Super-Resolution Deep Learning Reconstruction Improves Image Quality of Dynamic Myocardial Computed Tomography Perfusion Imaging

<b>Background/Objectives</b>: Super-resolution deep-learning reconstruction (SR-DLR) is an advanced image reconstruction technique, but its effect on dynamic myocardial computed tomography perfusion (CTP) imaging has not been evaluated. This study aimed to examine the impact of SR-DLR on image quality and perfusion parameters in dynamic myocardial CTP. <b>Methods</b>: Thirty-five patients who underwent dynamic myocardial CTP for coronary artery disease assessment were retrospectively analyzed. Two CTP datasets were reconstructed using hybrid iterative reconstruction (HIR) and SR-DLR. Image quality was compared qualitatively and quantitatively, including image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge rise slope (ERS). Equivalence of CT-derived myocardial blood flow (CT-MBF) between two reconstructions was tested using a previously reported 15% equivalence margin. Intra-patient variability of CT-MBF was evaluated using the robust coefficient of variation (rCV). <b>Results</b>: In the qualitative assessment, SR-DLR had significantly higher scores in contrast (4.0 vs. 2.0) and sharpness (4.5 vs. 2.5) compared with HIR (<i>p</i> < 0.001), while contrast scores were similar. In the quantitative assessment, SR-DLR demonstrated significantly lower image noise (19.4 vs. 29.4 HU), and improved SNR (6.1 vs. 4.1), CNR (13.7 vs. 10.9), and ERS (171.0 vs. 135.1 HU/mm) (all <i>p</i> < 0.001). Mean global CT-MBF was comparable (3.15 ± 0.91 mL/g/min for HIR vs. 3.18 ± 0.97 mL/g/min for SR-DLR) and equivalence was confirmed (<i>p</i> = 0.022). SR-DLR significantly reduced rCV compared with HIR (36.0% vs. 41.0%, <i>p</i> < 0.001). <b>Conclusions</b>: SR-DLR enhances image quality in dynamic myocardial CTP while maintaining mean global CT-MBF and reducing intra-patient variability.