Feasibility of Low-Dose Contrast Medium High Pitch CT Angiography for the Combined Evaluation of Coronary, Head and Neck Arteries

Abstract

PurposeTo evaluate the image quality and radiation dose of combined heart, head, and neck CT angiography (CTA) using prospectively electrocardiography (ECG)-triggered high-pitch spiral scan protocol, compared with single coronary CTA.Materials and Methods151 consecutive patients were prospectively included and randomly divided into three groups. Group 1 (n = 47) underwent combined heart, neck, and head CTA using prospectively ECG-triggered high-pitch spiral (Flash) scan protocol with a single-phase intravenous injection of iodinated contrast and saline flush; Group 2 (n = 51) underwent single coronary CTA with Flash scan protocol; and Group 3 (n = 53) underwent single coronary CTA with prospective sequence scan protocol. All patients were examined on a dual source CT (Definition FLASH). The image quality was determined for each CT study.ResultsPatients of scanning protocol Group 1, 2, and 3 showed no significant differences in age, sex, heart rates, and BMI. Evaluation of coronary artery image quality showed comparable results in the three scanning protocol groups on a per patient-based analysis. In group 1, image quality was found to be sufficient to be diagnostic in all arterial segments of carotid arteries. The mean dose-length product (DLP) for group 1 was 256.3±24.5 mGy×cm and was significantly higher in comparison with group 2 (93.4±19.9 mGy×cm; p < 0.001). However, there was no significant difference of DLP between group 1 and group 3 (254.1±69.9 mGy×cm).ConclusionsThe combined heart, neck, and head arteries scan using prospectively electrocardiography (ECG)-triggered high-pitch spiral scan protocol in 1 single examination resulted in an excellent opacification of the aorta, the carotid arteries, and the coronary arteries and provided a good image quality with low radiation dose.

70-kVp High-pitch Computed Tomography Pulmonary Angiography with 40 mL Contrast Agent

“…An additional concern is the contrast-induced nephropathy related to the administration of large doses of iodinated contrast media (7,8). In recent years, usage of reduced contrast agent volume has been advocated for CTPA (9)(10)(11)(12).…”

Ultra‑low dose one‑step CT angiography for coronary, carotid and cerebral arteries using 128‑slice dual‑source CT: A feasibility study

“…High-pitch scanning has a very fast table-moving speed, which is due to the double tube-detector systems with gaps (8,9). In the present study, only ~700 msec was required for scanning (10,11), which is the primary reason to reduce the injection time of the contrast agent. However, a low concentration and volume of the contrast agent were used for CTA, resulting in a decreasing trend in the time density curve (TDC), which affected the arterial enhancement.…”

“…High temporal resolution can also maintain or improve image quality for CT coronary angiography (CTCA) (8,9). In previous studies, cardiovascular and cerebrovascular imaging has utilized the 128-slice DSCT, obtaining a reliable image quality with a low-dose length product (DLP; 224.83–256.30 mGy·cm) and contrast agent (60–80 ml) (10,11). However, these studies were conservative with a high tube voltage (100 or 120 kV) and high concentration contrast agent (370 mg/ml), and did not utilize the advantages of 128-slice DSCT, particularly by combining the iterative algorithm and ultra-low tube voltage to reduce the radiation dose for the patients of standard body type.…”

Low kV and Low Concentration Contrast Agent with Iterative Reconstruction of Computed Tomography (CT) Coronary Angiography: A Preliminary Study

“…Recently, with the application of contrast agent, its risk in CTCA has also been a concern. Previous studies always focused on a single or double concentration in CTCA [ 6 , 7 ]. Therefore, the present study prospectively compared different concentrations of contrast agent, scanning parameters on image quality, and radiation and iodine dose.…”