Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study

Abstract

We explored whether dual-energy computed tomography (DECT) can allow a significant reduction in iodinated contrast volume during computed tomography angiography (CTA) without hampering image quality or assessibility. We prospectively randomized patients clinically referred to CTA to single energy computed tomography (SECT) with full iodine volume load (group A), DECT with 50 % iodine volume load (group B), DECT with 40 % iodine volume load (group C), and DECT with 30 % iodine volume load (group D); and compared image quality and assessibility. Eighty patients were enrolled and prospectively randomized. The mean age was 61.7 ± 15.0 years and 56 (71 %) patients were male. The demographical characteristics, body mass index, or mean radiation dose did not differ between groups. Significant reductions in total contrast volume were achieved in groups B, C, and D; with mean administrated contrast volumes of 90.3 ± 10.1, 39.5 ± 4.6, 28.3 ± 6.5, and 23.9 ± 6.0 mL, respectively, in groups A to D (p < 0.0001). With regard to image quality, no significant decrease in the Likert scale was observed with reductions of up to 60 % of the contrast volume (groups B and C). DECT at 50-60 keV in association with up to 60 % iodine load reduction, allowed similar signal density, image noise, and signal to noise ratio that SECT imaging with full iodine load. In this pilot, prospective, randomized study, dual energy CTA with up to 60 % iodine volume load reduction provided similar image quality and assessibility than full iodine load with conventional SECT imaging.

Myocardial signal density levels and beam-hardening artifact attenuation using dual-energy computed tomography

“…As expected, among the DE group, myocardial SD levels were highest at low energy levels, with significantly lower SD levels at increasing energy levels. In turn, myocardial signal-to-noise ratio was not significantly influenced by the energy level applied given that the energy level is inversely related to both SD and noise [22]. Furthermore, in line with a previous study involving conventional SE imaging, mild regional differences regarding myocardial SD levels were observed and should therefore be accounted for in order to avoid misinterpretation of the results.…”

The Impact of Combining a Low-Tube Voltage Acquisition with Iterative Reconstruction on Total Iodine Dose in Coronary CT Angiography

“…Several studies demonstrated that CIN incidence is related to the administered iodine load, which motivates the aim for the reduction of the total iodine dose (TID) [1–6]. In CT contrast studies, image quality largely depends on the contrast between enhanced and nonenhanced regions; hence a sufficient amount of contrast agent must be administered to the patient to assure a certain image quality.…”

New Applications of Cardiac Computed Tomography

“…Interestingly, this was accomplished despite a more than 50% reduction in iodine load for CT angiography with DECT. Similarly, a recently published study revealed that monochromatic images at 50–60 keV allow for a iodine volume reduction up to 60% without compromising image quality as reflected by similar contrast- and signal-to-noise ratios as those obtained with standard CCTA using full iodine load (68). …”