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European Radiology
Published in: European Radiology 12/2014

01-12-2014 | Chest

High-pitch computed tomography pulmonary angiography with iterative reconstruction at 80 kVp and 20 mL contrast agent volume

Authors: Guang Ming Lu, Song Luo, Felix G. Meinel, Andrew D. McQuiston, Chang Sheng Zhou, Xiang Kong, Yan E. Zhao, Ling Zheng, U. Joseph Schoepf, Long Jiang Zhang

Published in: European Radiology | Issue 12/2014

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Abstract

Objectives

To evaluate the image quality, radiation dose and diagnostic accuracy of 80kVp, high-pitch CT pulmonary angiography (CTPA) with iterative reconstruction using 20 ml of contrast agent.

Methods

One hundred patients with suspected pulmonary embolism (PE) were randomly divided into two groups (n = 50 each; group A, 100 kVp, 1.2 pitch, 60 ml of contrast medium and filtered back projection algorithm; group B, 80 kVp, 2.2 pitch, 20 ml of contrast medium and sinogram affirmed iterative reconstruction). Image quality, diagnostic accuracy and radiation dose were evaluated and compared.

Results

Mean CT numbers of pulmonary arteries in group B were higher than those in group A (all P < 0.001). Contrast-to-noise ratio and signal-to-noise ratio of group B were higher than those of group A (both P < 0.001). There was no significant difference in subjective image quality scores between two groups (P = 0.807). The interobserver agreement was excellent (k = 0.836). There was no significant difference in diagnostic accuracy between the two groups (P > 0.05). Compared with group A, radiation dose of group B was reduced by 50.3 % (P < 0.001).

Conclusions

High-pitch CTPA at 80 kVp can obtain sufficient image quality in normal-weight individuals with 20 ml of contrast agent and half the radiation dose of a conventional CTPA protocol.

Key Points

• CTPA is feasible at 80 kVp using only 20 ml of contrast agent.
• High-pitch CTPA at 80 kVp has an effective dose under 1 mSv.
• This CTPA protocol can obtain sufficient image quality in normal-weight individuals.
Literature
1.
Mayo J, Thakur Y (2013) Pulmonary CT angiography as first-line imaging for PE: image quality and radiation dose considerations. AJR Am J Roentgenol 200:522–528PubMedCrossRef
2.
3.
Costello JE, Cecava ND, Tucker JE et al (2007) CT radiation dose: Current controversies and dose reduction strategies. AJR Am J Roentgenol 201:1283–1290CrossRef
4.
Goodman DM (2013) Initiatives focus on limiting radiation exposure to patients during CT scans. JAMA 309:647–648PubMedCrossRef
5.
Morcos SK, Thomsen HS, Webb JA (1999) Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol 9:1602–1613PubMedCrossRef
6.
Newhouse JH, RoyChoudhury A (2013) Quantitating contrast medium–induced nephropathy controlling the controls. Radiology 267:4–8PubMedCrossRef
7.
Bolen MA, Renapurkar RD, Popovic ZB et al (2013) High-pitch ECG-synchronized pulmonary CT angiography versus standard CT pulmonary angiography. AJR Am J Roentgenol 201:971–976PubMedCrossRef
8.
Co SJ, Mayo J, Liang T, Krzymyk K, Yousefi M, Nicolaou S (2013) Iterative reconstructed ultra high pitch CT pulmonary angiography with cardiac bowtie-shaped filter in the acute setting: effect on dose and image quality. Eur J Radiol 82:1571–1576PubMedCrossRef
9.
De Zordo T, von Lutterotti K, Dejaco C et al (2012) Comparison of image quality and radiation dose of different pulmonary CTA protocols on a 128-slice CT: high-pitch dual source CT, dual energy CT and conventional spiral CT. Eur Radiol 22:279–286PubMedCrossRef
10.
Faggioni L, Neri E, Sbragia P et al (2012) 80-kV pulmonary CT angiography with 40 mL of iodinated contrast material in lean patients: comparison of vascular enhancement with iodixanol (320 mg I/mL) and iomeprol (400 mg I/mL). AJR Am J Roentgenol 199:1220–1225PubMedCrossRef
11.
Goble EW, Abdulkarim JA (2014) CT pulmonary angiography using a reduced volume of high-concentration iodinated contrast medium and multiphasic injection to achieve dose reduction. Clin Radiol 69:36–40PubMedCrossRef
12.
Holmquist F, Hansson K, Pasquariello F, Björk J, Nyman U (2009) Minimizing contrast medium doses to diagnose pulmonary embolism with 80-kVp multidetector computed tomography in azotemic patients. Acta Radiol 50:181–193PubMedCrossRef
13.
Hou DJ, Tso DK, Davison C et al (2013) Clinical utility of ultra high pitch dual source thoracic CT imaging of acute pulmonary embolism in the emergency department: are we one step closer towards a non-gated triple rule out. Eur J Radiol 82:1793–1798PubMedCrossRef
14.
Hunsaker AR, Oliva IB, Cai T (2010) Contrast opacification using a reduced volume of iodinated contrast material and low peak kilovoltage in pulmonary CT angiography objective and subjective evaluation. AJR Am J Roentgenol 195:W118–W124PubMedCrossRef
15.
Kerl JM, Lehnert T, Schell B et al (2012) Intravenous contrast material administration at high-pitch dual-source CT pulmonary angiography: Test bolus versus bolus-tracking technique. Eur J Radiol 81:2887–2891PubMedCrossRef
16.
17.
Nyman U, Björkdahl P, Olsson ML, Gunnarsson M, Goldman B (2012) Low-dose radiation with 80-kVp computed tomography to diagnose pulmonary embolism: a feasibility study. Acta Radiol 53:1004–1013PubMedCrossRef
18.
Pontana F, Pagniez J, Duhamel A et al (2013) Reduced-dose low-voltage chest CT angiography with sinogram-affirmed iterative reconstruction versus standard-dose filtered back projection. Radiology 267:609–618PubMedCrossRef
19.
Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M, Herold CJ, Prokop M (2006) CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 241:899–907PubMedCrossRef
20.
Sodickson A (2012) Strategies for reducing radiation exposure in multi-detector row CT. Radiol Clin N Am 50:1–14PubMedCrossRef
21.
Sodickson A, Weiss M (2012) Effects of patient size on radiation dose reduction and image quality in low-kVp CT pulmonary angiography performed with reduced IV contrast dose. Emerg Radiol 19:437–445PubMedCrossRef
22.
Szucs-Farkas Z, Kurmann L, Strautz T, Patak MA, Vock P, Schindera ST (2008) Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols. Invest Radiol 43:871–876PubMedCrossRef
23.
Szucs-Farkas Z, Schaller C, Bensler S, Patak MA, Vock P, Schindera ST (2009) Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort. Invest Radiol 44:793–799PubMedCrossRef
24.
Tacelli N, Remy-Jardin M, Flohr T et al (2010) Dual-source chest CT angiography with high temporal resolution and high pitch modes: evaluation of image quality in 140 patients. Eur Radiol 20:1188–1196PubMedCrossRef
25.
Viteri-Ramírez G, García-Lallana A, Simón-Yarza I et al (2012) Low radiation and low-contrast dose pulmonary CT angiography: Comparison of 80 kVp/60 ml and 100 kVp/80 ml protocols. Clin Radiol 67:833–839PubMedCrossRef
26.
Wu CC, Lee EW, Suh RD, Levine BS, Barack BM (2012) Pulmonary 64-MDCT angiography with 30 mL of IV contrast material: vascular enhancement and image quality. AJR Am J Roentgenol 199:1247–1251PubMedCrossRef
27.
Schuhbaeck A, Achenbach S, Layritz C et al (2013) Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction. Eur Radiol 23:597–606PubMedCrossRef
28.
Yang WJ, Yan FH, Liu B et al (2013) Can sinogram-affirmed iterative (SAFIRE) reconstruction improve imaging quality on low-dose lung CT screening compared with traditional filtered back projection. J Comput Assist Tomogr 37:301–305PubMedCrossRef
29.
Li Q, Yu H, Zhang L, Fan L, Liu SY (2013) Combining low tube voltage and iterative reconstruction for contrast-enhanced CT imaging of the chest-Initial clinical experience. Clin Radiol 68:e249–e253PubMedCrossRef
30.
Baumueller S, Winklehner A, Karlo C et al (2012) Low-dose CT of the lung: potential value of iterative reconstructions. Eur Radiol 22:2597–2606PubMedCrossRef
31.
Rodrigues JC, Mathias H, Negus IS, Manghat NE, Hamilton MC (2012) Intravenous contrast medium administration at 128 multidetector row CT pulmonary angiography: bolus tracking versus test bolus and the implications for diagnostic quality and effective dose. Clin Radiol 67:1053–1060PubMedCrossRef
Metadata
Title
High-pitch computed tomography pulmonary angiography with iterative reconstruction at 80 kVp and 20 mL contrast agent volume
Authors
Guang Ming Lu
Song Luo
Felix G. Meinel
Andrew D. McQuiston
Chang Sheng Zhou
Xiang Kong
Yan E. Zhao
Ling Zheng
U. Joseph Schoepf
Long Jiang Zhang
Publication date
01-12-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3365-9

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