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Kawai N, Noda Y, Nakamura F, Kaga T, Suzuki R, Miyoshi T, Mori F, Hyodo F, Kato H, Matsuo M. Low-tube-voltage whole-body CT angiography with extremely low iodine dose: a comparison between hybrid-iterative reconstruction and deep-learning image-reconstruction algorithms. Clin Radiol 2024; 79:e791-e798. [PMID: 38403540 DOI: 10.1016/j.crad.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
AIM To evaluate arterial enhancement, its depiction, and image quality in low-tube potential whole-body computed tomography (CT) angiography (CTA) with extremely low iodine dose and compare the results with those obtained by hybrid-iterative reconstruction (IR) and deep-learning image-reconstruction (DLIR) methods. MATERIALS AND METHODS This prospective study included 34 consecutive participants (27 men; mean age, 74.2 years) who underwent whole-body CTA at 80 kVp for evaluating aortic diseases between January and July 2020. Contrast material (240 mg iodine/ml) with simultaneous administration of its quarter volume of saline, which corresponded to 192 mg iodine/ml, was administered. CT raw data were reconstructed using adaptive statistical IR-Veo of 40% (hybrid-IR), DLIR with medium- (DLIR-M), and high-strength level (DLIR-H). A radiologist measured CT attenuation of the arteries and background noise, and the signal-to-noise ratio (SNR) was then calculated. Two reviewers qualitatively evaluated the arterial depictions and diagnostic acceptability on axial, multiplanar-reformatted (MPR), and volume-rendered (VR) images. RESULTS Mean contrast material volume and iodine weight administered were 64.1 ml and 15.4 g, respectively. The SNRs of the arteries were significantly higher in the following order of the DLIR-H, DLIR-M, and hybrid-IR (p<0.001). Depictions of six arteries on axial, three arteries on MPR, and four arteries on VR images were significantly superior in the DLIR-M or hybrid-IR than in the DLIR-H (p≤0.009 for each). Diagnostic acceptability was significantly better in the DLIR-M and DLIR-H than in the hybrid-IR (p<0.001-0.005). CONCLUSION DLIR-M showed well-balanced arterial depictions and image quality compared with the hybrid-IR and DLIR-H.
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Affiliation(s)
- N Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Y Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - F Nakamura
- Department of Radiology, Gifu Municipal Hospital, 7-1 Kashima, Gifu 500-8513, Japan
| | - T Kaga
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - R Suzuki
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - T Miyoshi
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - F Mori
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - F Hyodo
- Department of Pharmacology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Center for One Medicine Innovative Translational Research (COMIT), Institute for Advanced Study, Gifu University, Japan
| | - H Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - M Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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Skoog S, Sandborg M, Henriksson L, Sandstedt M, Gustafsson H, Persson A. A prospective study comparing the quality of coronary computed tomography angiography images from photon counting and energy integrating detector systems. Acta Radiol 2023; 64:2957-2966. [PMID: 37735891 DOI: 10.1177/02841851231199384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND As guidelines endorse the use of computed tomography (CT) for examining coronary artery disease (CAD), it is important to compare the advantages and disadvantages of the novel photon counting detector CT (PCD-CT) technology with the established energy integrating detector CT (EID-CT). PURPOSE To compare the image quality of coronary computed tomography angiography (CCTA) and the Agatston scores (AS) derived from EID-CT and PCD-CT. MATERIAL AND METHODS In this prospective observational study, 28 patients underwent clinical calcium score and CCTA scans on an EID-CT and a PCD-CT scanner. CCTA images were qualitatively analyzed by five observers using visual grading characteristics. The correlation and agreement of the AS were assessed using Spearman's rank correlation and Bland-Altman plots. RESULTS This qualitative analyses demonstrated a high fraction of "good" or "excellent" ratings for the image criteria in both CT systems. The sharpness of the distal lumen and image quality regarding motion artifacts were rated significantly higher for EID-CT (P < 0.05). However, the sharpness of coronary calcification was rated significantly higher for PCD-CT (P < 0.05). Spearman's rank correlation and Bland-Altman plots showed good correlation (P = 0.95) and agreement regarding the AS between EID-CT and PCD-CT. CONCLUSION Both CT systems exhibited high CCTA image quality. The sharpness of calcifications was rated significantly higher for PCD-CT. A good correlation was observed between the AS derived from the two systems.
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Affiliation(s)
- Susann Skoog
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Michael Sandborg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Medical Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lilian Henriksson
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Mårten Sandstedt
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Håkan Gustafsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Medical Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Muroga K, Minochi Y, Fukuzawa A. Improvement in arterial enhancement using diluted injection of contrast medium in CT angiography. Acta Radiol 2023; 64:489-495. [PMID: 35179050 DOI: 10.1177/02841851221077400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial enhancement after contrast injection affects the quality of computed tomography angiography (CTA) images. PURPOSE To evaluate whether the dilution of contrast medium (CM) for CTA increases arterial enhancement after the adjustment of iodine concentration as per the patient's body weight (BW). MATERIAL AND METHODS We retrospectively studied 700 patients who underwent coronary CTA. The first 350 consecutive patients underwent standard CTA with a fixed iodine concentration, whereas the remaining 350 underwent CTA with a diluted CM injection. All patients were classified into three groups according to their BW (<55, 55-65, and 66-73 kg). The mean and proportion of contrast enhancements (CEs) in the ascending aorta of ≥350 Hounsfield units (HUs) (CE350) were compared between the standard CTA and diluted CM injection and among the BW groups. The associations between BW and CE were analyzed using linear regression. RESULTS Receiving diluted CM increased the mean CE in the <55-kg group (403.4 ± 55.4 HU vs. 382.8 ± 59.3 HU; P < 0.01) but not in the groups with heavier BW. The proportion of patients with CE350 increased with BW (<55 kg = 71%, 55-65 kg = 84%, and 66-73 kg = 91%) and increased after dilution (86%, 93%, and 96%, respectively). After CM dilution, the correlation between BW and CE among patients undergoing CTA decreased from 0.37 to 0.22 (P < 0.05). CONCLUSION CM dilution for CTA improves arterial enhancement.
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Affiliation(s)
- Koji Muroga
- Department of Diagnostic Radiology, 26869Nagano Red Cross Hospital, Nagano, Japan
| | - Yoshimi Minochi
- Department of Diagnostic Radiology, 26869Nagano Red Cross Hospital, Nagano, Japan
| | - Akira Fukuzawa
- Department of Diagnostic Radiology, 26869Nagano Red Cross Hospital, Nagano, Japan
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Higashigaito K, Mergen V, Eberhard M, Jungblut L, Hebeisen M, Rätzer S, Zanini B, Kobe A, Martini K, Euler A, Alkadhi H. CT Angiography of the Aorta Using Photon-counting Detector CT with Reduced Contrast Media Volume. Radiol Cardiothorac Imaging 2023; 5:e220140. [PMID: 36860835 PMCID: PMC9969214 DOI: 10.1148/ryct.220140] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 01/27/2023]
Abstract
Purpose To develop and evaluate a low-volume contrast media protocol for thoracoabdominal CT angiography (CTA) with photon-counting detector (PCD) CT. Materials and Methods This prospective study included consecutive participants (April-September 2021) who underwent CTA with PCD CT of the thoracoabdominal aorta and previous CTA with energy-integrating detector (EID) CT at equal radiation doses. In PCD CT, virtual monoenergetic images (VMI) were reconstructed in 5-keV intervals from 40 to 60 keV. Attenuation of the aorta, image noise, and contrast-to-noise ratio (CNR) were measured, and subjective image quality was rated by two independent readers. In the first group of participants, the same contrast media protocol was used for both scans. CNR gain in PCD CT compared with EID CT served as the reference for contrast media volume reduction in the second group. Noninferiority analysis was used to test noninferior image quality of the low-volume contrast media protocol with PCD CT. Results The study included 100 participants (mean age, 75 years ± 8 [SD]; 83 men). In the first group (n = 40), VMI at 50 keV provided the best trade-off between objective and subjective image quality, achieving 25% higher CNR compared with EID CT. Contrast media volume in the second group (n = 60) was reduced by 25% (52.5 mL). Mean differences in CNR and subjective image quality between EID CT and PCD CT at 50 keV were above the predefined boundaries of noninferiority (-0.54 [95% CI: -1.71, 0.62] and -0.36 [95% CI: -0.41, -0.31], respectively). Conclusion CTA of the aorta with PCD CT was associated with higher CNR, which was translated into a low-volume contrast media protocol demonstrating noninferior image quality compared with EID CT at the same radiation dose.Keywords: CT Angiography, CT-Spectral, Vascular, Aorta, Contrast Agents-Intravenous, Technology Assessment© RSNA, 2023See also the commentary by Dundas and Leipsic in this issue.
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Affiliation(s)
- Kai Higashigaito
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Victor Mergen
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Lisa Jungblut
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Monika Hebeisen
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Susan Rätzer
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Bettina Zanini
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Adrian Kobe
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Katharina Martini
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - André Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland (K.H., V.M., M.E., L.J., S.R., B.Z., A.K., K.M., A.E., H.A.); and Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (M.H.)
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Sodagari F, Wood CG, Agrawal R, Yaghmai V. Feasibility of sub-second CT angiography of the abdomen and pelvis with very low volume of contrast media, low tube voltage, and high-pitch technique, on a third-generation dual-source CT scanner. Clin Imaging 2021; 82:15-20. [PMID: 34768221 DOI: 10.1016/j.clinimag.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 10/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Concerns about potential risks of using contrast media in patients with chronic renal insufficiency limit the utilization of CT angiography in this population. PURPOSE To evaluate the feasibility of abdominopelvic CTA with very low volumes of contrast media. MATERIAL AND METHODS In this retrospective study, 20 patients with chronic renal insufficiency underwent high-pitch abdominopelvic (AP) CTA on a third-generation dual-source CT scanner with 30 mL of nonionic iodinated contrast. The homogeneity of intravascular attenuation at the suprarenal aorta, infrarenal aorta, and the right common iliac artery was measured. Image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were used to assess objective image quality. Subjective image quality was evaluated on a 5-point scale (1 = unacceptable; 5 = excellent). RESULTS Twelve male and eight female patients underwent CTA of the abdomen and pelvis at 80 kVp. Five CTAs also included the chest (CAP). The mean scan duration was 0.78 ± 0.19 s for AP and 0.96 ± 0.06 s for CAP CTAs. The mean ± SD of attenuation at suprarenal aorta, infrarenal aorta, and right common iliac artery were 235.1 ± 68.0, 249.2 ± 61.3, and 254.4 ± 67.7 HU, respectively. The attenuation was homogeneous across vascular levels (P = 0.06). All scans had diagnostic subjective image quality with the median (IQR) of 3.5 (1.75). CNR and SNR were homogeneous across vascular levels (P = 0.08 and P = 0.14, respectively). CONCLUSION Sub-second, high-pitch abdominopelvic CTA with a low volume of contrast in patients with chronic renal insufficiency is technically and clinically feasible with good diagnostic image quality and homogenous attenuation across vascular levels.
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Affiliation(s)
- Faezeh Sodagari
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Cecil G Wood
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA.
| | - Rishi Agrawal
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA.
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA; Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, USA.
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Shohji T. [9. Basics of Radiation Exposure in X-ray CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:1223-1230. [PMID: 34670931 DOI: 10.6009/jjrt.2021_jsrt_77.10.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nautiyal A, Mondal T, Manii M, Kaushik A, Goel A, Dey SK, Mitra D. Significant reduction of radiation dose and DNA damage in 18F- FDG whole-body PET/CT study without compromising diagnostic image quality. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1969197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Amit Nautiyal
- Institute of Nuclear Medicine & Molecular Imaging, Amri Hospitals, Dhakuria, Kolkata
- Amity Institute of Nuclear Science & Technology, Amity University Uttar Pradesh, Noida
| | - Tanmoy Mondal
- Department of Biotechnology, Maulana Abul Kalam Azad University of Technology, Salt Lake, Kolkata
| | - Manu Manii
- Department of Nuclear Medicine, Quadra Medical Services Private Limited, Kolkata
| | - Aruna Kaushik
- Institute of Nuclear Medicine & Allied Sciences, Timarpur, Delhi
| | - Alpana Goel
- Amity Institute of Nuclear Science & Technology, Amity University Uttar Pradesh, Noida
| | - Subrata Kumar Dey
- Department of Biotechnology, Maulana Abul Kalam Azad University of Technology, Salt Lake, Kolkata
| | - Deepanjan Mitra
- Institute of Nuclear Medicine & Molecular Imaging, Amri Hospitals, Dhakuria, Kolkata
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Noda Y, Nakamura F, Kawai N, Suzuki R, Miyoshi T, Ishihara T, Hyodo F, Kambadakone AR, Matsuo M. Optimized Bolus Threshold for Dual-Energy CT Angiography with Monoenergetic Images: A Randomized Clinical Trial. Radiology 2021; 300:615-623. [PMID: 34128721 DOI: 10.1148/radiol.2021210102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The bolus-tracking technique from single-energy CT has been applied to dual-energy CT (DECT) without optimization or validation. Further optimization is imperative because of a paucity of literature and differences in the attenuation profile of virtual monoenergetic images (VMIs). Purpose To determine the optimal trigger threshold with bolus-tracking technique for DECT angiography (DECTA) in a phantom study and assess the feasibility of an optimized threshold for bolus-tracking technique in DECTA at 40 keV with a 50% reduced iodine dose in human participants. Materials and Methods A phantom study with rapid kilovoltage-switching DECT was performed to determine the optimal threshold for each kiloelectron-volt VMI. In a prospective study, consecutive participants who underwent whole-body CT angiography (CTA) from August 2018 to July 2019 were randomized into three groups: single-energy CTA (SECTA) with standard iodine dose (600 mg of iodine per kilogram), DECTA with 50% reduced iodine dose (300 mg of iodine per kilogram) by using a conventional threshold, and DECTA with 300 mg of iodine per kilogram by using an optimized threshold. A trigger threshold of 100 HU at 120 kVp was used as a reference for comparison. Injected iodine doses and aortic CT numbers were compared among the three groups using Kruskal-Wallis test. Results Ninety-six participants (mean age ± standard deviation, 72 years ± 9; 80 men) were evaluated (32 participants in each group). The optimized threshold for VMIs at 40 keV was 30 HU. The median iodine dose was lower in the optimized DECTA group (13 g) compared with conventional DECTA (19 g) and SECTA (26 g) groups (P < .017 for each comparison). The median aortic CT numbers were higher in the order corresponding to conventional DECTA (655-769 HU), optimized DECTA (543-610 HU), and SECTA (343-359 HU) groups (P < .001). Conclusion The optimized trigger threshold of 30 HU for bolus-tracking technique during dual-energy CT angiography at 40 keV achieved lower iodine load while maintaining aortic enhancement. ©RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Malayeri in this issue.
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Affiliation(s)
- Yoshifumi Noda
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Fumihiko Nakamura
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Nobuyuki Kawai
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Ryosuke Suzuki
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Toshiharu Miyoshi
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Takuma Ishihara
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Fuminori Hyodo
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Avinash R Kambadakone
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Masayuki Matsuo
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
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Euler A, Taslimi T, Eberhard M, Kobe A, Reeve K, Zimmermann A, Krauss A, Gutjahr R, Schmidt B, Alkadhi H. Computed Tomography Angiography of the Aorta-Optimization of Automatic Tube Voltage Selection Settings to Reduce Radiation Dose or Contrast Medium in a Prospective Randomized Trial. Invest Radiol 2021; 56:283-291. [PMID: 33226202 DOI: 10.1097/rli.0000000000000740] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the image quality of low-kV protocols with optimized automatic tube voltage selection (ATVS) settings to reduce either radiation dose or contrast medium (CM) with that of a reference protocol for computed tomography angiography (CTA) of the thoracoabdominal aorta. MATERIALS AND METHODS In this institutional review board-approved, single-center, prospective randomized controlled trial, 126 patients receiving CTA of the aorta were allocated to one of three computed tomography protocols: (A) reference protocol at 120 kVp and standard weight-adapted CM dose; (B) protocol at 90 kVp, reduced radiation and standard CM dose; and (C) protocol at 90 kVp, standard radiation and reduced CM dose. All three protocols were performed on a third-generation dual-source computed tomography scanner using the semimode of the ATVS system. The image-task-dependent optimization settings of the ATVS (slider level) were adjusted to level 11 (high-contrast task) for protocols A and B and level 3 (low-contrast task) for protocol C. Radiation dose parameters were assessed. The contrast-to-noise ratios (CNRs) of protocols B and C were tested for noninferiority compared with A. Subjective image quality was assessed using a 5-point Likert scale. RESULTS Size-specific dose estimate was 34.3% lower for protocol B compared with A (P < 0.0001). Contrast medium was 20.2% lower for protocol C compared with A (P < 0.0001). Mean CNR in B and C was noninferior to protocol A (CNR of 30.2 ± 7, 33.4 ± 6.7, and 30.5 ± 8.9 for protocols A, B, and C, respectively). There was no significant difference in overall subjective image quality among protocols (4.09 ± 0.21, 4.03 ± 0.19, and 4.08 ± 0.17 for protocols A, B, and C, respectively; P = 0.4). CONCLUSIONS The slider settings of an ATVS system can be adjusted to optimize either radiation dose or CM at noninferior image quality in low-kV CTA of the aorta. This optimization could be used to extend future ATVS algorithms to take clinical risk factors like kidney function of individual patients into account.
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Affiliation(s)
- André Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tilo Taslimi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Adrian Kobe
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Alexander Zimmermann
- Department of Vascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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10
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Noda Y, Nakamura F, Yasuda N, Miyoshi T, Kawai N, Kawada H, Hyodo F, Matsuo M. Advantages and disadvantages of single-source dual-energy whole-body CT angiography with 50% reduced iodine dose at 40 keV reconstruction. Br J Radiol 2021; 94:20201276. [PMID: 33617294 DOI: 10.1259/bjr.20201276] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the feasibility of whole-body dual-energy computed tomographic angiography (DECTA) at 40 keV with 50% reduced iodine dose protocol. METHODS Whole-body CTA was performed in 65 patients; 31 of these patients underwent 120 kVp single-energy computed tomographic angiography (SECTA) with standard iodine dose (600 mgI/kg) and 34 with 40 keV DECTA with 50% reduced iodine dose (300 mgI/kg). SECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (SECTA group), and DECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (DECTA-40% group) and 80% (DECTA-80% group). CT numbers of the thoracic and abdominal aorta, iliac artery, background noise, signal-to-noise ratio (SNR), and arterial depiction were compared among the three groups. The CT dose index volumes (CTDIvol) for the thorax, abdomen, and pelvis were compared between SECTA and DECTA protocols. RESULTS The vascular CT numbers and background noise were found to be significantly higher in DECTA groups than in the SECTA group (p < 0.001). SNR was significantly higher in the order corresponding to DECTA-80%, SECTA, and DECTA-40% (p < 0.001). The arterial depiction was comparable in almost all arteries; however, intrapelvic arterial depiction was significantly worse in DECTA groups than in the SECTA group (p < 0.0001-0.017). Unlike the pelvic region (p = 0.055), CTDIvol for the thorax (p < 0.0001) and abdomen (p = 0.0031) were significantly higher in the DECTA protocol than in the SECTA protocol. CONCLUSION DECTA at 40 keV with 50% reduced iodine dose provided higher vascular CT numbers and SNR than SECTA, and almost comparable arterial depiction, but had a degraded intrapelvic arterial depiction and required a larger radiation dose. ADVANCES IN KNOWLEDGE DECTA enables 50% reduction of iodine dose while maintaining image quality, arterial depiction in almost all arteries, vascular CT numbers, and SNR; however, it does not allow clear visualization of intrapelvic arteries, requiring a slightly larger radiation dose compared with SECTA with standard iodine dose.
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Affiliation(s)
| | | | | | | | | | | | - Fuminori Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
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11
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Kawada H, Goshima S, Sakurai K, Noda Y, Kajita K, Tanahashi Y, Kawai N, Ishida N, Shimabukuro K, Doi K, Matsuo M. Utility of Noncontrast Magnetic Resonance Angiography for Aneurysm Follow-Up and Detection of Endoleaks after Endovascular Aortic Repair. Korean J Radiol 2020; 22:513-524. [PMID: 33543842 PMCID: PMC8005350 DOI: 10.3348/kjr.2020.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the noncontrast two-dimensional single-shot balanced turbo-field-echo magnetic resonance angiography (b-TFE MRA) features of the abdominal aortic aneurysm (AAA) status following endovascular aneurysm repair (EVAR) and evaluate to detect endoleaks (ELs). Materials and Methods We examined four aortic stent-grafts in a phantom study to assess the degree of metallic artifacts. We enrolled 46 EVAR-treated patients with AAA and/or common iliac artery aneurysm who underwent both computed tomography angiography (CTA) and b-TFE MRA after EVAR. Vascular measurements on CTA and b-TFE MRA were compared, and signal intensity ratios (SIRs) of the aneurysmal sac were correlated with the size changes in the AAA after EVAR (AAA prognoses). Furthermore, we examined six feasible b-TFE MRA features for the assessment of ELs. Results There were robust intermodality (r = 0.92–0.99) correlations and interobserver (intraclass correlation coefficient = 0.97–0.99) agreement. No significant differences were noted between SIRs and aneurysm prognoses. Moreover, “mottled high-intensity” and “creeping high-intensity with the low-band rim” were recognized as significant imaging findings suspicious for the presence of ELs (p < 0.001), whereas “no signal black spot” and “layered high-intensity area” were determined as significant for the absence of ELs (p < 0.03). Based on the two positive features, sensitivity, specificity, and accuracy for the detection of ELs were 77.3%, 91.7%, and 84.8%, respectively. Furthermore, the k values (0.40–0.88) displayed moderate-to-almost perfect agreement. Conclusion Noncontrast MRA could be a promising imaging modality for ascertaining patient follow-up after EVAR.
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Affiliation(s)
- Hiroshi Kawada
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Satoshi Goshima
- Department of Radiology, Gifu University Hospital, Gifu, Japan.,Department of Diagnostic Radiology and Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Kota Sakurai
- Department of Radiology, Chuno Kosei Hospital, Seki, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Kimihiro Kajita
- Department of Radiology Services, Gifu University Hospital, Gifu, Japan
| | | | - Nobuyuki Kawai
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Narihiro Ishida
- Department of General and Cardiothoracic Surgery, Gifu University Hospital, Gifu, Japan
| | - Katsuya Shimabukuro
- Department of General and Cardiothoracic Surgery, Gifu University Hospital, Gifu, Japan
| | - Kiyoshi Doi
- Department of General and Cardiothoracic Surgery, Gifu University Hospital, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, Gifu, Japan
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Aldosari S, Sun Z. A Systematic Review of Double Low-dose CT Pulmonary Angiography in Pulmonary Embolism. Curr Med Imaging 2020; 15:453-460. [PMID: 32008552 DOI: 10.2174/1573405614666180813120619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study is to perform a systematic review of the feasibility and clinical application of double low-dose CT pulmonary angiography (CTPA) in the diagnosis of patients with suspected pulmonary embolism. DISCUSSION A total of 13 studies were found to meet selection criteria reporting both low radiation dose (70 or 80 kVp versus 100 or 120 kVp) and low contrast medium dose CTPA protocols. Lowdose CTPA resulted in radiation dose reduction from 29.6% to 87.5% in 12 studies (range: 0.4 to 23.5 mSv), while in one study, radiation dose was increased in the dual-energy CT group when compared to the standard 120 kVp group. CTPA with use of low contrast medium volume (range: 20 to 75 ml) was compared to standard CTPA (range: 50 to 101 ml) in 12 studies with reduction between 25 and 67%, while in the remaining study, low iodine concentration was used with 23% dose reduction achieved. Quantitative assessment of image quality (in terms of signal-to-noise ratio and contrast-to-noise ratio) showed that low-dose CTPA was associated with higher, lower and no change in image quality in 3, 3 and 6 studies, respectively when compared to the standard CTPA protocol. The subjective assessment indicated similar image quality in 11 studies between low-dose and standard CTPA groups, and improved image quality in 1 study with low-dose CTPA. CONCLUSION This review shows that double low-dose CTPA is feasible in the diagnosis of pulmonary embolism with significant reductions in both radiation and contrast medium doses, without compromising diagnostic image quality.
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Affiliation(s)
- Sultan Aldosari
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
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13
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Yuan W, Qu TT, Wang HJ, Wang MY, Qu Y, Niu G, Yang J. Coronary CT Angiography Using Low Iodine Delivery Rate and Tube Voltage Determined by Body Mass Index: Superiority in Clinical Practice. Curr Med Sci 2019; 39:825-830. [PMID: 31612403 DOI: 10.1007/s11596-019-2112-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 05/23/2019] [Indexed: 12/24/2022]
Abstract
To explore the feasibility and superiority of iodine delivery rate (IDR) and tube voltage determined by patients' body mass index (BMI) in coronary CT angiography (CCTA), a total of 1567 patients undertaking CCTA during Feb. and Dec. 2016 were enrolled and divided into two groups. In the control group, the IDR and tube voltage were fixed, while in the experimental group, the IDR and tube voltage were determined by patients' BMI. The volume of iodinated contrast media (ICM), extravasation rate, extravasation volume, extravasation recovery interval, incidence rate of adverse reactions, effective dose (ED) and image quality of the two groups were compared. The experiments demonstrated that the ICM volume, extravasation rate, extravasation volume, extravasation recovery interval, incidence of adverse reactions and ED were lower or shorter in the experimental group than in the control group, and the differences were statistically significant (all P<0.05). However, there were no significant differences in the mean CT value, image noise, signal to noise ratio and contrast to noise ratio between the two groups (all P<0.05), which were consistent with the diagnosticians' subjective evaluation outcomes. Our findings suggested that in CCTA, it is feasible to determine the IDR and tube voltage based on patients' BMI; low tube voltage and IDR are superior to the fixed tube voltage and IDR and are worthy of clinical promotion.
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Affiliation(s)
- Wang Yuan
- Department of Diagnostic Radiology, the First Hospital of Medical Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ting-Ting Qu
- Department of Diagnostic Radiology, the First Hospital of Medical Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hui-Juan Wang
- Department of Dermatology, the Ninth Hospital of Xi'an, Xi'an, 710054, China
| | - Mei-Yu Wang
- Department of Diagnostic Radiology, the First Hospital of Medical Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yuan Qu
- Department of Diagnostic Radiology, the First Hospital of Medical Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Gang Niu
- Department of Diagnostic Radiology, the First Hospital of Medical Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jian Yang
- Department of Diagnostic Radiology, the First Hospital of Medical Science Centre, Xi'an Jiaotong University, Xi'an, 710061, China.
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14
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Kim M, Hwang JY, Choo KS, Ryu H, Reid SNS, Kim YW, Kim TU, Kim JH. Comparison of image quality of abdominopelvic CT in paediatric patients: low osmolar contrast media versus less iodine-containing iso-osmolar contrast media at different peak kilovoltages. Clin Radiol 2019; 74:896.e9-896.e16. [PMID: 31431254 DOI: 10.1016/j.crad.2019.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
AIM To evaluate the effect of iso-osmolar contrast media (IOCM) at different tube voltages on image quality for abdominal computed tomography (CT) in paediatric patients. MATERIALS AND METHODS The low osmolar contrast media (LOCM) group and IOCM group consisted of 101 and 102 CT examinations, respectively, in patients <18 years old. Images were reviewed retrospectively. Objective measurement of the contrast enhancement and noise were analysed and contrast-to-noise ratios (CNRs) of the abdominal aorta, portal vein, and liver were calculated. Four radiologists participated in subjective analysis using a four-point scale system to evaluate degrees of contrast enhancement, image noise, beam-hardening artefact, and overall image quality. Reader performance for correctly differentiating the two kinds of contrast media was evaluated. RESULTS Regarding the objective measurement, contrast enhancement was significantly higher in the LOCM group (p<0.05). In subjective analysis, only CT using 120 kVp showed significantly stronger enhancement in the LOCM group (p=0.002), and sensitivity to differentiate the IOCM was 80.6%. Overall sensitivity and specificity for correctly differentiating IOCM were 57.1%, and 56.9%, respectively. CONCLUSION The application of IOCM was found to be feasible for performing paediatric abdominopelvic CT with a low tube voltage protocol. Although objective measurements of contrast enhancement were significantly lower in the IOCM group, subjective contrast enhancement and image quality assessments were not statistically different between groups.
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Affiliation(s)
- M Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - J Y Hwang
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea.
| | - K S Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - H Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - S N S Reid
- College of Creative Human Resource, School of Liberal Arts Education, Kyungsung University, Busan, 48434, Republic of Korea
| | - Y W Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - T U Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
| | - J H Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Geumo-ro 20, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea
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15
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[Kidney function in contrast media-enhanced imaging]. Radiologe 2019; 59:425-434. [PMID: 31016343 DOI: 10.1007/s00117-019-0529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The potential adverse reactions to contrast media-enhanced imaging regularly offer challenges in decision-making for nephrologists and radiologists. OBJECTIVE The clinical pictures of contrast media-induced acute kidney injury (CI-AKI) and nephrogenic systemic fibrosis (NSF) were evaluated, which are both caused by contrast media and closely linked to the kidney function. MATERIAL AND METHODS The literature in PubMed and Medline was searched for the terms "kidney function" and "contrast media" and complemented by our own experiences. RESULTS While there is an ongoing re-evaluation of the clinical relevance of CI-AKI, no new cases of NSF have recently been reported under consideration of certain preventive interventions and very restricted use of gadolinium-based contrast agents. CONCLUSION Considering the results of the latest clinical research, the potential risk of CI-AKI has been overestimated for a long time and should no longer outweigh the diagnostic benefit of contrast media-enhanced imaging. Nevertheless, the most effective prophylaxis for CI-AKI is the avoidance of unnecessary administration of contrast media.
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16
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Parakh A, Negreros-Osuna AA, Patino M, McNulty F, Kambadakone A, Sahani DV. Low-keV and Low-kVp CT for Positive Oral Contrast Media in Patients with Cancer: A Randomized Clinical Trial. Radiology 2019; 291:620-629. [PMID: 30964423 DOI: 10.1148/radiol.2019182393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Substantial gain in the attenuation of iodine on low-kVp and dual-energy CT processed low-keV virtual monochromatic images provides an opportunity for customization of positive oral contrast media administration. Purpose To perform an intrapatient comparison of bowel labeling, opacification, and taste preference with iodinated oral contrast medium (ICM) in standard (sICM) and 25%-reduced (rICM) concentrations at low tube voltage (100 kVp) or on low-energy (50-70 keV) virtual monochromatic images compared with barium-based oral contrast medium (BCM) at 120 kVp. Materials and Methods In this prospective clinical trial, 200 adults (97 men, 103 women; mean age, 63 years ± 13 [standard deviation]) who weighed less than 113 kg and who were undergoing oncologic surveillance (from April 2017 to July 2018) and who had previously undergone 120-kVp abdominopelvic CT with BCM randomly received sICM (7.2 g iodine) or rICM (5.4 g iodine) and underwent 100-kVp CT or dual-energy CT (80/140 kVp) scans to be in one of four groups (n = 50 each): sICM/100 kVp, rICM/100 kVp, sICM/dual-energy CT, and rICM/dual-energy CT. Qualitative analysis was performed for image quality (with a five-point scale), extent of bowel labeling, and homogeneity of opacification (with a four-point scale). Intraluminal attenuation of opacified small bowel was measured. A post-CT patient survey was performed to indicate contrast medium preference, taste of ICM (with a five-point scale), and adverse effects. Data were analyzed with analogs of analysis of variance. Results All CT studies were of diagnostic image quality (3.4 ± 0.3), with no difference in the degree of bowel opacification between sICM and rICM (P > .05). Compared with BCM/120 kVp (282 HU ± 73), mean attenuation was 78% higher with sICM/100 kVp (459 HU ± 282) and 26%-121% higher at sICM/50-65 keV (50 keV = 626 HU ± 285; 65 keV = 356 HU ± 171). With rICM, attenuation was 46% higher for 100 kVp (385 HU ± 215) and 19%-108% higher for 50-65 keV (50 keV = 567 HU ± 270; 65 keV = 325 HU ± 156) compared with BCM (P < .05). A total of 171 of 200 study participants preferred ICM to BCM, with no taste differences between sICM and rICM (3.9 ± 0.6). Fifteen participants had diarrhea with BCM, but none had diarrhea with ICM. Conclusion A 25%-reduced concentration of iodinated oral contrast medium resulted in acceptable bowel labeling while yielding substantially higher luminal attenuation at low-kVp and low-keV CT examinations with improved preference in patients undergoing treatment for cancer. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Laghi in this issue.
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Affiliation(s)
- Anushri Parakh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., A.A.N., M.P., F.M., A.K., D.V.S.); Department of Radiology, Hospital Universitario Jose Eleuterio Gonzalez, Monterrey, Mexico (A.A.N.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Adrian Antonio Negreros-Osuna
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., A.A.N., M.P., F.M., A.K., D.V.S.); Department of Radiology, Hospital Universitario Jose Eleuterio Gonzalez, Monterrey, Mexico (A.A.N.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Manuel Patino
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., A.A.N., M.P., F.M., A.K., D.V.S.); Department of Radiology, Hospital Universitario Jose Eleuterio Gonzalez, Monterrey, Mexico (A.A.N.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Fredrick McNulty
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., A.A.N., M.P., F.M., A.K., D.V.S.); Department of Radiology, Hospital Universitario Jose Eleuterio Gonzalez, Monterrey, Mexico (A.A.N.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Avinash Kambadakone
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., A.A.N., M.P., F.M., A.K., D.V.S.); Department of Radiology, Hospital Universitario Jose Eleuterio Gonzalez, Monterrey, Mexico (A.A.N.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
| | - Dushyant V Sahani
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., A.A.N., M.P., F.M., A.K., D.V.S.); Department of Radiology, Hospital Universitario Jose Eleuterio Gonzalez, Monterrey, Mexico (A.A.N.); and Department of Radiology, University of Washington, Seattle, Wash (D.V.S.)
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Abdominal CT Imaging Applications of Low Kilovoltage Peak Techniques. J Am Coll Radiol 2019; 16:482-484. [DOI: 10.1016/j.jacr.2018.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022]
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18
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Gottumukkala RV, Kalra MK, Tabari A, Otrakji A, Gee MS. Advanced CT Techniques for Decreasing Radiation Dose, Reducing Sedation Requirements, and Optimizing Image Quality in Children. Radiographics 2019; 39:709-726. [PMID: 30924753 DOI: 10.1148/rg.2019180082] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CT is an invaluable diagnostic tool for pediatric patients; however, concerns have arisen about the potential risks of ionizing radiation associated with diagnostic imaging in young patients, particularly for pediatric populations that may require serial CT examinations. Recent attention has also been focused on the immediate and long-term risks of administration of anesthetic medications to infants and young children who require sedation to undergo imaging examinations. These concerns can be mitigated with use of advanced CT techniques that can decrease scan time and radiation dose while preserving image quality. In this article, current state-of-the-art CT acquisition techniques are reviewed as part of a comprehensive strategy to reduce radiation dose, decrease sedation needs, and optimize image quality in infants and young children. Three imaging strategies are discussed, including (a) dual-energy CT (DECT), (b) imaging with a low tube potential, and (c) rapid scanning. Consolidating multiphase imaging protocols into a single phase with virtual nonenhanced imaging on DECT scanners, as well as use of low tube voltage, can reduce the radiation dose while increasing the conspicuity of contrast material-enhanced structures with a reduced volume of iodinated contrast material and a reduced rate of injection. Rapid scanning techniques with either ultrahigh pitch at dual-source CT or with wide-area detector single-source CT facilitate scanning without the need for sedation in many children. ©RSNA, 2019 See discussion on this article by Szczykutowicz .
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Affiliation(s)
- Ravi V Gottumukkala
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Mannudeep K Kalra
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Azadeh Tabari
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Alexi Otrakji
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Michael S Gee
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
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Sheafor DH, Kovacs MD, Burchett P, Picard MM, Davis B, Hardie AD. Impact of low-kVp scan technique on oral contrast density at abdominopelvic CT. Radiol Med 2018; 123:918-925. [PMID: 30084109 DOI: 10.1007/s11547-018-0928-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/30/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess quantitative and qualitative effects of kVp on oral contrast density. MATERIALS AND METHODS Three readers retrospectively reviewed 100 CT scans performed at a range of high- and low-energy settings, independently determining their preferred window and level settings for evaluation of the oral-contrast-opacified bowel. Contrast density was also assessed quantitatively in the stomach, jejunum, and ileum. Subsequently, a range of oral contrast dilutions were imaged at varying kVp's in a commercially available CIRS tissue equivalent phantom model. RESULTS In the retrospective patient study, mean oral contrast density increased significantly in the ileum compared to the jejunum (455.2 and 308.8 HU, respectively, p < 0.01). Similar findings were seen in patients regardless of patients' weight. Mean oral contrast density was higher on lower-energy scans, requiring more window/level adjustment. An oral contrast iodine concentration of 5.82-7.77 mg I/mL most closely approximated a target oral contrast density of 200 HU. CONCLUSIONS Oral contrast density is strongly influenced by kVp, supporting use of more dilute oral contrast when using lower-kVp techniques.
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Affiliation(s)
- Douglas H Sheafor
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, 210 CSB, Charleston, SC, 29425-3230, USA
| | - Mark D Kovacs
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, 210 CSB, Charleston, SC, 29425-3230, USA
| | - Philip Burchett
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, 210 CSB, Charleston, SC, 29425-3230, USA
| | - Melissa M Picard
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, 210 CSB, Charleston, SC, 29425-3230, USA
| | - Brenton Davis
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, 210 CSB, Charleston, SC, 29425-3230, USA
| | - Andrew D Hardie
- Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, 210 CSB, Charleston, SC, 29425-3230, USA.
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Araki K, Yoshizako T, Yoshida R, Tada K, Kitagaki H. Low-voltage (80-kVp) abdominopelvic computed tomography allows 60% contrast dose reduction in patients at risk of contrast-induced nephropathy. Clin Imaging 2018; 51:352-355. [PMID: 29982133 DOI: 10.1016/j.clinimag.2018.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/16/2018] [Accepted: 05/31/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the quality of image in abdominopelvic late phase computed tomography (CT) with a low tube voltage plus low dose contrast medium (CM) protocol (80-kVp, 60% CM). A compared with the conventional protocol (120-kVp, 100% CM) B in the same patients. MATERIAL AND METHODS This study included with 22 patients {36 to 77 kg (mean: 55.5 kg)} who had renal insufficiency and had experience of performance conventional CT without renal insufficiency during pre-18 months. The CT value of the portal vein, liver parenchyma, abdominal aorta, psoas muscle was measured. The estimated mean CNR (contrast-to-noise ratios), FOM (figure of merit), DLP (dose length product) and ED (effective dose) were compared between protocol A and B. Moreover, two radiologists assessed the visual quality of the CT images. RESULTS The mean DLP and ED in the protocol B was about 50% lower than that in the protocol A (p < 0.01). The mean CT value of the portal vein and abdominal aorta in the protocol B were significantly higher than that in the protocol A (p < 0.01). All of the FOM in the protocol B was significantly higher than that in the protocol A (p < 0.01). However, there was no significant difference in the mean CNR and visual quality between protocol A and B. CONCLUSION Performance of abdominopelvic CT using a low tube voltage plus reduced CM dose (80-kVp, 60% CM) achieved reduction of the radiation dose without impairing image quality in relatively light weight group. CLINICAL RELEVANCE/APPLICATION In abdominopelvic CT, protocol of low tube voltage (80-kVp) plus iodine dose reduction (60%) is able to provide the same quality of traditional protocols, also able to reducing radiation exposure (50%).
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Affiliation(s)
- Kazumi Araki
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan
| | - Takeshi Yoshizako
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan.
| | - Rika Yoshida
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan
| | - Keiji Tada
- Department of Radiology, Shimane University Hospital, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan
| | - Hajime Kitagaki
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enyacho, Izumo, Japan
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Noda Y, Goshima S, Nagata S, Miyoshi T, Kawada H, Kawai N, Tanahashi Y, Matsuo M. Right adrenal vein: comparison between adaptive statistical iterative reconstruction and model-based iterative reconstruction. Clin Radiol 2018; 73:594.e1-594.e6. [DOI: 10.1016/j.crad.2018.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
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22
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Zhao L, Li F, Zhang Z, Zhang Z, Jiang Y, Wang X, Gu J, Li D. Assessment of an advanced virtual monoenergetic reconstruction technique in cerebral and cervical angiography with third-generation dual-source CT: Feasibility of using low-concentration contrast medium. Eur Radiol 2018; 28:4379-4388. [PMID: 29654560 DOI: 10.1007/s00330-018-5407-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/13/2018] [Accepted: 02/22/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the feasibility of low-concentration contrast media (LC-CM) in cerebral and cervical dual-energy CT angiography (DE-CTA) using an advanced monoenergetic (Mono+) reconstruction technique. METHODS Sixty-five consecutive patients prospectively selected to undergo cerebral and cervical DE-CTA were randomised into two groups: 32 patients (63.7 ± 9.7 years) in the high-concentration contrast medium (HC-CM) group with iopromide 370 and 33 patients (60.7 ± 10.8 years) in the low-concentration contrast medium (LC-CM) group with iodixanol 270. Traditional monoenergetic (Mono) and Mono+ images from 40 to 100 keV levels (at 10-keV intervals) and the standard mixed (Mixed, 120 kVp equivalent) images were reconstructed. Subjective image quality parameters included the contrast-to-noise ratio (CNR) and objective image quality parameters were evaluated and compared between the two groups. RESULTS The 40-keV Mono+ images in the LC-CM group showed comparable objective CNR (common carotid arteries: 83.7 ± 24.5 vs. 78.1 ± 23.2; internal carotid arteries: 82.2 ± 26.8 vs. 76.8 ± 24.1; middle cerebral arteries: 72.5 ± 24.6 vs. 70.6 ± 19.2; all p > 0.05) and subjective image scores (3.95 ± 0.19 vs. 3.83 ± 0.35; p > 0.05) compared with Mixed images in the HC-CM group. CONCLUSION The Mono+ reconstruction technique could reduce the concentration of iodinated CM in the diagnosis of cerebral and cervical angiography. KEY POINTS • Mono+ shows decreased noise and superior CNR compared with Mono. • The 40-keV Mono+ images show the highest CNR in the LC-CM group. • The Mono+ reconstruction technique could reduce the concentration of iodinated CM.
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Affiliation(s)
- Lu Zhao
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fengtan Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Zewei Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Zhang Zhang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yingjian Jiang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xinyu Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jun Gu
- Siemens Healthineers, Beijing, 100102, China
| | - Dong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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Yoo RE, Yun TJ, Yoo DH, Cho YD, Kang HS, Yoon BW, Jung KH, Kang KM, Choi SH, Kim JH, Sohn CH. Monitoring cerebral blood flow change through use of arterial spin labelling in acute ischaemic stroke patients after intra-arterial thrombectomy. Eur Radiol 2018; 28:3276-3284. [PMID: 29476217 DOI: 10.1007/s00330-018-5319-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the ability of arterial spin labelling perfusion-weighted imaging (ASL-PWI) to identify reperfusion status and to predict the early neurological outcome of acute ischaemic stroke patients after intra-arterial (IA) thrombectomy. METHODS A total of 51 acute ischaemic stroke patients who underwent IA thrombectomy were retrospectively reviewed. Asymmetrical index before and after IA thrombectomy (AICBFpre and AICBFpost) and volume ratio of the reperfused territory to the baseline perfusion abnormality (reperfusion volume ratio) were calculated on ASL-PWI. A paired t-test was used to compare AICBFpre and AICBFpost. Pearson correlation and multiple linear regression were performed to evaluate correlations between the imaging parameters and NIHSS scores. RESULTS Mean AICBFpost was significantly higher than mean AICBFpre (0.923±0.352 vs. 0.312±0.191, p<0.001). AICBFpre had a significant correlation with NIHSSpre (pr=-0.430, p=.004). ∆AICBF had significant correlations with NIHSS24 h, NIHSS5-7 days and ∆NIHSS5-7 days (r=-0.356, p=0.028; r=-0.597, p<0.001; r=-0.346, p=0.033, respectively). ∆AICBF, reperfusion volume ratio and baseline infarct volume were significant independent predictors for NIHSS5-7 days. CONCLUSIONS ASL-PWI has the potential to serve as a non-invasive imaging tool to monitor the reperfusion status and predict the early neurological outcome of acute ischaemic stroke patients after IA thrombectomy. KEY POINTS • CBF change on ASL-PWI after IA thrombectomy correlated with NIHSS scores. • ASL-PWI can non-invasively monitor reperfusion in AIS patients after IA thrombectomy. • ASL-PWI may predict early outcome of AIS patients after IA thrombectomy.
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Affiliation(s)
- Roh-Eul Yoo
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea
| | - Tae Jin Yun
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea. .,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea.
| | - Dong Hyun Yoo
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea
| | - Young Dae Cho
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Koung Mi Kang
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea
| | - Seung Hong Choi
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea
| | - Ji-Hoon Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea
| | - Chul-Ho Sohn
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea
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Takahashi Y, Ota H, Omura K, Dendo Y, Otani K, Matsuura T, Kitami M, Seiji K, Tezuka Y, Nezu M, Ono Y, Morimoto R, Satoh F, Takase K. Image quality and radiation dose of low-tube-voltage CT with reduced contrast media for right adrenal vein imaging. Eur J Radiol 2017; 98:150-157. [PMID: 29279155 DOI: 10.1016/j.ejrad.2017.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/15/2017] [Accepted: 11/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare image quality and radiation dose of right adrenal vein (RAV) imaging computed tomography (CT) among conventional, low kV, and low kV with reduced contrast medium protocols. METHODS One-hundred-and-twenty patients undergoing adrenal CT were randomly assigned to one of three protocols: contrast dose of 600mgI/kg at 120-kV tube voltage setting (600-120 group), 600mgI/kg at 80kV (600-80 group), and 360mgI/kg at 80kV (360-80 group). Iterative reconstruction was used for 80-kV groups. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the RAV and size-specific dose estimates (SSDE) were measured. Three radiologists evaluated 4-point visualisation scores of RAV by consensus reading. RESULTS The RAV detectability was 95%, 97.2%, and 97.3% for 600-120, 600-80, and 360-80 groups, respectively (p=1.000). Visualisation scores were not significantly different among the groups (p=0.152). There were no significant differences in CNR or SNR between the 600-120 and 360-80 groups. SSDE of the 360-80 group was significantly lower than that of the 600-120 group (5.86mGy±1.44 vs. 7.27mGy±1.81, p<0.001). CONCLUSIONS 80-kV scans with 360 mgI/kg contrast media showed comparable detectability of RAV to conventional scans, while reducing 19% of SSDE.
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Affiliation(s)
- Yuki Takahashi
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Kensuke Omura
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yutaka Dendo
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Katharina Otani
- Diagnostic Imaging Business Area, DI Research & Collaboration Department, Siemens Healthcare KK, Gate City Osaki West Tower, 1-11-1, Osaki, Shinagawa-ku, Tokyo, 141-8644, Japan
| | - Tomonori Matsuura
- Department of Diagnostic Radiology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai 983-8512, Japan
| | - Masahiro Kitami
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yuta Tezuka
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masahiro Nezu
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yoshikiyo Ono
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ryo Morimoto
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Fumitoshi Satoh
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Noda Y, Goshima S, Koyasu H, Shigeyama S, Miyoshi T, Kawada H, Kawai N, Matsuo M. Renovascular CT: comparison between adaptive statistical iterative reconstruction and model-based iterative reconstruction. Clin Radiol 2017; 72:901.e13-901.e19. [DOI: 10.1016/j.crad.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
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Tanahashi Y, Goshima S, Kondo H, Noda Y, Sakurai K, Kawada H, Kawai N, Furui S, Matsuo M. Additional value of venous phase added to aortic CT angiography in patients with aortic aneurysm. Clin Imaging 2017; 44:51-56. [DOI: 10.1016/j.clinimag.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/01/2017] [Accepted: 04/10/2017] [Indexed: 01/16/2023]
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Aschoff AJ, Catalano C, Kirchin MA, Krix M, Albrecht T. Low radiation dose in computed tomography: the role of iodine. Br J Radiol 2017; 90:20170079. [PMID: 28471242 PMCID: PMC5603952 DOI: 10.1259/bjr.20170079] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Recent approaches to reducing radiation exposure during CT examinations typically utilize automated dose modulation strategies on the basis of lower tube voltage combined with iterative reconstruction and other dose-saving techniques. Less clearly appreciated is the potentially substantial role that iodinated contrast media (CM) can play in low-radiation-dose CT examinations. Herein we discuss the role of iodinated CM in low-radiation-dose examinations and describe approaches for the optimization of CM administration protocols to further reduce radiation dose and/or CM dose while maintaining image quality for accurate diagnosis. Similar to the higher iodine attenuation obtained at low-tube-voltage settings, high-iodine-signal protocols may permit radiation dose reduction by permitting a lowering of mAs while maintaining the signal-to-noise ratio. This is particularly feasible in first pass examinations where high iodine signal can be achieved by injecting iodine more rapidly. The combination of low kV and IR can also be used to reduce the iodine dose. Here, in optimum contrast injection protocols, the volume of CM administered rather than the iodine concentration should be reduced, since with high-iodine-concentration CM further reductions of iodine dose are achievable for modern first pass examinations. Moreover, higher concentrations of CM more readily allow reductions of both flow rate and volume, thereby improving the tolerability of contrast administration.
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Affiliation(s)
- Andrik J Aschoff
- 1 Department for Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Kempten, Kempten, Germany
| | - Carlo Catalano
- 2 Department of Radiological Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Miles A Kirchin
- 3 Bracco Imaging SpA, Global Medical & Regulatory Affairs, Milan, Italy
| | - Martin Krix
- 4 Bracco Imaging Germany, Global Medical & Regulatory Affairs, Konstanz, Germany
| | - Thomas Albrecht
- 5 Institut für Radiologie und Interventionelle Therapie, Vivantes-Klinikum Neukölln, Berlin, Germany
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Impact of low-energy CT imaging on selection of positive oral contrast media concentration. Abdom Radiol (NY) 2017; 42:1298-1309. [PMID: 27933477 DOI: 10.1007/s00261-016-0993-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine to what extent low-energy CT imaging affects attenuation of gastrointestinal tract (GIT) opacified with positive oral contrast media (OCM). Second, to establish optimal OCM concentrations for low-energy diagnostic CT exams. METHODS One hundred patients (38 men and 62 women; age 62 ± 11 years; BMI 26 ± 5) with positive OCM-enhanced 120-kVp single-energy CT (SECT), and follow-up 100-kVp acquisitions (group A; n = 50), or 40-70-keV reconstructions from rapid kV switching-single-source dual-energy CT (ssDECT) (group B; n = 50) were included. Luminal attenuation from different GIT segments was compared between exams. Standard dose of three OCM and diluted solutions (75%, 50%, and 25% concentrations) were introduced serially in a gastrointestinal phantom and scanned using SECT (120, 100, and 80 kVp) and DECT (80/140 kVp) acquisitions on a ssDECT scanner. Luminal attenuation was obtained on SECT and DECT images (40-70 keV), and compared to 120-kVp scans with standard OCM concentrations. RESULTS Luminal attenuation was higher on 100-kVp (328 HU) and on 40-60-keV images (410-924 HU) in comparison to 120-kVp scans (298 HU) in groups A and B (p < 0.05). Phantom: There was an inverse correlation between luminal attenuation and X-ray energy, increasing up to 527 HU on low-kVp and 999 HU on low-keV images (p < 0.05). 25% and 50% diluted OCM solutions provided similar or higher attenuation than 120 kVp, at low kVp and keV, respectively. CONCLUSIONS Low-energy CT imaging increases the attenuation of GIT opacified with positive OCM, permitting reduction of 25%-75% OCM concentration.
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Lell MM, Fleischmann U, Pietsch H, Korporaal JG, Haberland U, Mahnken AH, Flohr TG, Uder M, Jost G. Relationship between low tube voltage (70 kV) and the iodine delivery rate (IDR) in CT angiography: An experimental in-vivo study. PLoS One 2017; 12:e0173592. [PMID: 28319203 PMCID: PMC5358883 DOI: 10.1371/journal.pone.0173592] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
Objective Very short acquisition times and the use of low-kV protocols in CTA demand modifications in the contrast media (CM) injection regimen. The aim of this study was to optimize the use of CM delivery parameters in thoraco-abdominal CTA in a porcine model. Materials and methods Six pigs (55–68 kg) were examined with a dynamic CTA protocol (454 mm scan length, 2.5 s temporal resolution, 70 s total acquisition time). Four CM injection protocols were applied in a randomized order. 120 kV CTA protocol: (A) 300 mg iodine/kg bodyweight (bw), IDR = 1.5 g/s (flow = 5 mL/s), injection time (ti) 12 s (60 kg bw). 70 kV CTA protocols: 150 mg iodine/kg bw: (B) IDR = 0.75 g/s (flow = 2.5 mL/s), ti = 12 s (60 kg bw); (C) IDR = 1.5 g/s (flow = 5 mL/s), ti = 12 s (60 kg bw); (D) IDR = 3.0 g/s (flow = 10 mL/s), ti = 3 s (60 kg bw). The complete CM bolus shape was monitored by creating time attenuation curves (TAC) in different vascular territories. Based on the TAC, the time to peak (TTP) and the peak enhancement were determined. The diagnostic window (relative enhancement > 300 HU), was calculated and compared to visual inspection of the corresponding CTA data sets. Results The average relative arterial peak enhancements after baseline correction were 358.6 HU (A), 356.6 HU (B), 464.0 HU (C), and 477.6 HU (D). The TTP decreased with increasing IDR and decreasing ti, protocols A and B did not differ significantly (systemic arteries, p = 0.843; pulmonary arteries, p = 0.183). The delay time for bolus tracking (trigger level 100 HU; target enhancement 300 HU) for single-phase CTA was comparable for protocol A and B (3.9, 4.3 s) and C and D (2.4, 2.0 s). The scan window time frame was comparable for the different protocols by visual inspection of the different CTA data sets and by analyzing the TAC. Conclusions All protocols provided sufficient arterial enhancement. The use of a 70 kV CTA protocol is recommended because of a 50% reduction of total CM volume and a 50% reduced flow rate while maintaining the bolus profile. In contrast to pulmonary arterial enhancement, the systemic arterial enhancement improved only slightly increasing the IDR from 1.5 g/s to 3 g/s because of bolus dispersion of the very short bolus (3s) in the lungs.
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Affiliation(s)
- Michael M. Lell
- Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuernberg, Germany
- * E-mail:
| | - Ulrike Fleischmann
- Department of Radiology, Friedrich-Alexander University Erlangen, Erlangen, Germany
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer Healthcare, Berlin, Germany
| | | | | | | | | | - Michael Uder
- Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuernberg, Germany
- Imaging Science Institute (ISI) Erlangen, Erlangen, Germany
| | - Gregor Jost
- MR and CT Contrast Media Research, Bayer Healthcare, Berlin, Germany
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Computed Tomographic Angiography of the Abdomen and Pelvis in Azotemic Patients Utilizing 80-kV(p) Technique and Reduced Dose Iodinated Contrast. J Comput Assist Tomogr 2017; 41:141-147. [DOI: 10.1097/rct.0000000000000478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Shen Y, Hu X, Zou X, Zhu D, Li Z, Hu D. Did low tube voltage CT combined with low contrast media burden protocols accomplish the goal of "double low" for patients? An overview of applications in vessels and abdominal parenchymal organs over the past 5 years. Int J Clin Pract 2016; 70 Suppl 9B:B5-B15. [PMID: 27577514 DOI: 10.1111/ijcp.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 06/15/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Imaging communities have already reached a consensus that the radiation dose of computed tomography (CT) should be reduced as much as reasonably achievable to lower population risks. Increasing attention is being paid to iodinated contrast media (CM) induced nephrotoxicity (CIN); a decrease in the intake of iodinated CM is required by increasingly more radiologists. Theoretically, the radiation dose varies with the tube current time and square of the tube voltage, with higher iodine contrast at low photon energies (Huda et al. [2000] Radiology, 21 7, 430-435).The use of low tube voltage is a promising strategy to reduce both the radiation dose and CM burden. The term 'double low' has been coined to describe scanning protocols that reduce radiation dose and iodine intake synchronously. These protocols are becoming increasingly popular in the clinical setting. PURPOSE The aim of this review was to describe all original studies using the 'double low' strategy in the last 5 years. METHODS We searched an online electronic database (PubMed) from January 2011 to December 2015 for original studies published on the relationship of low tube voltage with low radiation dose and low iodine contrast media burden in patients undergoing CT scans. Studies that failed to reduce radiation dose or iodine CM burden were excluded in this study. RESULTS Thirty-seven studies aimed at reducing radiation dose using low tube voltage combined with iodine CM reduced protocols were included in this study. Most studies evaluated conditions associated with arteries. Four were cerebral and neck computed tomography angiography (CTA) studies, 15 were pulmonary CTA (pCTA) and coronary CTA (cCTA) studies, one concerned myocardial perfusion, five studies focused on the thoracic and abdominal aorta, and one investigated renal arteries. Three studies consisted of CT venography (CTV) of the pelvis and lower extremities. Six publications examined the liver, and two focused on the kidney. CONCLUSION Overall, this review demonstrates that the low tube voltage CT protocol is a powerful tool to reduce the radiation dose in CTA, especially with pCTA and cCTA.
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Affiliation(s)
- Yaqi Shen
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xuemei Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xianlun Zou
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Di Zhu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhen Li
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Daoyu Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Noda Y, Goshima S, Miyoshi T, Watanabe H, Kawada H, Kawai N, Koyasu H, Kanematsu M, Matsuo M, T Bae K. Determination of the least amount of iodine load required for the detection of pancreatic adenocarcinoma at 80-kVp CT. Eur J Radiol 2016; 85:901-5. [DOI: 10.1016/j.ejrad.2016.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Shuman WP, Chan KT, Busey JM, Mitsumori LM, Koprowicz KM. Dual-energy CT Aortography with 50% Reduced Iodine Dose Versus Single-energy CT Aortography with Standard Iodine Dose. Acad Radiol 2016; 23:611-8. [PMID: 26897602 DOI: 10.1016/j.acra.2015.12.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVES Because many patients with aortic pathology also have compromised renal function, we wished to investigate dual-energy computed tomography (DECT) aortography with 50% reduced iodine dose compared to single-energy computed tomography (SECT) aortography with standard iodine dose. MATERIALS AND METHODS Fifty patients had DECT aortography with 50% reduced iodine dose. Thirty-four of these patients had prior SECT aortography with standard iodine dose. DECT images were reconstructed at both 50 and 77 keV and were compared to SECT 120 kVp images. Reviewers measured aortic attenuation, image noise, and scored vascular enhancement. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were calculated. Volume CT dose index was recorded. RESULTS Mean iodine dose was 47 g for SECT and 24 g for DECT. Aortic attenuation was highest at reduced iodine dose DECT 50 keV (570 ± 105 Hounsfield units [HU]) compared to 77 keV (239 ± 40 HU) or to standard iodine dose SECT 120 kVp (356 ± 69 HU) (P < 0.05). Image noise was greatest at 50 keV compared to 77 keV and 120 kVp (P < 0.05) but was similar between 77 keV and 120 kVp (P > 0.05). SNR and CNR were the same at 50 keV and 120 kVp (P > 0.05). Mean vascular enhancement scores were all above 3.0 (good, typical enhancement). Volume CT dose index was 11.7 mGy for DECT and 11.8 mGy for SECT (P = 0.37). CONCLUSIONS DECT aortography with 50% reduced iodine reconstructed at 50 keV resulted in significantly greater aortic attenuation, good subjective vascular enhancement, and comparable SNR and CNR compared to standard iodine dose SECT. DECT image noise at 77 keV was similar to SECT at 120 kVp.
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Affiliation(s)
- William P Shuman
- Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195.
| | - Keith T Chan
- Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195
| | - Janet M Busey
- Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195
| | - Lee M Mitsumori
- Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195
| | - Kent M Koprowicz
- Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195
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White Paper of the Society of Computed Body Tomography and Magnetic Resonance on Dual-Energy CT, Part 2. J Comput Assist Tomogr 2016; 40:846-850. [DOI: 10.1097/rct.0000000000000539] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Automated tube voltage selection in thoracoabdominal computed tomography at high pitch using a third-generation dual-source scanner: image quality and radiation dose performance. Invest Radiol 2015; 50:352-60. [PMID: 25591129 DOI: 10.1097/rli.0000000000000133] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the radiation dose and image quality performance of thoracoabdominal examinations with an automated tube voltage selection (tube voltage adaptation), tube current modulation, and high pitch using a third-generation dual-source computed tomography (CT) compared intraindividually with 120-kV examinations with tube current modulation with special attention on clinically relevant lesions in the liver, the lungs, and extrahepatic soft tissues. MATERIALS AND METHODS This study was approved by the institutional review board. Computed tomography of the body was performed using a third-generation dual-source system in 95 patients (mean body mass index, 25 kg/m²; range, 18-35 kg/m²). For 49 of these patients, all calculated tube settings and resulting dose values were recorded for each of the 12 gradual contrast weightings of the tube voltage adaptation algorithm. Spiral CT was performed for all patients with an intermediate weighting (grade 7) in a portal venous phase at 120 reference kV, 180 reference mAs, and pitch of 1.55. Objective image quality was assessed on the basis of contrast-to-noise ratio. Subjective image quality was assessed on the basis of clarity and sharpness of anatomical and pathological structures as well as interfering beam hardening and spiral and motion artifacts (heart, lungs, diaphragm). Previous examinations on a 64-slice scanner served as reference. RESULTS All examinations were rated good or excellent for clinical diagnosis. Automated tube voltage selection resulted in significantly lower effective radiation dose (9.5 mSv) compared with the reference (12.0 mSv; P < 0.01). Contrast-to-noise ratio and image quality of soft tissue lesions were significantly increased (P < 0.01). Motion artifacts were significantly reduced (P < 0.01). CONCLUSIONS Automated tube voltage adaptation combined with high-pitch protocols allows for a substantial radiation dose reduction while substantially increasing the image quality, even at large-volume exposure.
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Macchi M, Floridi C, Strocchi S, Fontana F, Mangini M, Piacentino F, Duka E, Donati AV, Fugazzola C. Role of low dose CT angiography in the follow-up after endovascular aneurysm repair of abdominal aorta. Acta Radiol 2015; 56:1471-8. [PMID: 25487715 DOI: 10.1177/0284185114560210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 10/14/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Computed tomography angiography (CTA) is the most employed modality in the follow-up after endovascular aneurysm repair (EVAR) of abdominal aorta (AA); repeated standard controls expose patients to a high cumulative radiation dose (RD). PURPOSE To compare image quality and RD between 100 kV and 120 kV protocols in the same group of patients, previously treated with EVAR. MATERIAL AND METHODS Thirty patients, who had performed a previous CTA at 120 kV, underwent a low dose CTA with the same 64-detector machine. Images were evaluated qualitatively and quantitatively. The influence of body mass index (BMI), considering three groups of patients (normal weight, overweight, and obese) was also assessed. RD values (volume CT dose index and effective dose) were calculated. RESULTS The mean qualitative score at 100 kV was worse than that at 120 kV, but the difference was not statistically significant and in all cases the image quality was satisfactory. At 100 kV the vessels mean attenuation value was significantly higher; signal-to-noise ratio significantly lower; contrast-to-noise ratio lower, but the difference was not significant. Regarding BMI, the difference in the qualitative score was significant in the obese group, but not in the other two groups; of the quantitative parameters only the signal-to-noise ratio presented a significant difference in the obese group. The average CTDIvol was reduced by 22% and the mean effective dose by 36% with the 100 kV protocol compared to the 120 kV protocol. Both differences were significant. CONCLUSION The 100 kV protocol allowed a consistent RD reduction, maintaining a satisfactory image quality in all patients.
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Affiliation(s)
- Monica Macchi
- Department of Radiology. University Hospital. Varese, Italy
| | - Chiara Floridi
- Department of Radiology. University Hospital. Varese, Italy
| | - Sabina Strocchi
- Department of Medical Physics. University Hospital. Varese, Italy
| | | | - Monica Mangini
- Department of Radiology. University Hospital. Varese, Italy
| | | | - Ejona Duka
- Department of Radiology. University Hospital. Varese, Italy
| | - Alberto V Donati
- Interventional Radiology Research Center. University of Insubria, Varese, Italy
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Shin HJ, Kim SS, Lee JH, Park JH, Jeong JO, Jin SA, Shin BS, Shin KS, Ahn M. Feasibility of low-concentration iodinated contrast medium with lower-tube-voltage dual-source CT aortography using iterative reconstruction: comparison with automatic exposure control CT aortography. Int J Cardiovasc Imaging 2015; 32 Suppl 1:53-61. [PMID: 26621755 DOI: 10.1007/s10554-015-0816-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Hee Jeong Shin
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Korea
| | - Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Korea.
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seon Ah Jin
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Byung Seok Shin
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Korea
| | - Kyung-Sook Shin
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Korea
| | - Moonsang Ahn
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Evaluation of A New Bolus Tracking–Based Algorithm for Predicting A Patient-Specific Time of Arterial Peak Enhancement in Computed Tomography Angiography. Invest Radiol 2015; 50:531-8. [DOI: 10.1097/rli.0000000000000160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kanematsu M, Goshima S, Kawai N, Kondo H, Miyoshi T, Watanabe H, Noda Y, Tanahashi Y, Bae KT. Low-Iodine-Load and Low-Tube-Voltage CT Angiographic Imaging of the Kidney by Using Bolus Tracking with Saline Flushing. Radiology 2015; 275:832-40. [PMID: 25494297 DOI: 10.1148/radiol.14141457] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Masayuki Kanematsu
- From the Departments of Radiology (M.K., S.G., N.K., H.K., H.W., Y.N., Y.T.) and Radiology Services (M.K., T.M.), Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan; and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (K.T.B.)
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Objective and subjective image quality of primary and recurrent squamous cell carcinoma on head and neck low-tube-voltage 80-kVp computed tomography. Neuroradiology 2015; 57:645-51. [DOI: 10.1007/s00234-015-1512-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022]
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Contrast media controversies in 2015: imaging patients with renal impairment or risk of contrast reaction. AJR Am J Roentgenol 2015; 204:1174-81. [PMID: 25730301 DOI: 10.2214/ajr.14.14259] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The incidence and significance of complications related to intravascular contrast material administration have become increasingly controversial. This review will highlight current thinking regarding the imaging of patients with renal impairment and those at risk for an allergiclike contrast reaction. CONCLUSION The risk of contrast-induced acute kidney injury remains uncertain for patients with an estimated glomerular filtration rate (GFR) less than 45 mL/min/1.73 m(2), but if there is a risk, it is greatest in those with estimated GFR less than 30 mL/min/1.73 m(2). In this population, low-risk gadolinium-based contrast agents appear to have a large safety margin. Corticosteroid prophylaxis remains the standard of care in the United States for patients identified to be at high risk of a contrast reaction, but it has an incomplete mitigating effect on contrast reaction rates and the number needed to treat is large.
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Optimizing Contrast Media Injection Protocols in State-of-the Art Computed Tomographic Angiography. Invest Radiol 2015; 50:161-7. [DOI: 10.1097/rli.0000000000000119] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Automated attenuation-based tube voltage selection for body CTA: Performance evaluation of 192-slice dual-source CT. Eur Radiol 2015; 25:2346-53. [PMID: 25693663 DOI: 10.1007/s00330-015-3632-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/01/2015] [Accepted: 01/21/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess radiation dose and image quality in body CT-angiography (CTA) with automated attenuation-based tube voltage selection (ATVS) on a 192-slice dual-source CT (DSCT). METHODS Forty patients (69.5 ± 9.6 years) who had undergone body CTA with ATVS (ref.kVp 100, ref.mAs 90) using a 2x192-slice CT in single-source mode were retrospectively included. All patients had undergone prior CTA with a 2x128-slice CT and ATVS with identical imaging and contrast media protocols, serving for comparison. Images were reconstructed with iterative reconstruction at similar strength levels. Radiation dose was determined. Image quality was assessed semi-quantitatively (1:excellent, 5:non-diagnostic), aortic attenuation, noise and CNR were determined. RESULTS As compared to 128-slice DSCT, 192-slice DSCT selected tube voltages were lower in 30 patients (75 %), higher in 3 (7.5 %), and similar in 7 patients (17.5 %). CTDIvol was lower with 192-slice DSCT (4.7 ± 1.9 mGy vs. 5.8 ± 2.1 mGy; p < 0.001). Subjective image quality, mean aortic attenuation (342 ± 67HU vs. 268 ± 67HU) and CNR (9.8 ± 2.5 vs. 8.2 ± 2.9) were higher with 192-slice DSCT (all p < 0.01), all datasets being diagnostic. CONCLUSION Our study suggests that ATVS of 192-slice DSCT for body CTA is associated with an improved image quality and further radiation dose reduction of 19 % compared to 128-slice DSCT. KEY POINTS • 192-slice DSCT allows imaging from 70 kVp to 150 kVp at 10 kVp increments. • 192-slice DSCT allows for radiation-dose reduction in body-CTA with ATVS. • Subjective and objective image quality increase compared to 128-slice DSCT.
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Kanematsu M, Kondo H, Miyoshi T, Goshima S, Noda Y, Tanahashi Y, Bae KT. Whole-body CT with high heat-capacity X-ray tube and automated tube current modulation--effect of tube current limitation on contrast enhancement, image quality and radiation dose. Eur J Radiol 2015; 84:877-83. [PMID: 25740700 DOI: 10.1016/j.ejrad.2015.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/25/2014] [Accepted: 01/29/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the effect of tube current limitation on contrast enhancement, image quality, and radiation dose in whole-body 64-detector CT with a high heat-capacity X-ray tube and automated tube current modulation. MATERIALS AND METHODS One hundred eighteen patients were randomized into three whole-body CT protocols: tube current limitation at 210 mA, 450 mA, and no limitation. Signal-to-noise ratio (SNR), dose-length product (DLP), estimated effective dose (ED), and image quality were assessed. RESULTS Mean SNR of aorta was comparable among protocols, but that of liver was somewhat lower in 210-mA than in 450-mA and no-limitation protocols (p<0.05). Mean DLP with 210-mA (533.8 mGy cm) was reduced by 31% from that with 450-mA (768.4 mGy cm) and by 38% from that with no-limitation protocol (861.3 mGy cm), respectively. Image quality was slightly degraded (p<0.017) with 210 mA relative to the others in thorax and pelvis, but no difference was found in diagnostic acceptability. CONCLUSION For whole-body CT using multidetector CT mounted with a high heat-capacity X-ray tube, an appropriate tube current limitation setting may help reduce excessive radiation dose without significant compromise in diagnostic acceptability.
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Affiliation(s)
- Masayuki Kanematsu
- Departments of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan; Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Hiroshi Kondo
- Departments of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Toshiharu Miyoshi
- Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Satoshi Goshima
- Departments of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yoshifumi Noda
- Departments of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yukichi Tanahashi
- Departments of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kyongtae T Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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