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European Radiology
Published in: European Radiology 11/2014

01-11-2014 | Cardiac

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

Authors: Benjamin Dubourg, Jérôme Caudron, Jean-Pierre Lestrat, Michael Bubenheim, Valentin Lefebvre, Matthieu Godin, Christophe Tron, Hélène Eltchaninoff, Fabrice Bauer, Jean-Nicolas Dacher

Published in: European Radiology | Issue 11/2014

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Abstract

Objectives

To compare image quality and radiation dose of pre-transcatheter aortic valve implantation (TAVI) aortoiliofemoral CT angiography (AICTA) provided by standard vs. dual-energy mode with reduced iodine load protocols.

Methods

One hundred and sixty-one patients underwent a two-step CTA protocol before TAVI including cardiac CTA with injection of 65 mL of iodinated contrast agent (ICA), immediately followed by AICTA. From this second acquisition, the following three different patient groups were identified: Group 1: 52 patients with standard AICTA (60 mL ICA, 100 kVp, mA automodulation); Group 2: 48 patients with dual-energy AICTA with 50 % iodine load reduction (30 mL ICA, fast kVp switching, 600 mA); Group 3: 61 patients with an identical protocol to Group 2, but exposed to 375 mA. The qualitative/subjective image quality (13-point score) and quantitative/objective image quality (contrast attenuation and image noise) were evaluated. The radiation dose was recorded.

Results

There was no significant difference in non-diagnostic images between the three protocols. Contrast attenuation, signal-to-noise ratio and contrast-to-noise ratio were significantly higher, whereas noise was significantly lower in the standard protocol (all P < 0.05). The radiation dose was lower in the dual-energy protocol at 375 mA (P < 0.05).

Conclusions

Dual-energy AICTA before TAVI results in a reduction of iodine load while maintaining sufficient diagnostic information despite increased noise.

Key Points

• Dual-energy AICTA before TAVI results in a 50 % reduction of iodine load.
•The reduction of iodine load maintains sufficient image quality despite increased noise.
• Using 375 mA in dual-energy mode results in a reduction of radiation dose.
• A high tube current setting (600 mA) should be used in overweight patients.
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Metadata
Title
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
Authors
Benjamin Dubourg
Jérôme Caudron
Jean-Pierre Lestrat
Michael Bubenheim
Valentin Lefebvre
Matthieu Godin
Christophe Tron
Hélène Eltchaninoff
Fabrice Bauer
Jean-Nicolas Dacher
Publication date
01-11-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3263-1

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