Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 8/2018

01-08-2018 | Cardiac

Contrast media injection protocol optimization for dual-energy coronary CT angiography: results from a circulation phantom

Authors: Domenico De Santis, Damiano Caruso, U. Joseph Schoepf, Marwen Eid, Moritz H. Albrecht, Taylor M. Duguay, Akos Varga-Szemes, Andrea Laghi, Carlo N. De Cecco

Published in: European Radiology | Issue 8/2018

Login to get access

Abstract

Objectives

To investigate the minimum iodine delivery rate (IDR) required to achieve diagnostic coronary attenuation (300 HU) with dual-energy coronary CTA.

Methods

Acquisitions were performed on a circulation phantom with a third- generation dual-source CT scanner. Contrast media was injected for a fixed time whilst IDRs varied from 1.0 to 0.3 gI/s in 0.1-gI/s intervals. Noise-optimized virtual monoenergetic imaging (VMI+) reconstructions from 40 to 90 keV in 5 keV increments were generated. Contrast-to-noise ratio (CNR) and coronary HU were measured for each injection.

Results

VMI+ from 40–70 keV reached diagnostic attenuation with at least one IDR. The minimum IDR achieving a diagnostic attenuation ranged from 0.4 gI/s at 40 keV (312.8 HU) to 1.0 gI/s at 70 keV (334.1 HU). Attenuation values reached with IDR of 1.0 gI/s were significantly higher at each keV level (p<0.001). CNR showed a near perfect correlation with the IDR (ρ≥0.962; p<0.001), the IDR of 1.0 gI/s provided the highest CNR at each keV level, achieving the highest overall value at 40 keV (54.0±3.1).

Conclusions

IDRs from 0.4–1.0 gI/s associated with VMI+ from 40–70 keV provide diagnostic coronary attenuation with dual-energy coronary CTA.

Key Points

• Iodine delivery rate (IDR) is a major determinant of contrast enhancement.
• Low-keV noise-optimized monoenergetic images (VMI+) maximize iodine attenuation.
• Low-keV VMI+ allows for lower IDRs while maintaining adequate coronary attenuation.
• Lowest IDR to reach 300 HU was 0.4 gI/s, 40 keV VMI+.
Literature
1.
Meyer M, Haubenreisser H, Schoepf UJ et al (2014) Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 273:373–382CrossRefPubMed
2.
Yu L, Leng S, McCollough CH (2012) Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 199:S9–S15CrossRefPubMed
3.
Grant KL, Flohr TG, Krauss B, Sedlmair M, Thomas C, Schmidt B (2014) Assessment of an advanced image-based technique to calculate virtual monoenergetic computed tomographic images from a dual-energy examination to improve contrast-to-noise ratio in examinations using iodinated contrast media. Invest Radiol 49:586–592CrossRefPubMed
4.
Carrascosa P, Leipsic JA, Capunay C et al (2015) Monochromatic image reconstruction by dual energy imaging allows half iodine load computed tomography coronary angiography. Eur J Radiol 84:1915–1920CrossRefPubMed
5.
Dubourg B, Caudron J, Lestrat JP et al (2014) Single-source dual-energy CT angiography with reduced iodine load in patients referred for aortoiliofemoral evaluation before transcatheter aortic valve implantation: impact on image quality and radiation dose. Eur Radiol 24:2659–2668CrossRefPubMed
6.
Delesalle MA, Pontana F, Duhamel A et al (2013) Spectral optimization of chest CT angiography with reduced iodine load: experience in 80 patients evaluated with dual-source, dual-energy CT. Radiology 267:256–266CrossRefPubMed
7.
Raju R, Thompson AG, Lee K et al (2014) Reduced iodine load with CT coronary angiography using dual-energy imaging: a prospective randomized trial compared with standard coronary CT angiography. J Cardiovasc Comput Tomogr 8:282–288CrossRefPubMedPubMedCentral
8.
Yuan R, Shuman WP, Earls JP et al (2012) Reduced iodine load at CT pulmonary angiography with dual-energy monochromatic imaging: comparison with standard CT pulmonary angiography--a prospective randomized trial. Radiology 262:290–297CrossRefPubMed
9.
Shuman WP, O’Malley RB, Busey JM, Ramos MM, Koprowicz KM (2017) Prospective comparison of dual-energy CT aortography using 70% reduced iodine dose versus single-energy CT aortography using standard iodine dose in the same patient. Abdom Radiol (NY) 42:759–765CrossRef
10.
Caruso D, Eid M, Schoepf UJ et al (2017) Optimizing contrast media injection protocols in computed tomography angiography at different tube voltages: evaluation in a circulation phantom. J Comput Assist Tomogr 41:804–810CrossRefPubMed
11.
Higashigaito K, Schmid T, Puippe G et al (2016) CT angiography of the aorta: prospective evaluation of individualized low-volume contrast media protocols. Radiology 280:960–968CrossRefPubMed
12.
Kok M, Mihl C, Hendriks BM et al (2016) Optimizing contrast media application in coronary CT angiography at lower tube voltage: evaluation in a circulation phantom and sixty patients. Eur J Radiol 85:1068–1074CrossRefPubMed
13.
Behrendt FF, Bruners P, Kalafut J et al (2008) Introduction of a dedicated circulation phantom for comprehensive in vitro analysis of intravascular contrast material application. Invest Radiol 43:729–736CrossRefPubMed
14.
Mihl C, Wildberger JE, Jurencak T et al (2013) Intravascular enhancement with identical iodine delivery rate using different iodine contrast media in a circulation phantom. Invest Radiol 48:813–818CrossRefPubMed
15.
Lell MM, Jost G, Korporaal JG et al (2015) Optimizing contrast media injection protocols in state-of-the art computed tomographic angiography. Invest Radiol 50:161–167CrossRefPubMed
16.
Carrascosa P, Capunay C, Rodriguez-Granillo GA, Deviggiano A, Vallejos J, Leipsic JA (2014) Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study. Int J Cardiovasc Imaging 30:1613–1620CrossRefPubMed
17.
Apfaltrer P, Hanna EL, Schoepf UJ et al (2012) Radiation dose and image quality at high-pitch CT angiography of the aorta: intraindividual and interindividual comparisons with conventional CT angiography. AJR Am J Roentgenol 199:1402–1409CrossRefPubMed
18.
Weininger M, Barraza JM, Kemper CA, Kalafut JF, Costello P, Schoepf UJ (2011) Cardiothoracic CT angiography: current contrast medium delivery strategies. AJR Am J Roentgenol 196:W260–W272CrossRefPubMed
19.
Cademartiri F, Mollet NR, van der Lugt A et al (2005) Intravenous contrast material administration at helical 16-detector row CT coronary angiography: effect of iodine concentration on vascular attenuation. Radiology 236:661–665CrossRefPubMed
20.
Isobe S, Yamada T, Sato K et al (2013) Diabetes with preserved renal function is an independent risk factor for renal function deterioration after coronary computed tomography angiography. J Comput Assist Tomogr 37:750–754CrossRefPubMed
21.
Kooiman J, Pasha SM, Zondag W et al (2012) Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol 81:2554–2561CrossRefPubMed
22.
Kane GC, Doyle BJ, Lerman A, Barsness GW, Best PJ, Rihal CS (2008) Ultra-low contrast volumes reduce rates of contrast-induced nephropathy in patients with chronic kidney disease undergoing coronary angiography. J Am Coll Cardiol 51:89–90CrossRefPubMed
23.
Albrecht MH, Scholtz JE, Kraft J et al (2015) Assessment of an advanced monoenergetic reconstruction technique in dual-energy computed tomography of head and neck cancer. Eur Radiol 25:2493–2501CrossRefPubMed
24.
Albrecht MH, Trommer J, Wichmann JL et al (2016) Comprehensive comparison of virtual monoenergetic and linearly blended reconstruction techniques in third-generation dual-source dual-energy computed tomography angiography of the thorax and abdomen. Invest Radiol 51:582–590CrossRefPubMed
25.
Martin SS, Albrecht MH, Wichmann JL et al (2017) Value of a noise-optimized virtual monoenergetic reconstruction technique in dual-energy CT for planning of transcatheter aortic valve replacement. Eur Radiol 27:705–714CrossRefPubMed
26.
Mangold S, De Cecco CN, Schoepf UJ et al (2016) A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography. Eur Radiol 26:4380–4389CrossRefPubMed
27.
Fleischmann D (2003) Use of high concentration contrast media: principles and rationale-vascular district. Eur J Radiol 45 Suppl 1:S88–S93CrossRefPubMed
28.
Mangold S, Wichmann JL, Schoepf UJ et al (2017) Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection: clinical application in a non-obese and obese patient population. Eur Radiol 27:2298–2308CrossRefPubMed
Metadata
Title
Contrast media injection protocol optimization for dual-energy coronary CT angiography: results from a circulation phantom
Authors
Domenico De Santis
Damiano Caruso
U. Joseph Schoepf
Marwen Eid
Moritz H. Albrecht
Taylor M. Duguay
Akos Varga-Szemes
Andrea Laghi
Carlo N. De Cecco
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5308-3

Other articles of this Issue 8/2018

European Radiology 8/2018 Go to the issue

Magnetic Resonance

Renal fat fraction and diffusion tensor imaging in patients with early-stage diabetic nephropathy

Molecular Imaging

Robustness versus disease differentiation when varying parameter settings in radiomics features: application to nasopharyngeal PET/CT

Neuro

Extraction of large-scale structural covariance networks from grey matter volume for Parkinson’s disease classification

Musculoskeletal

Imaging complex ventral hernias, their surgical repair, and their complications

Oncology

18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients

Computed Tomography

A noise-optimized virtual monoenergetic reconstruction algorithm improves the diagnostic accuracy of late hepatic arterial phase dual-energy CT for the detection of hypervascular liver lesions