumor size on CT and pathological specimens.

## Abstract

To evaluate the effects of four-dimensional noise reduction filtering using a similarity algorithm (4D-SF) on the image quality and tumor visibility of low-dose dynamic computed tomography (CT) in evaluating breast cancer.

Thirty-four patients with 38 lesions who underwent low-dose dynamic breast CT and were pathologically diagnosed with breast cancer were enrolled. Dynamic CT images were reconstructed using iterative reconstruction alone or in combination with 4D-SF. We selected the peak enhancement phase image of breast cancer for each patient for quantitative and qualitative evaluations of image quality and measurement of the maximum diameter of breast cancer. The signal-to-noise and contrast-to-noise ratios were calculated for quantitative evaluation. The maximum diameters of the breast cancer were measured from the images obtained with and without 4D-SF (4D-SF ±) (size-4D-SF + and size-4D-SF-) and for the pathological specimen (size-PS) and compared.

The median and interquartile ranges of the signal-to-noise ratio [4D-SF-: 3.03 (2.54–4.17) vs 4D-SF + : 5.52 (4.75–6.66)] and contrast-to-noise ratio [4D-SF-: 2.88 (2.00–3.60) vs 4D-SF + : 7.84 (4.65–10.35)] were significantly higher for 4D-SF + than for 4D-SF- (p < 0.001). The overall image quality (Observer 1, p < 0.001; Observer 2, p < 0.001) and tumor margin sharpness scores (Observer 1, p = 0.003; Observer 2, p < 0.001) were significantly higher for 4D-SF + than for 4D-SF-. The tumor contrast scores for 4D-SF + and 4D-SF- were not significantly different (Observers 1, 2; p = 0.083). Size-4D-SF- was significantly smaller than size-PS (p < 0.001); size-4D-SF + was also smaller than size-PS, but the difference was not significant (p = 0.088). The Spearman’s rank correlation coefficient was 0.65 for size-PS and size-4D-SF- and 0.77 for size-PS and size-4D-SF + .

The 4D-SF can improve the image quality and tumor visibility of low-dose dynamic CT in evaluating breast cancer extent due to noise reduction.