ACR Appropriateness Criteria® Lower Extremity Arterial Claudication-Imaging Assessment for Revascularization: 2022 Update

Azene, Ezana M.; Steigner, Michael L.; Aghayev, Ayaz; Ahmad, Sarah Aftab; Clough, Rachel E.; Ferencik, Maros; Hedgire, Sandeep; Hicks, Caitlin W.; Kirsch, David; Lee, Yoo Jin; Myers, Lee; Nagpal, Prashant; Osborne, Nicholas H.; Pillai, Anil K.; Ripley, Beth; Singh, Nimarta; Thomas, Richard; Kalva, Sanjeeva P.

doi:10.1016/j.jacr.2022.09.002

Cited by 2 publications

(1 citation statement)

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“…Moreover, an effort should be made to reduce iodine usage due to recent concerns regarding the ecological impacts of iodinated contrast media in drinking and surface water ( 11 ) and the risks of contrast media shortages, such as during the covid-19 pandemic ( 12 ). In the current guidelines, high-iodine (350–400 mg/ml) contrast media are used ( 13 , 14 ), with a volume of 120 to 140 ml ( 4 , 7 ), with some reduced contrast volume protocols using down to 80 ml ( 15 ). Lower iodine volumes protocols such as at 45–50 ml have been successfully performed for aortic and lower extremity CTA ( 16 – 20 ) but not yet at 40 ml.…”

Section: Introductionmentioning

confidence: 99%

Low-iodine 40-keV virtual monoenergetic CT angiography of the lower extremities

Fahrni,

Mingas,

Deliessche

et al. 2023

Front. Cardiovasc. Med.

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IntroductionTo evaluate a reduced iodine volume protocol for lower extremity CT angiography (CTA) using dual-energy CT (DECT).MethodsThis retrospective study included consecutive patients who underwent lower extremity CTA from June to December 2022. A 10 ml 1:1 mixed test bolus was performed, followed by a 40 ml full bolus at a 2.5/s injection rate, using 400 mg/ml iodine contrast media. Conventional and 40 keV virtual monoenergetic images (VMI) were reconstructed. For both reconstructions, five main artery segments were assessed with a 3-point image quality score as well as quantitative attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements with diagnostic quality thresholds (respectively >150 HU and >3).ResultsForty patients were included in the study (mean age 68 ± 12 yo). 200 artery segments were assessed. Median qualitative image scores were 3 [IQR, 3, 3] for both reconstructions. 40 keV VMI upgraded qualitative scores for 51 (26%) of patients, including 9 (5%) from nondiagnostic to diagnostic quality. 40 keV VMI obtained attenuation and CNR diagnostic quality for respectively 100% and 100% of segments, compared with 96% and 98% for conventional images (p < 0.001). Distal artery segments showed the most differences between 40 keV VMI and conventional images.ConclusionA low-iodine lower extremity CTA protocol is feasible, with 40 keV virtual monoenergetic spectral reconstruction enabling maintained diagnostic image quality at the distal artery segments.

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