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Mishra S, Mishra S, Regmi S, Gupta V. A comparative study of low voltage, low contrast cerebral computed tomography angiography with iterative reconstruction and conventional cerebral computed tomography angiography. Neuroradiol J 2024; 37:221-228. [PMID: 38148622 DOI: 10.1177/19714009231224412] [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: 12/28/2023] Open
Abstract
BACKGROUND Cerebral computed tomography angiography (CTA) has revolutionized the diagnosis of neurovascular emergencies. Strategies to reduce radiation, a concern for cancer, involve tube voltage and current reduction but with increased noise and inferior image quality. Hence, the objective of the study was to evaluate the quality of images obtained through low-dose radiation and low-contrast volume CTA with an iterative reconstruction (IR) technique versus standard CTA without IR. METHODS This prospective trial involved 100 adults requiring cerebral CTA for cerebrovascular diseases. They were split into two groups: one with 120 kVp tube voltage and 80 mL contrast using filtered back projection, and the other with 80 kVp and 30 mL contrast with IR. Evaluation criteria included attenuation values, signal-to-noise ratio, contrast-to-noise ratio, and subjective assessments. RESULTS Compared to 120 kVp, 80 kVp showed higher vessel attenuation in the internal (272.91 ± 30.59 vs 405.52 ± 53.08; p < .001) and middle cerebral artery (247.55 ± 29.84 vs 372.55 ± 49.02; p < .001) regions. Brain parenchymal attenuation at the centrum semiovale was lower with 80 kVp (29.12 ± 1.87 vs 24.78 ± 2.94; p < .001), accompanied by higher noise. Signal-to-noise ratio (p < .001) and contrast-to-noise ratio (p < .05) were lower at 80 kVp. Image quality didn't significantly differ, and radiation exposure reduced significantly by 70% in the 80 kVp group, suggesting its diagnostic feasibility. CONCLUSIONS The 80 kVp protocol for CTA of the cerebral vessels combined with lower contrast volume produces images with similar image quality with significant radiation effective dose and total iodine dose reduction. The 80 kVp protocol holds significant promise for replacing the standard 120 kVp protocol in cerebral CTA.
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Affiliation(s)
- Saurav Mishra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, India
- Department of Radiodiagnosis and Imaging, Vayodha Hospital, Nepal
| | - Sandeep Mishra
- Department of Neurosurgery and Neuro-intervention, Neo Multispecialty Hospital, India
| | - Sabina Regmi
- Department of Anesthesia and Intensive care, Neo Multispecialty Hospital, India
| | - Vivek Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, India
- Department of Neuro-interventional Radiology, Fortis Hospital, India
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Du B, Zhang W, Shao X, An J, Ma H, Zhao X, Xu L, An D, Tian Y, Dong Y, Niu H. "Triple-low" radiation dose bronchial artery CT angiography before bronchial artery embolisation: a feasibility study. Clin Radiol 2023; 78:e1017-e1022. [PMID: 37813755 DOI: 10.1016/j.crad.2023.09.005] [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: 03/28/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
AIM To explore the feasibility of a "triple-low" dose (low tube voltage, low tube current, and low contrast agent volume) bronchial artery computed tomography (CT) angiography (CTA) to replace routine dose bronchial artery CTA before bronchial artery embolisation (BAE). MATERIALS AND METHODS CTA was obtained from 60 patients with body mass index (BMI) < 30 kg/m2 using a 256 multi-section iCT system, and they were divided into two groups: (1) group A: 100 kVp, 100 mAs, 50 ml contrast medium (CM); (2) group B: 120 kVp, automatic tube current modulation (ACTM), 80 ml CM. CT attenuation of the thoracic aorta, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated, and subjective image quality scores and traceability scores assessed. The effective radiation dose was calculated. RESULTS The radiation dose was reduced by 79.7% in group A compared to group B (p<0.05). The CT attenuation of the thoracic aorta was increased by approximately 13% in group A compared to group B (p<0.05). Higher image noise, lower SNR, and CNR were obtained in group A compared to group B (all p<0.05). Both subjective image quality scores and traceability scores did not differ between groups A and B (both p>0.05). CONCLUSION It is feasible to use the "triple-low" dose CTA protocol for patients with a body mass index (BMI) < 30 kg/m2. The radiation dose was reduced by 79.7%, and the dose of contrast medium was reduced by 37.5% to ensure the diagnostic value.
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Affiliation(s)
- B Du
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - W Zhang
- Chengde Medical University, Anyuan Road, Chengde, 067000, Hebei, China
| | - X Shao
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - J An
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - H Ma
- Chengde Medical University, Anyuan Road, Chengde, 067000, Hebei, China
| | - X Zhao
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - L Xu
- Department of Radiology, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050011, Hebei, China
| | - D An
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - Y Tian
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - Y Dong
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China
| | - H Niu
- Department of Interventional Treatment, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, 066099, Hebei, China.
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Dieckmeyer M, Sollmann N, Kupfer K, Löffler MT, Paprottka KJ, Kirschke JS, Baum T. Computed Tomography of the Head : A Systematic Review on Acquisition and Reconstruction Techniques to Reduce Radiation Dose. Clin Neuroradiol 2023; 33:591-610. [PMID: 36862232 PMCID: PMC10449676 DOI: 10.1007/s00062-023-01271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023]
Abstract
In 1971, the first computed tomography (CT) scan was performed on a patient's brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.
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Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Karina Kupfer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Karolin J. Paprottka
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Jabas A, Abello Mercado MA, Altmann S, Ringel F, Booz C, Kronfeld A, Sanner AP, Brockmann MA, Othman AE. Single-Energy Metal Artifact Reduction (SEMAR) in Ultra-High-Resolution CT Angiography of Patients with Intracranial Implants. Diagnostics (Basel) 2023; 13:diagnostics13040620. [PMID: 36832109 PMCID: PMC9955916 DOI: 10.3390/diagnostics13040620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
PURPOSE To evaluate the effects of single-energy metal artifact reduction (SEMAR) on image quality of ultra-high-resolution CT-angiography (UHR-CTA) with intracranial implants after aneurysm treatment. METHODS Image quality of standard and SEMAR-reconstructed UHR-CT-angiography images of 54 patients who underwent coiling or clipping was retrospectively evaluated. Image noise (i.e., index for metal-artifact strength) was analyzed in close proximity to and more distally from the metal implant. Frequencies and intensities of metal artifacts were additionally measured and intensity-differences between both reconstructions were compared in different frequencies and distances. Qualitative analysis was performed by two radiologists using a four-point Likert-scale. All measured results from both quantitative and qualitative analysis were then compared between coils and clips. RESULTS Metal artifact index (MAI) and the intensity of coil-artifacts were significantly lower in SEMAR than in standard CTA in close vicinity to and more distally from the coil-package (p < 0.001, each). MAI and the intensity of clip-artifacts were significantly lower in close vicinity (p = 0.036; p < 0.001, respectively) and more distally from the clip (p = 0.007; p < 0.001, respectively). In patients with coils, SEMAR was significantly superior in all qualitative categories to standard images (p < 0.001), whereas in patients with clips, only artifacts were significantly less (p < 0.05) for SEMAR. CONCLUSION SEMAR significantly reduces metal artifacts in UHR-CT-angiography images with intracranial implants and improves image quality and diagnostic confidence. SEMAR effects were strongest in patients with coils, whereas the effects were minor in patients with titanium-clips due to the absent of or minimal artifacts.
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Affiliation(s)
- Abdullah Jabas
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | | | - Sebastian Altmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Andrea Kronfeld
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Antoine P. Sanner
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Computer Science, Technical University Darmstad, Fraunhofer IGD, Fraunhoferstraße 5, 64283 Darmstadt, Germany
| | - Marc A. Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ahmed E. Othman
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
- Correspondence: ; Tel.: +49-6131-177139
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Temporal averaging angiographic reconstructions from whole-brain CT perfusion for the detection of vasospasm. J Neuroradiol 2022; 50:333-340. [PMID: 36216294 DOI: 10.1016/j.neurad.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study is to evaluate the image quality and diagnostic performance of angiographic images reconstructed from whole-brain CT perfusion (CTP) using temporal averaging compared to CT angiography (CTA) for the detection of vasospasm. MATERIALS AND METHODS 39 CT studies in 28 consecutive patients who underwent brain CTA with CTP for suspected vasospasm between September 2020 and May 2021 were retrospectively evaluated. The image quality of these two vascular imaging techniques was assessed either quantitatively (image noise, vascular enhancement, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios,) and qualitatively (4 criteria assessed on a 5-point scale). Intra and interobserver agreements and a diagnostic confidence score on the diagnosis of vasospasm were measured. Radiation dose parameters (volume CT dose index (CTDIvol) and dose-length product (DLP)) were recorded. RESULTS Both SNR and CNR were significantly higher with temporal averaging compared to CTA, increasing by 104% and 113%, respectively (p<0.001). The qualitative assessment found no significant difference in overall image quality between temporal averaging (4.33 ± 0.48) and brain CTA (4.19 ± 0.52) (p = 0.12).There was a significant improvement in intravascular noise and arterial contrast enhancement with temporal averaging. The evaluation of intra and interobserver agreements showed a robust concordance in the diagnosis of vasospasm between the two techniques. CONCLUSIONS Temporal averaging appeared as a feasible and reliable imaging technique for the detection of vasospasm. The use of temporal averaging, replacing brain CTA, could represent a new strategy of radiation and contrast material doses reduction in these patients.
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Yang J, Wang J, Zhai D, Zhou X, Yan J, Liu R, Zhang B, Fan G, Cai W. Low-dose three-dimensional CT angiography for the evaluation of posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: a quantitative anatomical comparison study of the rotational and neutral positions. Clin Radiol 2022; 77:384-389. [PMID: 35177230 DOI: 10.1016/j.crad.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
Abstract
AIM To investigate the changes in relevant anatomical parameters of posterolateral protrusion of the vertebral artery (VA) between head-neck rotational and neutral positions using low-dose three-dimensional computed tomography angiography (3D-CTA). MATERIALS AND METHODS Low-dose 3D-CTA images obtained for various craniocervical diseases in 36 non-dominant VA side patients with neutral, left and right head-neck rotational positions were evaluated. The relevant parameters from superior and inferior views, including external diameter (ED), internal diameter (ID), transverse diameter (TD), heights and diameters of posterolateral protrusion of the VA over the posterior arch of the atlas in the neutral and rotational positions, were recorded and compared. RESULTS There was no significant differences in the rotational angle (left/right: 31.23 ± 6.60/29.94 ± 6.09°, p>0.05). There were no significant differences in heights and diameters of bilateral VA between rotational and neutral positions (all p>0.05). The contralateral ID, ED, and TD of the rotational positions were significantly shorter than those of the neutral position (all p<0.05), while there were no significant differences in the three ipsilateral diameters (all p>0.05). CONCLUSIONS Posterolateral protrusion of the VA is not uncommon in the population, and surgeons should be aware of its presence, especially the increased possibility of injury to the VA caused by head-neck rotation, during the operation; thus, preoperative evaluation by low-dose 3D-CTA should be considered.
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Affiliation(s)
- J Yang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - J Wang
- Department of Radiology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, 314000, China
| | - D Zhai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - X Zhou
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - J Yan
- Department of Spinal Surgery, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - R Liu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - B Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - G Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China
| | - W Cai
- Department of Radiology, The Second Affiliated Hospital of Soochow University, San Xiang Road No. 1055, Suzhou, Jiangsu, 215004, China; State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, Jiangsu, 215123, China.
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Wang Y, Chen Y, Liu P, Lv W, Wu J, Wei M, Shi D, Wu X, Liu W, Tao X, Hu H, Ma X, Yang X, Xue H, Jin Z. Clinical effectiveness of contrast medium injection protocols for 80-kV coronary and craniocervical CT angiography-a prospective multicenter observational study. Eur Radiol 2022; 32:3808-3818. [PMID: 35103828 DOI: 10.1007/s00330-021-08505-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Decreasing X-ray tube voltage is an effective way to reduce radiation and contrast dose, especially in non-obese patients. The current study focuses on CTA in non-obese patients to evaluate image quality and feasibility of 80-kV acquisition protocols with varying iodine delivery rates (IDR) and contrast concentrations in routine clinical practice. METHODS A prospective observational study in patients ≥ 18 years and ≤ 90 kg referred for coronary or craniocervical CTA at 10 centers in China (ClinicalTrials.gov: NCT02840903). Patients were divided into four groups: a standard 100-kV protocol (370 mgI/ml, IDR 1.48 gI/s), and three 80-kV protocols (370 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 0.96gI/s). The primary outcome was contrast opacification of target vascular segments. Secondary outcomes were image quality (contrast-to-noise ratio, signal-to-noise ratio, visual image quality, and diagnostic confidence assessment), radiation, and iodine dose. RESULTS From July 2016 to July 2017, 1213 patients were enrolled: 614 coronary and 599 craniocervical CTA. The mean contrast opacification was ≥ 300 HU for 80-kV 1.2 gI/s IDR scanned segments; IDR 0.96 gI/s led to lower opacification. Image quality and diagnostic confidence were fair to excellent (≥ 98% of images), despite lower contrast-to-noise ratios and signal-to-noise ratios in 80-kV images. Compared to the standard protocol, 80-kV protocols led to 44-52% radiation dose reductions (p < 0.001) and 19% iodine dose reductions (p < 0.001). CONCLUSION Eighty-kilovolt 1.2 gI/s IDR protocols can be recommended for coronary and craniocervical CTA in non-obese patients, reducing radiation and iodine dose without compromising image quality. KEY POINTS • Using low-voltage scanning CTA protocols, in which tube voltage and iodine delivery rate are reduced proportionally (voltage: 80 kV, IDR: 1.2 gI/s), reduces radiation and contrast dose without compromising image quality in routine clinical practice. • Reducing iodine delivery rate beyond direct proportionality to tube voltage is not beneficial.
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Affiliation(s)
- Yining Wang
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Yu Chen
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Peijun Liu
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Wan Lv
- The First People's Hospital of Yulin, # 495, JiaoYu Central Road, Yulin, 537000, Guangxi, China
| | - Jianlin Wu
- Affiliated Zhongshan Hospital of Dalian University, # 6, Jiefang Road Zhongshan District, Dalian, 116001, Liaoning, China
| | - Mengqi Wei
- The First Affiliated Hospital of Air Force Medical University, # 15 Changle West Road, Xian, 710032, Shanxi, China
| | - Dapeng Shi
- Henan Provincial People's Hospital, # 7, Weiwu Road, Zhengzhou, 450000, Henan, China
| | - Xianheng Wu
- The Second People's Hospital of Shantou, # 28, Waimalu Road, Shantou, 515031, Guangdong, China
| | - Wenya Liu
- The First Affiliated Hospital of Xinjiang Medical University, # 137, Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Xiaofeng Tao
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, # 639, Zaoju Road, Shanghai, 200011, China
| | - Hongjie Hu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun East Road, Hangzhou, 310016, Zhejiang, China
| | - Xiangxing Ma
- Qilu Hospital of Shandong University (Qingdao), North District, # 758, Hefei Road, Qingdao, 266035, Shandong, China
| | - Xiaozheng Yang
- Medical Affairs, Bayer Healthcare Co. Ltd, Dongshanhuan Central Road, Beijing, 100010, China
| | - Huadan Xue
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Zhengyu Jin
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China.
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High-strength deep learning image reconstruction in coronary CT angiography at 70-kVp tube voltage significantly improves image quality and reduces both radiation and contrast doses. Eur Radiol 2022; 32:2912-2920. [DOI: 10.1007/s00330-021-08424-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
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Yue W, Yang W, peng H, Zhong Feng N, Hong Jie H. Comparative study of the image quality of twin beam dual energy and single energy carotid CT angiography. Eur J Radiol 2022; 148:110160. [DOI: 10.1016/j.ejrad.2022.110160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/18/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
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Morisaka H, Matsuura K, Yamaguchi H, Ichikawa T, Onishi H. Effect of decreased contrast injection flow rate on aortic enhancement in 80-KV peak CT with contrast dose reduction. Acta Radiol 2021; 64:353-359. [PMID: 34923851 DOI: 10.1177/02841851211067144] [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 Effect of decreased injection flow rate of contrast agent at the same iodine dose and delivery rate on aortic enhancement has not been clearly elucidated. PURPOSE To evaluate the effect of decreased injection flow rate of contrast agent on aortic peak enhancement in a dynamic flow phantom and on aortic enhancement in clinical dynamic 80-kVp computed tomography (CT) with contrast dose reduction. MATERIAL AND METHODS In the dynamic flow phantom experiment, the effect of a decreased injection flow rate at the same total iodine dose and delivery rate on simulated aortic peak enhancement was evaluated. In the clinical retrospective study, we searched 312 patients with renal dysfunction who underwent an 80-kVp abdominal dynamic CT with 40% reduction of contrast agent from a standard 120-kVp protocol and measured the aortic enhancement at the level of the hepatic hilum. Independent predictors for aortic enhancement were determined by multiple linear regression analysis, and after adjustment of significant predictors, independent variables for acquiring optimal aortic enhancement, ≥300 HU, were determined by multiple logistic regression analysis. RESULTS In the phantom experiment, decreased flow rate showed a significant but small descent effect (6%-9%) on simulated aortic peak enhancement. In the multiple linear regression analysis, only age was an independent predictor of aortic enhancement; there was no independent predictor for optimal age-adjusted aortic enhancement of ≥300 HU. CONCLUSIONS Decreased injection flow rate had a small influence on aortic enhancement in vitro but had no significant effect on the aortic enhancement in clinical dynamic 80-kVp CT.
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Affiliation(s)
- Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
- Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Koichiro Matsuura
- Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Haruomi Yamaguchi
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomoaki Ichikawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
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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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Hamaguchi N, Fujima N, Hamaguchi A, Kodera S. Improved Depictions of the Anterior Choroidal Artery and Thalamoperforating Arteries on 3D-CTA Images Using Model-based Iterative Reconstruction. Acad Radiol 2021; 28:e14-e19. [PMID: 32037258 DOI: 10.1016/j.acra.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the depictability of intracranial small arteries using high-resolution CTA with model-based iterative reconstruction (MBIR). MATERIALS AND METHODS We retrospectively analyzed 21 patients who underwent brain 3D-CTA. Axial and volume-rendered (VR) images were reconstructed from the 3D-CTA raw data using adaptive statistical image reconstruction (ASIR) and MBIR. As a quantitative assessment, intra-arterial CT values of the ICA and contrast-to-noise ratio were measured to evaluate vessel enhancement. Additionally, CT values and standard deviations (SDs) of CT values and signal to noise ratio in white matter parenchyma were measured to evaluate background noise. As a qualitative assessment, the degree of vessel depictability in the anterior choroidal artery (AchoA) and the perforating branches of thalamoperforating arteries (TPA) on VR images using two different reconstruction algorithms was visually evaluated using a 3-point grading system. RESULTS The CT value of the ICA [605.27± 89.76 Hounsfield units (HU)] was significantly increased and the SD value (i.e., image noise) of the white matter parenchyma [6.79 ± 0.81(HU)] was decreased on MBIR compared with ASIR [546.76 ± 85.27 (HU)] and [8.04 ± 1.08 HU)] (p <.05 for all). Contrast-to-noise ratio of ICA [84.48 ± 20.17] and signal to noise ratio of white matter [6.18 ± 0.75] with MBIR were significantly higher than ASIR [65.98 ± 13.08] and [5.28 ± 0.78] (p < 0.05 for all). In addition, depictions of the AchoA and TPA on VR images were significantly improved using MBIR compared with ASIR (p < 0.05). CONCLUSION MBIR allows depiction of small intracranial arteries such as AchoA and TPA with better visibility than ASIR without increasing the dose of radiation and the amount of contrast agent.
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Bathla G, Priya S, Samaniego E, Deo SK, Fain NH, Soni N, Ward C, Derdeyn CP. Cerebral computed tomographic angiography using third-generation reconstruction algorithm provides improved image quality with lower contrast and radiation dose. Neuroradiology 2020; 62:965-970. [PMID: 32277245 DOI: 10.1007/s00234-020-02406-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/13/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE We hypothesized that cerebral CT angiogram performed using third-generation reconstruction algorithm and lower contrast dose-low-kVp technique (LD-CTA) will provide better image quality when compared with regular contrast dose CTA at 120 kVp using a sinogram-affirmed iterative reconstruction algorithm (ND-CTA). METHODS Retrospective imaging review of 100 consecutive patients (50 each in LD- and ND-CTA groups). Two readers independently assessed the subjective image quality across multiple vascular segments on a Likert-like scale. Differences in contrast dose, CT dose index (CTDI), and dose length product (DLP) were compared using Mann-Whitney U test. Fisher's exact test was used to compare subjective image quality. Similarly, contrast- and signal-to-noise ratios (CNR and SNR) were compared in the mid-M1 MCA vessels bilaterally and the mid-basilar artery using Mann-Whitney U test. Interclass correlation coefficient (ICC) was calculated for the SNR/CNR values. RESULTS Both observers showed excellent correlation in subjective image quality (mean percentage agreement of 95.2% for group 1 versus 89.2% for group 2). LD-CTA group showed better SNR and CNR (p < 0.0001) for both MCA vessels and the mid-basilar artery. Interclass correlation coefficient showed moderate correlation (0.51-0.63) between readers. LD-CTA group also used lower contrast (49 cc versus 97 cc in ND-CTA) and had lower radiation exposure (DLP/CTDI for both groups 268.3/80.7 vs 519.5/36.08, both < 0.0001). CONCLUSION Next-generation reconstruction algorithm and low-kV scanning significantly improved image quality on cerebral CTA images despite lower contrast dose and, in addition, have lower radiation exposure.
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Affiliation(s)
- Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Sarv Priya
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Edgar Samaniego
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Simmi K Deo
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nicholas H Fain
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Neetu Soni
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Caitlin Ward
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Zhang F, Yang L, Gan L, Fan Z, Zhou B, Deng Z, Dey D, Berman DS, Li D, Xie Y. Spotty Calcium on Cervicocerebral Computed Tomography Angiography Associates With Increased Risk of Ischemic Stroke. Stroke 2020; 50:859-866. [PMID: 30879439 DOI: 10.1161/strokeaha.118.023273] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cervicocerebral vascular calcification on computed tomography angiography is a known sign of advanced atherosclerosis. However, the clinical significance of calcification pattern remains unclear. In this study, we aimed to investigate the potential association between spotty calcium and acute ischemic stroke. Methods- This study included patients with first-time nonlacunar ischemic stroke (N=50) confirmed by brain magnetic resonance imaging or nonenhanced head computed tomography, as well as control subjects with asymptomatic carotid atherosclerosis (N=50) confirmed by carotid ultrasonography. Subjects in both groups underwent contrast-enhanced cervicocerebral computed tomography angiography within a week after the initial imaging examination. Spotty calcification was evaluated at 11 arterial segments commonly affected by atherosclerosis along the carotid and vertebrobasilar circulation. Statistical analysis was performed comparing the frequency and spatial pattern of spotty calcification between the 2 groups. Results- Spotty calcification in the Stroke group was markedly more prevalent than that in the Control group (total SC count: 8.74±4.96 versus 1.84±1.82, P<0.001). The odds ratio (95% CI) for stroke was 2.49 (1.55-4.00) for spotty calcification at bilateral carotid bifurcation, 1.52 (1.13-2.04) at carotid siphon, and 1.98 (1.45-2.69) at all evaluated locations. A total number of 3 spotty calcifications were determined as the optimal cutoff threshold for increased risk of stroke. Spotty calcium showed significantly greater area under the receiver operating characteristics curve than total calcium volume irrespective of size (0.88 versus 0.77). Within the Stroke group, ipsilateral lateral side showed significantly more spotty calcium than the contralateral side (5.18±3.05 versus 3.56±2.67, P<0.001). Conclusions- Nonlacunar ischemia stroke was associated with markedly increased incidence of spotty calcification with a distinct spatial pattern on cervicocerebral computed tomography compared with subclinical atherosclerosis, suggesting the potential role of spotty calcification for improving the risk stratification for ischemic stroke.
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Affiliation(s)
- Fan Zhang
- From the Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, China (F.Z.).,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Li Yang
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China (L.Y.)
| | - Lu Gan
- Department of Radiology, Tiantan Hospital, Capital Medical University, Beijing, China (L.G.)
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles.,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Bill Zhou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Zixin Deng
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles.,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
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Harvey EC, Feng M, Ji X, Zhang R, Li Y, Chen GH, Li K. Impacts of photon counting CT to maximum intensity projection (MIP) images of cerebral CT angiography: theoretical and experimental studies. Phys Med Biol 2019; 64:185015. [PMID: 31315093 DOI: 10.1088/1361-6560/ab32fe] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While CTA is an established clinical gold standard for imaging large cerebral arteries and veins, an important challenge that currently remains for CTA is its limited performance in imaging small perforating arteries with diameters below 0.5 mm. The purpose of this work was to theoretically and experimentally study the potential benefits of using photon counting detector (PCD)-based CT (PCCT) to improve the performance of CTA in imaging these small arteries. In particular, the study focused on an important component of the CTA image package known as the maximum intensity projection (MIP) image. To help understand how the physical properties of a detector quantitatively influence the MIP image quality, a theoretical model on the statistical properties of MIP images was developed. After validating this model, it was used to explore the individual and joint contribution of the following detector properties to the MIP signal-to-noise ratio (SNR): inter-slice noise covariance, spatial resolution along the z direction, and native pixel pitch along z. The model demonstrated that superior slice sensitivity, reduced inter-slice noise correlation, and smaller native pixel pitch along z provided by PCDs lead to improved vessel SNR in MIP images. Finally, experiments were performed by scanning an anthropomorphic cerebral angiographic phantom using a benchtop PCCT system and a commercial MDCT system. The experimental MIP results consistently demonstrated that compared with MDCT, PCCT provides superior vessel conspicuity and reduced artifactual stenosis.
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Affiliation(s)
- Evan Cary Harvey
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America
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Tube Current Reduction in CT Angiography: How Low Can We Go in Imaging of Patients With Suspected Acute Stroke? AJR Am J Roentgenol 2019; 213:410-416. [DOI: 10.2214/ajr.18.20954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Application of Monochromatic Imaging and Metal Artifact Reduction Software in Computed Tomography Angiography after Treatment of Cerebral Aneurysms. J Comput Assist Tomogr 2019; 43:948-952. [DOI: 10.1097/rct.0000000000000923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Cheng B, Xing H, Lei D, Guo Y, Ning G, Gong Q, Cai W. Impact of iterative model reconstruction combined with dose reduction on the image quality of head and neck CTA in children. Sci Rep 2018; 8:12613. [PMID: 30135541 PMCID: PMC6105670 DOI: 10.1038/s41598-018-30300-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/26/2018] [Indexed: 02/05/2023] Open
Abstract
This study aimed to evaluate the imaging quality of head and neck computed tomographic angiography (CTA) in pediatric patients at a lowered radiation dose by combining an iterative model reconstruction (IMR) with low voltage scanning. Eighty-three pediatric patients were randomized into two groups as follows: Group A (n = 42), 100 kV/50 ml contrast media (CM), using filtered back projection (FBP); and Group B (n = 41), 80 kV/30 ml CM, using IMR. The enhanced CT value of the arteries, the image noise, the signal-to-noise ratio (SNR)/contrast-to-noise ratio (CNR), the image quality, the effective radiation dose (ED) and the iodine intake were compared between the two groups. The mean ED and iodine intake of group B were reduced by 69.8% and 40.0%, respectively, compared to those of group A. The mean CT values of the arteries in group B were higher than those in group A (p < 0.01), whereas the image noise of group B was lower than that of group A (p < 0.01). Group B exhibited a better image quality and a higher mean CNR/SNR than that of group A (p < 0.01). Compared to FBP, IMR in head and neck CTA enables a significant reduction in the radiation dose while preserving the diagnostic image quality. Thus, IMR, combined with low tube voltage scanning, provided an excellent solution for improving the image quality of craniocervical vessels in children.
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Affiliation(s)
- Bochao Cheng
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Haoyang Xing
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- College of Physical Science and Technology, Sichuan University, Chengdu, China
| | - Du Lei
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Gang Ning
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wu Cai
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China.
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Wang X, Zhu C, Li J, Degnan AJ, Jiang T, Lu J. Knowledge-based iterative model reconstruction: Comparative image quality with low tube voltage cerebral CT angiography. Medicine (Baltimore) 2018; 97:e11514. [PMID: 30045274 PMCID: PMC6078758 DOI: 10.1097/md.0000000000011514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to compare image quality of low tube voltage cerebral computed tomography angiography (CTA) reconstructed with knowledge-based iterative model reconstruction (IMR), filtered back projection (FBP), and hybrid iterative reconstruction (HIR).A total of 101 patients with suspected cerebrovascular diseases were enrolled and randomized into 2 groups, 100 kVp tube voltage (n = 53) and reduced tube voltage (80 kVp) (n = 48). Computed tomography data were reconstructed with IMR, FBP, and HIR algorithms. The image noise, vascular attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured and calculated. Two blinded radiologists independently evaluated image quality based on diagnostic confidence on a 3-point scale. Quantitative and qualitative assessments were compared between different groups and reconstruction subgroups.Vascular attenuation was higher in the reduced tube voltage group than in 100-kVp tube voltage group, but showed no significant difference within each group. In both groups, the image noise, vascular SNR, and CNR were significantly improved by IMR as compared with FBP and HIR. Inter-group comparison indicated that IMR with reduced tube voltage showed better image quality with lower image noise and higher vascular SNR and CNR than FBP and HIR at 100 kVp, but slightly inferior to IMR at 100 kVp. IMR also yields the best qualitative image quality, and improves the diagnostic confidence of atherosclerosis and aneurysm. Compared with the standard 120-kVp protocol (1.86mSv), the radiation doses of 100 kVp (1.13mSv) and 80 kVp (0.56mSv) were 39% and 70% less, respectively.The quantitative and qualitative image quality obtained by IMR was superior to that obtained by FBP and HIR for low tube voltage cerebral CTA.
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Affiliation(s)
- Xinrui Wang
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chengcheng Zhu
- From the Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA
| | - Jing Li
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Andrew J. Degnan
- From the Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Tao Jiang
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianping Lu
- From the Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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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: 0.8] [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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Hajdu SD, Daniel RT, Meuli RA, Zerlauth JB, Dunet V. Impact of model-based iterative reconstruction (MBIR) on image quality in cerebral CT angiography before and after intracranial aneurysm treatment. Eur J Radiol 2018; 102:109-114. [PMID: 29685523 DOI: 10.1016/j.ejrad.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To subjectively and objectively assess the impact of model-based iterative reconstruction(MBIR) on image quality in cerebral computed tomography angiography compared to adaptive statistical iterative reconstruction (ASIR). METHODS 107 patients (mean age: 58 ± 14 years) were included prior to (n = 38) and after (n = 69) intracranial aneurysm treatment. Images were acquired using a routine protocol and reconstructed with MBIR and ASIR. Image noise, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios in the internal carotid and middle cerebral arteries were compared between MBIR and ASIR using the Wilcoxon signed-rank test. Additionally, two neuroradiologists subjectively assessed noise, artefacts, vessel sharpness and overall quality using a semi-quantitative assessment scale. RESULTS Objective assessment revealed that MBIR reduced noise (p < 0.0001) and additionally improved SNR (p < 0.0001) and CNR (p < 0.0001) compared to ASIR in untreated and treated patients. Subjective assessment revealed that in untreated patients, MBIR improved noise reduction, artefacts, vessel sharpness and overall quality relative to ASIR (p < 0.0001). In the treated groups, noise and vessel sharpness were improved (p < 0.0001) with no change in artefacts on images reconstructed with MBIR compared to ASIR. CONCLUSION MBIR significantly improves noise, SNR, CNR and vessel sharpness in untreated and treated patients with intracranial aneurysms. MBIR does not reduce artefacts generated by metallic devices following intracranial aneurysm treatment.
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Affiliation(s)
- Steven David Hajdu
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
| | - Roy Thomas Daniel
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Antoine Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Baptiste Zerlauth
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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Cai W, Hu C, Hu S, Wang X, Gong J, Zhang W, Shi D, Cheng B. Feasibility study of iterative model reconstruction combined with low tube voltage, low iodine load, and low iodine delivery rate in craniocervical CT angiography. Clin Radiol 2017; 73:217.e1-217.e6. [PMID: 29066028 DOI: 10.1016/j.crad.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/18/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
Abstract
AIM To investigate the feasibility of iterative model reconstruction (IMR) combined with low tube voltage, low iodine load, and low iodine deliver rate in craniocervical computed tomography angiography (CTA). MATERIALS AND METHODS Sixty patients were randomly divided into two groups (n=30 for each): group A: 120 kVp, 50 ml of iopromide at a flow rate of 5 ml/s; filtered back projection (FBP) reconstruction; group B: 80 kVp, 30 ml of iohexol at 4.5 ml/s; hybrid iterative reconstruction (HIR) for group B1 and IMR for group B2. CT attenuation values, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective image quality, effective dose (ED), iodine load, and iodine delivery rate (IDR) were compared. RESULTS CT attenuation values of the arteries were higher in groups B1 and B2 than group A. The SNR and CNR were higher, while image noise was lower, for group B2 compared with groups B1 and A. The best subjective image quality was obtained with group B2. ED, iodine load, and IDR reduction of 69.6%, 51.4%, 27%, respectively, was obtained in group B compared with group A. CONCLUSION IMR combined with 80 kVp and 30 ml of iohexol at a flow rate of 4.5 ml/s for craniocervical CTA can reduce ED, iodine load, and IDR, while improving image quality.
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Affiliation(s)
- W Cai
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - C Hu
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - S Hu
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - X Wang
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - J Gong
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - W Zhang
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - D Shi
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - B Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
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Chen Y, Zhang X, Xue H, Zhu Y, Wang Y, Li Y, Zhang Z, Jin Z. Head and neck angiography at 70 kVp with a third-generation dual-source CT system in patients: comparison with 100 kVp. Neuroradiology 2017; 59:1071-1081. [DOI: 10.1007/s00234-017-1901-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/01/2017] [Indexed: 11/30/2022]
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Scan time adapted contrast agent injection protocols with low volume for low-tube voltage CT angiography: An in vitro study. Eur J Radiol 2017; 93:65-69. [DOI: 10.1016/j.ejrad.2017.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022]
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Dunet V, Bernasconi M, Hajdu SD, Meuli RA, Daniel RT, Zerlauth JB. Impact of metal artifact reduction software on image quality of gemstone spectral imaging dual-energy cerebral CT angiography after intracranial aneurysm clipping. Neuroradiology 2017; 59:845-852. [DOI: 10.1007/s00234-017-1871-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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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: 6.0] [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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Chen GZ, Fang XK, Zhou CS, Zhang LJ, Lu GM. Cerebral CT angiography with iterative reconstruction at 70 kVp and 30 mL iodinated contrast agent: Initial experience. Eur J Radiol 2017; 88:102-108. [DOI: 10.1016/j.ejrad.2016.12.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/10/2016] [Accepted: 12/30/2016] [Indexed: 01/07/2023]
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Nagayama Y, Nakaura T, Tsuji A, Urata J, Furusawa M, Yuki H, Hirarta K, Oda S, Kidoh M, Utsunomiya D, Yamashita Y. Cerebral bone subtraction CT angiography using 80 kVp and sinogram-affirmed iterative reconstruction: contrast medium and radiation dose reduction with improvement of image quality. Neuroradiology 2017; 59:127-134. [DOI: 10.1007/s00234-016-1776-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
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Shirasaka T, Hiwatashi A, Yamashita K, Kondo M, Hamasaki H, Shimomiya Y, Nakamura Y, Funama Y, Honda H. Optimal scan timing for artery-vein separation at whole-brain CT angiography using a 320-row MDCT volume scanner. Br J Radiol 2016; 90:20160634. [PMID: 27995807 DOI: 10.1259/bjr.20160634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A 320-row multidetector CT (MDCT) is expected for a good artery-vein separation in terms of temporal resolution. However, a shortened scan duration may lead to insufficient vascular enhancement. We assessed the optimal scan timing for the artery-vein separation at whole-brain CT angiography (CTA) when bolus tracking was used at 320-row MDCT. METHODS We analyzed 60 patients, who underwent whole-brain four-dimensional CTA. Difference in CT attenuation between the internal carotid artery (ICA) and the superior sagittal sinus (Datt) was calculated in each phase. Using a visual evaluation score for the depiction of arteries and veins, we calculated the difference between the mean score for the intracranial arteries and the mean score for the veins (Dscore). We assessed the time at which the maximum Datt and Dscore were simultaneously observed. RESULTS The maximum Datt was observed at 6.0 s and 8.0 s in the arterial-dominant phase and at 16.0 s and 18.0 s in the venous-dominant phase after the contrast media arrival time at the ICA (Taa). The maximum Dscore was observed at 6.0 s and 8.0 s in the arterial-dominant phase and at 16.0 s in the venous-dominant phase after the Taa. There were no statistically significant differences in Datt (p = 0.375) or Dscore (p = 0.139) between these scan timings. CONCLUSION The optimal scan timing for artery-vein separation at whole-brain CTA was 6.0 s or 8.0 s for the arteries and 16.0 s for the veins after the Taa. Advances in knowledge: Optimal scan timing allowed us to visualize intracranial arteries or veins with minimal superimposition.
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Affiliation(s)
- Takashi Shirasaka
- 1 Department of Medical Technology, Division of Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Akio Hiwatashi
- 2 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yamashita
- 2 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Kondo
- 1 Department of Medical Technology, Division of Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Hamasaki
- 1 Department of Medical Technology, Division of Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Yamato Shimomiya
- 1 Department of Medical Technology, Division of Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Yasuhiko Nakamura
- 1 Department of Medical Technology, Division of Radiology, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshinori Funama
- 3 Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Honda
- 2 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Ni QQ, Chen GZ, Schoepf UJ, Klitsie MAJ, De Cecco CN, Zhou CS, Luo S, Lu GM, Zhang LJ. Cerebral CTA with Low Tube Voltage and Low Contrast Material Volume for Detection of Intracranial Aneurysms. AJNR Am J Neuroradiol 2016; 37:1774-1780. [PMID: 27151751 DOI: 10.3174/ajnr.a4803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/06/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Multidetector row CTA has become the primary imaging technique for detecting intracranial aneurysms. Technical progress enables the use of cerebral CTA with lower radiation doses and contrast media. We evaluated the diagnostic accuracy of 80-kV(peak) cerebral CTA with 30 mL of contrast agent for detecting intracranial aneurysms. MATERIALS AND METHODS Two hundred four patients were randomly divided into 2 groups. Patients in group A (n = 102) underwent 80-kVp CTA with 30 mL of contrast agent, while patients in group B (n = 102) underwent conventional CTA (120 kVp, 60 mL of contrast agent). All patients underwent DSA. Image quality, diagnostic accuracy, and radiation dose between the 2 groups were compared. RESULTS Diagnostic image quality was obtained in 100 and 99 patients in groups A and B, respectively (P = .65). With DSA as reference standard, diagnostic accuracy on a per-aneurysm basis was 89.9% for group A and 93.9% for group B. For evaluating smaller aneurysms (<3 mm), the diagnostic accuracy of groups A and B was 86.3% and 90.8%, respectively. There was no difference in diagnostic accuracy between each CTA group and DSA (all, P > .05) or between the 2 CTA groups (all, P > .05). The effective dose in group A was reduced by 72.7% compared with group B. CONCLUSIONS In detecting intracranial aneurysms with substantial radiation dose and contrast agent reduction, 80-kVp/30-mL contrast CTA provides the same diagnostic accuracy as conventional CTA.
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Affiliation(s)
- Q Q Ni
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - G Z Chen
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - U J Schoepf
- Department of Radiology and Radiological Science (U.J.S., M.A.J.K., C.N.D.C.), Medical University of South Carolina, Charleston, South Carolina
| | - M A J Klitsie
- Department of Radiology and Radiological Science (U.J.S., M.A.J.K., C.N.D.C.), Medical University of South Carolina, Charleston, South Carolina
| | - C N De Cecco
- Department of Radiology and Radiological Science (U.J.S., M.A.J.K., C.N.D.C.), Medical University of South Carolina, Charleston, South Carolina
| | - C S Zhou
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - S Luo
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - G M Lu
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - L J Zhang
- From the Department of Medical Imaging (Q.Q.N., G.Z.C., C.S.Z., S.L., G.M.L., L.J.Z.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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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: 2.0] [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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Kayan M, Demirtas H, Türker Y, Kayan F, Çetinkaya G, Kara M, Orhan Çelik A, Umul A, Yılmaz Ö, Recep Aktaş A. Carotid and cerebral CT angiography using low volume of iodinated contrast material and low tube voltage. Diagn Interv Imaging 2016; 97:1173-1179. [PMID: 27421672 DOI: 10.1016/j.diii.2016.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/12/2016] [Accepted: 06/14/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate image quality of carotid computed tomography angiography (CTA) using a low voltage (80kV) and low amount of iodinated contrast material. MATERIALS-METHODS A total of 101 patients referred for carotid CTA were randomly assigned to receive a specific protocol. In group A patients received intravenous administration of contrast material at a dose of 1mL/kg and CTA examinations were performed at 100kV. In group B, patients received intravenous administration of contrast material at a dose of 0.5mL/kg and CTA examinations were performed at 80kV. The same nonionic iodinated contrast material containing 370mg of iodine per mL was used in both groups. Attenuation values were measured from the center of specific arterial segments using regions of interest. Attenuation values above 300HU were accepted as significant. Institutional review board approval was obtained. RESULTS A total of 50 patients were included in group A (38 men, 12 women; mean age, 63.56 years±13.18 [SD]) and 51 patients in group B (33 men, 18 women; mean age, 59.60 years±16.63 [SD]). A total of 1615 arterial segments (1515 common carotid artery-middle cerebral artery and 101 aortic arches) were analyzed. Venous contamination was not observed in either group. The mean attenuation values of all arterial segments in both groups were greater than 300HU. Mean arterial attenuation value in group B (499.22HU±97.25 [SD]) was significantly greater than in group A (374.36HU±73.79 [SD]) (P<0.01). Hemodynamically significant stenosis (grade III stenosis or >70%) was detected in 2 segments in group A and in 3 segments in group B, while grade IV stenosis (occlusion) was detected in 2 segments in group B. Distal common carotid artery dissection was detected in 1 patient and aortic dissection was detected in 1 patient in group B. Total dose-length product (DLP) value was significantly greater in group A (225.74mGy·cm±21.80 [SD]) than in group B (116.60mGy·cm±21.22 [SD]) (P<0.01). The mean tube current was similar in group A (2013.11mAs±195.92 [SD]) and in group B (2096.64 mAs±309.03 [SD]) (P<0.05). CONCLUSION Carotid and cerebral CTA examinations using 128-section CT can be successfully obtained using an imaging protocol that combines low voltage and 50% reduction in the volume of iodinated contrast material. This provides good image quality with low radiation dose.
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Affiliation(s)
- M Kayan
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - H Demirtas
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - Y Türker
- Department of Cardiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - F Kayan
- Clinic of Chest Diseases, Isparta State Hospital, Isparta, Turkey.
| | - G Çetinkaya
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - M Kara
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - A Orhan Çelik
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - A Umul
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - Ö Yılmaz
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
| | - A Recep Aktaş
- Department of Radiology, Faculty of Medicine, Süleyman Demirel University, 32260 Isparta, Turkey.
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Image quality, radiation dose and diagnostic accuracy of 70 kVp whole brain volumetric CT perfusion imaging: a preliminary study. Eur Radiol 2016; 26:4184-4193. [DOI: 10.1007/s00330-016-4225-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/02/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
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Non–Electrocardiogram-Triggered 70-kVp High-Pitch Computed Tomography Angiography of the Whole Aorta With Iterative Reconstruction. J Comput Assist Tomogr 2016; 40:109-17. [DOI: 10.1097/rct.0000000000000329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tao SM, Wichmann JL, Schoepf UJ, Fuller SR, Lu GM, Zhang LJ. Contrast-induced nephropathy in CT: incidence, risk factors and strategies for prevention. Eur Radiol 2015; 26:3310-8. [PMID: 26685852 DOI: 10.1007/s00330-015-4155-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 11/28/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED In the past, a high percentage of hospital-acquired renal failure was attributed to contrast media. That position is now very controversial. Recently, doubts have been raised regarding the real relationship between acute kidney injury and intravenous contrast media administration. Similarly, statements about specific methods of preventing contrast-inducing nephropathy have been challenged. This review article addresses the controversies of incidence, causation, and prevention in an attempt to help the practicing radiologist adopt methods for their own department. KEY POINTS • The reported CIN incidence ranges from 2-12 % following contrast-enhanced CT. • Studies without a non-contrast CT control group may overestimate CIN incidence. • Development and application of a comprehensive CIN prevention strategy is recommended.
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Affiliation(s)
- Shu Min Tao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Stephen R Fuller
- Division of Cardiovascular Imaging, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29425, USA
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
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Yang B, Gao Y, Yang YY, Zhao W. Influence of selective photon shield combined with sinogram-affirmed iterative reconstruction on image quality and radiation dose during dual-energy CT angiography-mediated diagnosis of intracranial aneurysms. Int J Neurosci 2015; 126:1084-91. [DOI: 10.3109/00207454.2015.1121389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Comparison of Imaging Selection Criteria for Intra-Arterial Thrombectomy in Acute Ischemic Stroke with Advanced CT. Eur Radiol 2015; 26:2974-81. [DOI: 10.1007/s00330-015-4141-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/30/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
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Wojak JC, Abruzzo TA, Bello JA, Blackham KA, Hirsch JA, Jayaraman MV, Dariushnia SR, Meyers PM, Midia M, Russell EJ, Walker TG, Nikolic B. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2015; 26:1596-608. [DOI: 10.1016/j.jvir.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022] Open
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Seventy-Peak Kilovoltage High-Pitch Thoracic Aortic CT Angiography without ECG Gating: Evaluation of Image Quality and Radiation Dose. Acad Radiol 2015; 22:890-7. [PMID: 25872860 DOI: 10.1016/j.acra.2015.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the feasibility of 70-kVp high-pitch non-ECG-gated thoracic aortic computed tomography angiography (CTA) with 40-mL contrast agent compared to 100-kVp standard-pitch CTA with 60-mL contrast agent. MATERIALS AND METHODS Sixty-seven patients (51 men and 16 women; mean age, 55 ± 14 years) received non-ECG-gated aortic CTA at 70 kVp, high pitch of 3.4, and 40-mL contrast agent (group A, n = 31) or CTA at 100-kVp, pitch of 1.2, and 60-mL contrast agent (group B, n = 36). Iterative reconstruction was used in all patients. For image quality assessment, CTA images were evaluated on a three-point scale and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated and compared. Furthermore, computed tomography (CT) dose index was recorded. RESULTS Mean CT values and noise levels were higher in group A compared to group B (all P < .001), whereas SNR and CNR were lower than those in group B (all P < .001). Furthermore, the image quality of the aorta at the level of the diaphragm was lower in group A than that in group B (P < .05). However, image quality was graded as diagnostic in all patients, and motion artifacts of the aortic arch were significantly decreased in group A (P <.05). Interreader agreement was good or excellent for image quality assessment (k = 0.625-0.835). The 70-kVp CTA protocol, which allows dose reduction of 85%, was considered diagnostic in all instances by two readers. CONCLUSIONS Our proposed thoracic aortic CTA protocol provides diagnostic information with substantial reduction of both radiation and contrast agent doses compared to standard-pitch CTA at 100 kVp.
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Chen GZ, Zhang LJ, Schoepf UJ, Wichmann JL, Milliken CM, Zhou CS, Qi L, Luo S, Lu GM. Radiation dose and image quality of 70 kVp cerebral CT angiography with optimized sinogram-affirmed iterative reconstruction: comparison with 120 kVp cerebral CT angiography. Eur Radiol 2015; 25:1453-63. [PMID: 25636415 DOI: 10.1007/s00330-014-3533-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/15/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate radiation dose, image quality, and optimal level of sinogram-affirmed iterative reconstruction (SAFIRE) of cerebral CT angiography (CTA) at 70 kVp. METHODS One hundred patients were prospectively classified into two groups: Group A (n = 50), 70 kVp cerebral CTA with 5 levels of SAFIRE reconstruction (S1-S5); and Group B (n = 50), 120 kVp with filtered back projection (FBP) reconstruction. CT attenuation values, noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the internal carotid artery (ICA) and middle cerebral artery (MCA) were measured. Subjective image quality was evaluated. Effective dose (ED) was estimated. RESULTS CT attenuation and noise of the ICA and MCA in Group A were higher than those of Group B (all P < 0.001) while the SNRICA, SNRMCA, CNRICA, and CNRMCA of Group A at S4-5 were comparable to (P > 0.05) or higher than in Group B (P < 0.05). There was no difference in overall image quality between Group A S3-5 and Group B (P > 0.05). ED was 0.2 ± 0.0 mSv for Group A with 85 % ED reduction in comparison to Group B (1.3 ± 0.2 mSv). CONCLUSION Cerebral CTA at 70 kVp is feasible, allowing for substantial radiation dose reduction. SAFIRE S4 level is recommended for obtaining optimal image quality. KEY POINTS • 70 kVp cerebral CTA is feasible and provides diagnostic image quality. • 70 kVp cerebral CTA resulted in 85% effective dose reduction. • S4 level of SAFIRE is recommended for 70 kVp cerebral CTA.
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Affiliation(s)
- Guo Zhong Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
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Yin WH, Lu B, Gao JB, Li PL, Sun K, Wu ZF, Yang WJ, Zhang XQ, Zheng MW, McQuiston AD, Meinel FG, Schoepf UJ. Effect of reduced x-ray tube voltage, low iodine concentration contrast medium, and sinogram-affirmed iterative reconstruction on image quality and radiation dose at coronary CT angiography: results of the prospective multicenter REALISE trial. J Cardiovasc Comput Tomogr 2015; 9:215-24. [PMID: 25843243 DOI: 10.1016/j.jcct.2015.01.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/02/2015] [Accepted: 01/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both low tube voltage and sinogram-affirmed iterative reconstruction (IR) techniques hold promise to decrease radiation dose at coronary CT angiography (CCTA). The increased iodine contrast at low tube voltage allows for minimizing iodine load. OBJECTIVE To assess the effect of reduced x-ray tube voltage, low iodine concentration contrast medium and IR on image quality and radiation dose at CCTA. METHODS Two hundred thirty-one consecutive patients with suspected coronary artery disease were enrolled in this prospective, multicenter trial and randomized to 1 of 2 dual-source CCTA protocols: 120-kVp with 370 mgI/mL iopromide or iopamidol (n = 116; 44 women; 55.3 ± 9.8 years) or 100 kVp with 270 mgI/mL iodixanol (n = 115; 48 women; 54.2 ± 10.4 years). Reconstruction was performed with filtered back projection and IR. Attenuation, image noise, signal-to-noise ratio, and contrast-to-noise ratio were measured and image quality scored. Size-specific dose estimates and effective doses were calculated. RESULTS There were no significant differences in mean arterial attenuation (406.6 ± 76.7 vs 409.7 ± 65.2 Hounsfield units; P = .739), image noise (18.7 ± 3.8 vs 17.9 ± 3.4 Hounsfield units; P = .138), signal-to-noise ratio (22.5 ± 5.4 vs 23.7 ± 6.1; P = .126), contrast-to-noise ratio (17.5 ± 5.5 vs 18.3 ± 6.1; P = .286), or image quality scores (4.1 ± 0.9 vs 4.0 ± 0.9; P > .05) between 120-kVp filtered back projection-reconstructed and 100-kVp IR-reconstructed series. Mean iodine dose was 26.5% lower (18.3 ± 0.5 vs 24.9 ± 0.9 g; P < .0001), mean size-specific dose estimate was 35.1% lower (17.9 ± 6.6 vs 27.5 ± 8.2 mGy; P < .0001), and effective dose was 34.9% lower (2.3 ± 1.0 vs 3.5 ± 1.1 mSv; P < .0001) with the 100 kVp compared with the 120-kVp protocol, respectively. CONCLUSION Using low x-ray tube voltage and IR allows for decreasing the iodine load and effective radiation dose at CCTA while maintaining image quality.
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Affiliation(s)
- Wei-Hua Yin
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, People's Republic of China
| | - Bin Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, People's Republic of China.
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pei-Ling Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Zhi-Feng Wu
- Department of Radiology, Shanxi DAYI Hospital, Taiyuan, Shanxi, China
| | - Wen-Jie Yang
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Qin Zhang
- Department of Radiology, Inner Mongolia People's Hospital, Huhehaote, Inner Mongolia, China
| | - Min-Wen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University. Xi'an, Shaanxi, China
| | - Andrew D McQuiston
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Felix G Meinel
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Uwe Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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