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Im DJ, Kim YH, Choo KS, Kang JW, Jung JI, Won Y, Kim HR, Chung MH, Han K, Choi BW. Comparison of Coronary Computed Tomography Angiography Image Quality With High-concentration and Low-concentration Contrast Agents: The Randomized CONCENTRATE Trial. J Thorac Imaging 2023; 38:120-127. [PMID: 36821380 DOI: 10.1097/rti.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To confirm that the image quality of coronary computed tomography (CT) angiography with a low tube voltage (80 to 100 kVp), iterative reconstruction, and low-concentration contrast agents (iodixanol 270 to 320 mgI/mL) was not inferior to that with conventional high tube voltage (120 kVp) and high-concentration contrast agent (iopamidol 370 mgI/mL). MATERIALS AND METHODS This prospective, multicenter, noninferiority, randomized trial enrolled a total of 318 patients from 8 clinical sites. All patients were randomly assigned 1: 1: 1 for each contrast medium of 270, 320, and 370 mgI/mL. CT scans were taken with a standard protocol in the high-concentration group (370 mgI/mL) and with 20 kVp lower protocol in the low-concentration group (270 or 320 mgI/mL). Image quality and radiation dose were compared between the groups. Image quality was evaluated with a score of 1 to 4 as subject image quality. RESULTS The mean HU, signal-to-noise ratio, and contrast-to-noise ratio of the 3 groups were significantly different (all P<0.0001). The signal-to-noise ratio and contrast-to-noise ratio of the low-concentration groups were significantly lower than those of the high-concentration group (P<0.05). However, the image quality scores were not significantly different among the 3 groups (P=0.745). The dose length product and effective dose of the high-concentration group were significantly higher than those of the low-concentration group (P<0.0001 and 0.003, respectively). CONCLUSIONS The CT protocol with iterative reconstruction and lower tube voltage for low-concentration contrast agents significantly reduced the effective radiation dose (mean: 3.7±2.7 to 4.1±3.1 mSv) while keeping the subjective image quality as good as the standard protocol (mean: 5.7±3.4 mSv).
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Affiliation(s)
- Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam University Medical School, Gwangju
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital
| | - Yoodong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, Catholic University of Korea, Uijeongbu
| | - Hyo Rim Kim
- Department of Radiology, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul
| | - Myung Hee Chung
- Department of Radiology, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine
| | - Byoung Wook Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine
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Li Y, Younis MH, Wang H, Zhang J, Cai W, Ni D. Spectral computed tomography with inorganic nanomaterials: State-of-the-art. Adv Drug Deliv Rev 2022; 189:114524. [PMID: 36058350 PMCID: PMC9664656 DOI: 10.1016/j.addr.2022.114524] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/09/2022] [Accepted: 08/27/2022] [Indexed: 01/24/2023]
Abstract
Recently, spectral computed tomography (CT) technology has received great interest in the field of radiology. Spectral CT imaging utilizes the distinct, energy-dependent X-ray absorption properties of substances in order to provide additional imaging information. Dual-energy CT and multi-energy CT (Spectral CT) are capable of constructing monochromatic energy images, material separation images, energy spectrum curves, constructing effective atomic number maps, and more. However, poor contrast, due to neighboring X-ray attenuation of organs and tissues, is still a challenge to spectral CT. Hence, contrast agents (CAs) are applied for better differentiation of a given region of interest (ROI). Currently, many different kinds of inorganic nanoparticulate CAs for spectral CT have been developed due to the limitations of clinical iodine (I)-based contrast media, leading to the conclusion that inorganic nanomedicine applied to spectral CT will be a powerful collaboration both in basic research and in clinics. In this review, the underlying principles and types of spectral CT techniques are discussed, and some evolving clinical diagnosis applications of spectral CT techniques are introduced. In particular, recent developments in inorganic CAs used for spectral CT are summarized. Finally, the challenges and future developments of inorganic nanomedicine in spectral CT are briefly discussed.
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Affiliation(s)
- Yuhan Li
- School of Medicine, Shanghai University, No. 99 Shangda Rd, Shanghai 200444, PR China
| | - Muhsin H Younis
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, WI 53705, United States
| | - Han Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Rd, Shanghai 200025, PR China
| | - Jian Zhang
- School of Medicine, Shanghai University, No. 99 Shangda Rd, Shanghai 200444, PR China; Shanghai Universal Medical Imaging Diagnostic Center, Bldg 8, No. 406 Guilin Rd, Shanghai 200233, PR China.
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, WI 53705, United States.
| | - Dalong Ni
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Rd, Shanghai 200025, PR China.
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Pötsch N, Vatteroni G, Clauser P, Helbich TH, Baltzer PAT. Contrast-enhanced Mammography versus Contrast-enhanced Breast MRI: A Systematic Review and Meta-Analysis. Radiology 2022; 305:94-103. [PMID: 36154284 DOI: 10.1148/radiol.212530] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a more accessible alternative to contrast-enhanced MRI (CE-MRI) in breast imaging, but a summary comparison of published studies is lacking. Purpose To directly compare the performance of CEM and CE-MRI regarding sensitivity, specificity, and negative predictive value in detecting breast cancer, involving all publicly available studies in the English language. Materials and Methods Two readers extracted characteristics of studies investigating the comparative diagnostic performance of CEM and CE-MRI in detecting breast cancer. Studies published until April 2021 were eligible. Sensitivity, specificity, negative predictive value, and positive and negative likelihood ratios were calculated using bivariate random effects models. A Fagan nomogram was used to identify the maximum pretest probability at which posttest probabilities of a negative CEM or CE-MRI examination were in line with the 2% malignancy rate benchmark for downgrading a Breast Imaging Reporting and Data System (BI-RADS) category 4 to a BI-RADS category 3 result. I 2 statistics, Deeks funnel plot asymmetry test for publication bias, and meta-regression were used. Results Seven studies investigating 1137 lesions (654 malignant, 483 benign) with an average cancer prevalence of 65.3% (range: 47.3%-82.2%) were included. No publication bias was found (P = .57). While the positive likelihood ratio was equal at a value of 3.1 for CE-MRI and 3.6 for CEM, the negative likelihood ratio of CE-MRI (0.04) was lower than that with CEM (0.12). CE-MRI had higher sensitivity for breast cancer than CEM (97% [95% CI: 86, 99] vs 91% [95% CI: 77, 97], respectively; P < .001) but lower specificity (69% [95% CI: 46, 85] vs 74% [95% CI: 52, 89]; P = .09). A Fagan nomogram demonstrated that the maximum pretest probability at which both tests could rule out breast cancer was 33% for CE-MRI and 14% for CEM. Furthermore, iodine concentration was positively associated with CEM sensitivity and negatively associated with its specificity (P = .04 and P < .001, respectively). Conclusion Contrast-enhanced MRI had superior sensitivity and negative likelihood ratios with higher pretest probabilities to rule out malignancy compared with contrast-enhanced mammography. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mann and Veldhuis in this issue.
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Affiliation(s)
- Nina Pötsch
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Giulia Vatteroni
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Paola Clauser
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Thomas H. Helbich
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Pascal A. T. Baltzer
- From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Huang H, Liang J, Chen X, Shi L, Zeng G, Wu Y, Yang C. Clinical Application Value of Multimedia Education and Nursing Intervention in a Coronary Computed Tomography Angiography. Clin Nurs Res 2022; 31:607-614. [PMID: 35306865 DOI: 10.1177/10547738221075726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To explore the application value of multimedia education and nursing intervention in a coronary computed tomography angiography (CCTA). A total of 120 patients who underwent a 256-slice spiral CCTA examination in our hospital from April 2019 to April 2020 were selected. Patients were divided into two groups of 60 patients each, that is, the control group and the observation group, using a random number table method. The control group received traditional education before an examination, and patients were given routine breathing training. The observation group was given multimedia education and nursing intervention. The heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP), and respiratory rate in the two groups were observed. The psychological status, imaging quality, and incidence of adverse reactions were compared between the two groups. The HR, DBP, SBP, and respiratory rate of the observation group were all lower compared to those in control group, and the differences were statistically significant ( p < 0.05). Following multimedia education and nursing intervention, the anxiety and depression scores of patients in the observation group were considerably lower compared with those in the control group, and the differences were statistically significant ( p < 0.05). Observation group image quality I level higher than the control group, and the proportion of patients with the difference was statistically significant ( p < 0.05). The proportion of grade II to IV patients was lower in the observation group than in the control group; however, the difference was not statistically significant ( p > 0.05). There was a significant difference in the incidence of adverse reactions between the two groups (χ2, p = .031). For patients undergoing a CCTA examination, multimedia education and nursing intervention can effectively improve their immediate psychological state, control their heart rate, and blood pressure before the examination, reduce the incidence of adverse reactions and improve imaging quality, thereby improving the overall reliability of a clinical diagnosis.
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Affiliation(s)
- Hongfang Huang
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Junli Liang
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Xiuzhen Chen
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Lili Shi
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Guanzhen Zeng
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Yaomin Wu
- The First Affiliated Hospital of Guangxi Medical University, China
| | - Chunhong Yang
- The First Affiliated Hospital of Guangxi Medical University, China
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Henning MK, Aaløkken TM, Johansen S. Contrast medium protocols in routine chest CT: a survey study. Acta Radiol 2022; 63:351-359. [PMID: 33648351 DOI: 10.1177/0284185121997111] [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: 11/15/2022]
Abstract
BACKGROUND Administration of contrast medium (CM) is an important image quality factor in computed tomography (CT) of the chest. There is no clear evidence or guidelines on CM strategies for chest CT, thus a consensus approach is needed. PURPOSE To survey the potential impact on differences in chest CT protocols, with emphasis on strategies for the administration of CM. MATERIAL AND METHODS A total of 170 respondents were included in this survey, which used two different approaches: (i) an online survey was sent to the members of the European Society of Thoracic Imaging (ESTI); and (ii) an email requesting a copy of their CT protocol was sent to all hospitals in Norway, and university hospitals in Sweden and Denmark. The survey focused on factors affecting CM protocols and enhancement in chest CT. RESULTS The overall response rate was 24% (n = 170): 76% of the respondents used a CM concentration of ≥350 mgI/mL; 52% of the respondents used a fixed CM volume strategy. Fixed strategies for injection rate and delay were also the most common approach, practiced by 73% and 57% of the respondents, respectively. The fixed delay was in the range of 20-90 s. Of the respondents, 56% used flexible tube potential strategies (kV). CONCLUSION The chest CT protocols and CM administration strategies employed by the respondents vary widely, affecting the image quality. The results of this study underline the need for further research and consensus guidelines related to chest CT.
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Affiliation(s)
- Mette Karen Henning
- Faculty of Health Sciences, Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Trond Mogens Aaløkken
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Faulty of Medicine, University of Oslo, Oslo, Norway
| | - Safora Johansen
- Faculty of Health Sciences, Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
- Department of Cancer Treatment, Oslo University Hospital, Oslo, Norway
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In Vitro Study of the Precision and Accuracy of Measurement of the Vascular Inner Diameter on Computed Tomography Angiography Using Deep Learning Image Reconstruction. J Comput Assist Tomogr 2021; 46:17-22. [DOI: 10.1097/rct.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vimala LR, Eifer DA, Karimzad Y, Paul NS. Prospective Clinical Trial Comparing IV Esmolol to IV Metoprolol in CT Coronary Angiography: Effect on Hemodynamic, Technical Parameters and Cost. Can Assoc Radiol J 2021; 73:240-248. [PMID: 34293933 DOI: 10.1177/08465371211023947] [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: 11/17/2022] Open
Abstract
BACKGROUND Intravenous [IV] esmolol, an alternative to IV metoprolol for coronary computed tomography angiography [CCTA], has shorter half-life that decreases the risk of prolonged hypotension. The primary aim was to prospectively compare IV esmolol alone to IV metoprolol alone for effectiveness in achieving heart rate [HR] of 60 beats per minute[bpm] during CCTA. The secondary aim was to compare hemodynamic response, image quality, radiation dose and cost. MATERIALS AND METHODS Institutional Review Board approved prospective randomized study of 28 CCTA patients medicated in a 1:1 blinded match with IV esmolol or IV metoprolol to achieve HR of 60 bpm. Serial hemodynamic response was measured at 6 specified times. Two cardiac radiologists independently scored the image quality. RESULTS Both IV esmolol and IV metoprolol achieved the target HR. IV esmolol resulted in significantly less profound and shorter duration of reduction in systolic blood pressure [BP] than IV metoprolol with a difference of -10, -14 and -9 mm Hg compared to -20, -26 and -25 mmHg at 2, 15 & 30 min respectively. No significant difference in HR at image acquisition, exposure window, radiation dose and image quality. Although IV esmolol was expensive, the overall cost of care was comparable to IV metoprolol due to shortened post CCTA observation period consequent to faster restoration of hemodynamic status. CONCLUSION Comparison of IV esmolol and IV metoprolol demonstrate that both are effective in achieving the target HR but significantly faster recovery of HR and BP in patients who receive IV esmolol was found.
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Affiliation(s)
- Leena Robinson Vimala
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada.,Department of Medical Imaging, London Health Sciences Centre, University Hospital, London, United Kingdom
| | - Diego Andre Eifer
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
| | - Yasser Karimzad
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada
| | - Narinder S Paul
- Joint Department of Medical Imaging, Toronto General Hospital, Ontario, Canada.,Department of Medical Imaging, London Health Sciences Centre, University Hospital, London, United Kingdom
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Jin L, Jie B, Gao Y, Jiang A, Weng T, Li M. Low dose contrast media in step-and-shoot coronary angiography with third-generation dual-source computed tomography: feasibility of using 30 mL of contrast media in patients with body surface area <1.7 m 2. Quant Imaging Med Surg 2021; 11:2598-2609. [PMID: 34079726 DOI: 10.21037/qims-20-500] [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] [Indexed: 11/06/2022]
Abstract
Background Reducing contrast media volume in coronary computed tomography angiography minimizes the risk of adverse events but may compromise diagnostic image quality. We aimed to evaluate coronary computed tomography angiography's diagnostic image quality while using 30 mL of contrast media in patients with a body surface area <1.7 m2. Methods This prospective study included patients who underwent coronary computed tomography angiography from May 2018 to June 2019. The patients were divided into a low-dose group, who received 30 mL of contrast media, and a routine-dose group, who received contrast media based on body weight. Patient characteristics, coronary computed tomography angiography results, and quantitative and qualitative image results were assessed and compared. Results In total, 103 patients with a body surface area <1.7 m2 were 53 in the low-dose group and 50 in the routine-dose group. Sex, age, body surface area, body weight, and heart rate were similar between the groups (P>0.05). A contrast media volume of 30±0 mL was used for the low-dose group, and 41.62±4.59 mL was used for the routine-dose group. The low-dose group's computed tomography values were significantly different from those of the routine-dose group (P<0.05). The radiologists demonstrated agreement regarding diagnostic image quality and accuracy (kappa =0.91 and 0.85, respectively). Conclusions Using 30 mL of contrast media for coronary computed tomography angiography in patients with a body surface area <1.7 m2 provided a suitable diagnostic image quality for coronary artery disease diagnosis. Although radiation doses were similar between the groups, the decreased contrast media volume was likely beneficial for the patients.
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Affiliation(s)
- Liang Jin
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - Bing Jie
- Radiology Department, Shanghai Pulmonary Hospital, Affiliated with Tongji University, Shanghai, China
| | - Yiyi Gao
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - An'qi Jiang
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - Tingwen Weng
- Cardiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
| | - Ming Li
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
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Reduced-iodine-dose dual-energy coronary CT angiography: qualitative and quantitative comparison between virtual monochromatic and polychromatic CT images. Eur Radiol 2021; 31:7132-7142. [PMID: 33740093 PMCID: PMC8379124 DOI: 10.1007/s00330-021-07809-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/06/2021] [Accepted: 02/17/2021] [Indexed: 12/29/2022]
Abstract
Objectives To quantitatively evaluate the impact of virtual monochromatic images (VMI) on reduced-iodine-dose dual-energy coronary computed tomography angiography (CCTA) in terms of coronary lumen segmentation in vitro, and secondly to assess the image quality in vivo, compared with conventional CT obtained with regular iodine dose. Materials and methods A phantom simulating regular and reduced iodine injection was used to determine the accuracy and precision of lumen area segmentation for various VMI energy levels. We retrospectively included 203 patients from December 2017 to August 2018 (mean age, 51.7 ± 16.8 years) who underwent CCTA using either standard (group A, n = 103) or reduced (group B, n = 100) iodine doses. Conventional images (group A) were qualitatively and quantitatively compared with 55-keV VMI (group B). We recorded the location of venous catheters. Results In vitro, VMI outperformed conventional CT, with a segmentation accuracy of 0.998 vs. 1.684 mm2, respectively (p < 0.001), and a precision of 0.982 vs. 1.229 mm2, respectively (p < 0.001), in simulated overweight adult subjects. In vivo, the rate of diagnostic CCTA in groups A and B was 88.4% (n = 91/103) vs. 89% (n = 89/100), respectively, and noninferiority of protocol B was inferred. Contrast-to-noise ratios (CNR) of lumen versus fat and muscle were higher in group B (p < 0.001) and comparable for lumen versus calcium (p = 0.423). Venous catheters were more often placed on the forearm or hand in group B (p < 0.001). Conclusion In vitro, low-keV VMI improve vessel area segmentation. In vivo, low-keV VMI allows for a 40% iodine dose and injection rate reduction while maintaining diagnostic image quality and improves the CNR between lumen versus fat and muscle. Key Points • Dual-energy coronary CT angiography is becoming increasingly available and might help improve patient management. • Compared with regular-iodine-dose coronary CT angiography, reduced-iodine-dose dual-energy CT with low-keV monochromatic image reconstructions performed better in phantom-based vessel cross-sectional segmentation and proved to be noninferior in vivo. • Patients receiving reduced-iodine-dose dual-energy coronary CT angiography often had the venous catheter placed on the forearm or wrist without compromising image quality. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07809-w.
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Liang CR, Ong CC, Chai P, Teo LLS. Comparison of radiation dose, contrast enhancement and image quality of prospective ECG-Gated CT coronary angiography: Single versus dual source CT. Radiography (Lond) 2021; 27:831-839. [PMID: 33581989 DOI: 10.1016/j.radi.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The updated National Institute of Clinical Excellence (NICE) guidelines of 2017 state that new generation cardiac CT scanners (Aquilion ONE, Brilliance iCT, Discovery CT750 HD and Somatom Definition Flash) are recommended as an option for first-line imaging of the coronary arteries in people with suspected stable coronary artery disease (with an estimated likelihood of coronary artery disease of 10-29%) in whom imaging with earlier generation CT scanners is difficult. New generation cardiac CT scanners are also recommended as an option for first-line evaluation of disease progression, to establish need for revascularisation in people with known coronary artery disease in whom imaging with earlier generation CT scanners is difficult. CT scanning might not be necessary in situations in which immediate revascularisation is being considered. The European Society of Cardiology 2019 clinical practice guidelines recommend non-invasive functional imaging for myocardial ischaemia or coronary CT angiography (CTA) as the initial test to diagnose CAD in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone. Given increased computed tomography coronary angiogram (CTCA) utilisation, radiation dose, contrast enhancement and image quality of prospective ECG-gated CTCA between 256-slice single-source and 192x2-slice dual-source CT scanners were retrospectively evaluated. METHODS Prospectively gated CTCA data from 63 patients on a 256-slice CT (group A) and 71 patients on a 192x2-slice dual source CT (group B) from January to December 2016 were retrospectively evaluated respectively. Scanner-reported dose length product values were used with a conversion factor (k = 0.014 mSv/mGy x cm) to estimate effective dose. Contrast enhancement was assessed with mean CT attenuation at selected regions of interest on axial coronary images. Image quality of the coronary arteries was assessed by a 4-point grading score (1 = non-diagnostic, 4 = excellent image quality). RESULTS The radiation doses in group B were significantly lower than group A (3.68 + 2.13 mSv versus 4.81 + 1.56 mSv, p < 0.001). There were no significant differences in contrast enhancement in the left coronary artery, proximal right coronary artery and left ventricular wall for both groups. Vessel image quality scores for group B were higher than group A (right coronary artery (RCA): 3.2 + 0.7 versus 2.4 + 0.7, p < 0.001; left anterior descending (LAD) artery: 3.0 + 0.8 vs 2.5 + 0.6, p < 0.001; left circumflex (LCx) artery: 3.3 + 0.7 vs 2.6 + 0.6, p < 0.001). Coronary artery contour scores for group B were significantly higher than group A (RCA: 3.2 + 0.8 versus 2.3 + 0.7, p < 0.001; LAD: 3.0 + 0.7 versus 2.4 + 0.6, p < 0.001; LCx: 3.3 + 0.6 versus 2.5 + 0.6, p < 0.001). CONCLUSION Prospective ECG-gated CTCA performed on 192x2-slice CT results in better image quality and lower radiation dose than 256-slice CT. There were no significant differences in contrast enhancement in left main coronary artery (LMCA), proximal RCA and left ventricular wall in both groups. IMPLICATIONS FOR PRACTICE In institutions with both 256-slice and 192x2-slice CT scanners, we recommend that CTCAs be preferentially performed using the 192x2-slice CT scanner.
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Affiliation(s)
- C R Liang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - C C Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - P Chai
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - L L S Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore.
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Focused, low tube potential, coronary calcium assessment prior to coronary CT angiography: A prospective, randomized clinical trial. J Cardiovasc Comput Tomogr 2020; 15:240-245. [PMID: 32868247 DOI: 10.1016/j.jcct.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) scanning is commonly performed before coronary CT angiography (CTA) based partly on its potential to influence CTA scan parameters. Encompassing the whole heart and performed at high tube potential (120 kVp), standard (Agatston) CAC scanning adds to patient radiation exposure. Most CAC exists in the proximal and mid coronary segments and is easily visualized at low kVp. METHODS We tested the impact of a modified calcium scan on coronary CTA acquisition decision-making and image quality in a randomized clinical trial. Providers documented planned CTA acquisition parameters prior to CAC scanning in a blinded manner. Standard Agatston CAC scans proceeded in typical fashion whereas modified scans utilized 80 kVp and reduced z-axis length focused on the proximal-to-mid coronary arteries. CTA providers reviewed the CAC burden then documented final acquisition parameters. RESULTS The study included 172 patients (48% female; mean age 59 ± 6.7). As planned, the calcium scan effective dose was significantly lower in the modified CAC scan group (0.14 vs. 0.74 mSv using a 0.014 k-factor or 0.26 vs. 1.38 mSv using a 0.026 k-factor; both p < 0.001). Initially selected CTA parameters were changed at an identical rate following visual CAC assessment (59%). There was no significant difference in coronary CTA image quality (median quality score = 4 in both groups, p = 0.26), noise (31.0 vs 31.4 HU; p = 0.81), or signal/noise ratio (17.9 vs 16.8; p = 0.26). CONCLUSIONS A low-kVp scan with focused field-of-view provides actionable information regarding the presence and severity of CAC prior to coronary CTA. Coronary CTA parameters based on patient variables are frequently modified after assessing CAC burden in the CTA suite. CLINICALTRIALS. GOV REGISTRATION NUMBER NCT02972242.
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Comparing feasibility of low-tube-voltage protocol with low-iodine-concentration contrast and high-tube-voltage protocol with high-iodine-concentration contrast in coronary computed tomography angiography. PLoS One 2020; 15:e0236108. [PMID: 32673356 PMCID: PMC7365455 DOI: 10.1371/journal.pone.0236108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background To investigate the feasibility of a low tube voltage (80 kVp) protocol with low concentration contrast media (CM) (iodixanol 320 mgl/ml) as compared with a high tube voltage (100 kVp) protocol with high concentration CM (iomeprol 400 mgl/ml) in coronary CT angiography (CCTA) for patients with body mass index less than 30. Materials and methods A total of 93 patients were randomly assigned into three groups and underwent CCTA as follows: Group A) 100 kVp, 100–350 mAs, 400 mgl/ml CM at 4ml/s, and reconstructed with filtered back projection; Group B and C) 80 kVp, 100–450 mAs, 320 mgl/ml CM at 4 ml/s and 5 ml/s, respectively and reconstructed with iterative reconstruction. Objective and subjective image quality (IQ) was analyzed. Results The image noise, intravascular attenuation, signal-to-noise ratio and contrast-to-noise ratio of major coronary arteries did not differ significantly among three groups. Subjective IQ analyses on vascular attenuation and image noise did not differ significantly, either (all of p > 0.05). Qualitative IQ of Group B and C was non-inferior to that of Group A. Substantial reduction of radiation exposure was achieved in group B (2.60 ± 0.48 mSv) and C (2.72 ± 0.54 mSv), compared with group A (3.58 ± 0.67 mSv) (p < 0.05). Conclusion CCTA at 80 kVp with 320 mgl/ml CM and iterative reconstruction is feasible, achieving radiation dose reduction, while preserving IQ.
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Hong JH, Park EA, Lee W, Ahn C, Kim JH. Incremental Image Noise Reduction in Coronary CT Angiography Using a Deep Learning-Based Technique with Iterative Reconstruction. Korean J Radiol 2020; 21:1165-1177. [PMID: 32729262 PMCID: PMC7458859 DOI: 10.3348/kjr.2020.0020] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess the feasibility of applying a deep learning-based denoising technique to coronary CT angiography (CCTA) along with iterative reconstruction for additional noise reduction. Materials and Methods We retrospectively enrolled 82 consecutive patients (male:female = 60:22; mean age, 67.0 ± 10.8 years) who had undergone both CCTA and invasive coronary artery angiography from March 2017 to June 2018. All included patients underwent CCTA with iterative reconstruction (ADMIRE level 3, Siemens Healthineers). We developed a deep learning based denoising technique (ClariCT.AI, ClariPI), which was based on a modified U-net type convolutional neural net model designed to predict the possible occurrence of low-dose noise in the originals. Denoised images were obtained by subtracting the predicted noise from the originals. Image noise, CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were objectively calculated. The edge rise distance (ERD) was measured as an indicator of image sharpness. Two blinded readers subjectively graded the image quality using a 5-point scale. Diagnostic performance of the CCTA was evaluated based on the presence or absence of significant stenosis (≥ 50% lumen reduction). Results Objective image qualities (original vs. denoised: image noise, 67.22 ± 25.74 vs. 52.64 ± 27.40; SNR [left main], 21.91 ± 6.38 vs. 30.35 ± 10.46; CNR [left main], 23.24 ± 6.52 vs. 31.93 ± 10.72; all p < 0.001) and subjective image quality (2.45 ± 0.62 vs. 3.65 ± 0.60, p < 0.001) improved significantly in the denoised images. The average ERDs of the denoised images were significantly smaller than those of originals (0.98 ± 0.08 vs. 0.09 ± 0.08, p < 0.001). With regard to diagnostic accuracy, no significant differences were observed among paired comparisons. Conclusion Application of the deep learning technique along with iterative reconstruction can enhance the noise reduction performance with a significant improvement in objective and subjective image qualities of CCTA images.
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Affiliation(s)
- Jung Hee Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Whal Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chulkyun Ahn
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Gu MJ, Yi JH, Kim YH, Lee HJ, Kang UR, Ji SW. Comparative Analysis of Image Quality and Adverse Events between Iopamidol 250 and Ioversol 320 in Hepatic Angiography for Transcatheter Arterial Chemoembolization. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:166-175. [PMID: 36238118 PMCID: PMC9432096 DOI: 10.3348/jksr.2020.81.1.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 12/02/2022]
Abstract
목적 간세포암의 화학색전술에 사용되는 조영제인 Ioversol 320과 Iopamidol 250을 영상 화질과 유해반응에서 차이가 있는지 비교 분석하고자 하였다. 대상과 방법 경동맥 화학색전술을 시행 받은 113명의 간세포암 환자를 대상으로 후향적으로 분석하였고, Iopamidol 250은 44명, Ioversol 320은 69명에게 주입하였다. 영상 화질은 혈관 인지도 및 일치도로 평가하였다. 혈관인지도는 두 명의 영상의학과 전문의가 간동맥 혈관조영술에서 간세분엽동맥, 췌십이지장동맥, 우위동맥, 우위대망동맥이 보이는 인지도와 명확도에 따라 3단계로 점수화하였다. 일치도는 혈관조영술과 전산화단층촬영에서 발견된 간세포암 수를 비교하였다. 시술 전후 임상증상을 조사하여 조영제 유해반응을 평가하였다. 결과 혈관인지도의 평균 점수는 Iopamidol 250은 2.92점, Ioversol 320은 2.94점이었다. 일치도는 Iopamidol 250은 31명(70.5%), Ioversol 320은 46명(66.7%)이 일치했으며, 혈관인지도와 일치도는 통계적 유의한 차이가 없었다(p > 0.05). Iopamidol 250은 1명, Ioversol 320은 6명의 환자가 오심을 호소하였으며, 유해반응 빈도의 유의한 차이는 없었다(p = 0.24). 결론 간세포암 화학색전술에서 Iopamidol 250은 Ioversol 320과 영상의 화질 및 유해반응에 유의한 차이가 없이 사용될 수 있을 것으로 생각된다.
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Affiliation(s)
- Min Jae Gu
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Hyuck Yi
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Hee Jung Lee
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Seung Woo Ji
- Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine, Daegu, Korea
- Department of Radiology, CHA Gumi Medical Center, CHA University, Gumi, Korea
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Influence of virtual monochromatic spectral image at different energy levels on motion artifact correction in dual-energy spectral coronary CT angiography. Jpn J Radiol 2019; 37:636-641. [PMID: 31270660 DOI: 10.1007/s11604-019-00852-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/28/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the influence of virtual monochromatic spectral (VMS) CT images at different energy levels on the effectiveness of a motion correction technique (SSF) in dual-energy Spectral coronary CT angiography (CCTA). MATERIALS AND METHODS 29 cases suspected of or diagnosed with coronary artery disease underwent Spectral CCTA using a prospective ECG triggering with 250 ms padding time. SSF was applied to the determined least-motion phase to generate 6 additional sets of VMS images with energy levels from 40 to 100 keV. CT value and standard deviation (SD) in the aortic root and epicardial adipose tissue were measured. Image quality of the RCA, LAD and LCX was evaluated on a per-vessel basis in each patient. Two reviewers evaluated the artery using the score of the segment. RESULTS The low energy VMS images increased CT value and image noise compared with higher-energy VMS images, except 90 keV and 100 keV. The CNR of 40-70 keV were higher than those of 80-100 keV (P < 0.05). The image quality scores for images at 50-80 keV were higher than those of 40, 90, and 100 keV (P < 0.05), and the VMS image quality at 50 keV and 60 keV with SSF was the highest. CONCLUSION SSF can effectively reduce the motion artifacts when coronary vessels have suitable contrast enhancement which can be achieved by adjusting energy levels of VMS images.
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Ippolito D, Riva L, Talei Franzesi CR, Cangiotti C, De Vito A, Di Gennaro F, D'andrea G, Crespi A, Sironi S. Diagnostic efficacy of model-based iterative reconstruction algorithm in an assessment of coronary artery in comparison with standard hybrid-Iterative reconstruction algorithm: dose reduction and image quality. LA RADIOLOGIA MEDICA 2019; 124:350-359. [PMID: 30539411 DOI: 10.1007/s11547-018-0964-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/25/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the image quality and radiation dose exposure of low-dose coronary CTA (cCTA) study, reconstructed with the new model-based iterative reconstruction algorithm (IMR), compared with standard hybrid-iterative reconstruction (iDose4) cCTA in patients with suspected coronary artery disease. MATERIALS AND METHODS Ninety-eight patients with an indication for coronary CT study were prospectively enrolled. Fifty-two patients (study group) underwent 256-MDCT low-dose cCTA (80 kV; automated-mAs; 60 mL of CM, 350 mgL/mL) with prospective ECG-triggering acquisition and IMR. A control group of 46 patients underwent 256-MDCT standard prospective ECG-gated protocol (100 kV; automated-mAs; 70 mL of CM, 400 mgL/mL; iDose4). Subjective and objective image quality (attenuation value, SD, SNR and CNR) were evaluated by two radiologists subjectively. Radiation dose exposure was quantified as DLP, CTDIvol and ED. RESULTS Mean values of mAs were significantly lower for IMR-cCTA (167 ± 62 mAs) compared to iDose-cCTA (278 ± 55 mAs), p < 0.001. With a significant reduction of 38% in radiation dose exposure (DLP: IMR-cCTA 91.7 ± 26 mGy cm vs. iDose-cCTA 148.6 ± 35 mGy cm; p value < 0.001), despite the use of different CM, we found higher mean attenuation values of the coronary arteries in IMR group compared to iDose4 (mean density in LAD: 491HU IMR-cCTA vs. 443HU iDose-cCTA; p = 0.03). We observed a significant higher value of SNR and CNR in study group due to a lower noise level. Qualitative analysis did not reveal any significant differences between the two groups (p = 0.23). CONCLUSIONS Low-dose cCTA study combined with IMR reconstruction allows to correctly evaluate coronary arteries disease, offering high-quality images and significant radiation dose exposure reduction (38%), as compared to standard cCTA protocol.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy.
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
| | - Luca Riva
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Cammillo R Talei Franzesi
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Cecilia Cangiotti
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Andrea De Vito
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Filiberto Di Gennaro
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Gabriele D'andrea
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Andrea Crespi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Medical Physics, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
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Qu TT, Li JY, Jiao XJ, Zhang XL, Song ZF, Guo YX, Guo JX. Contrast dose reduction with shortened injection durations in coronary CT angiography on 16-cm Wide-detector CT scanner. Br J Radiol 2018; 91:20180580. [PMID: 30160183 DOI: 10.1259/bjr.20180580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES: To investigate the use of shortened contrast injection with late triggering in coronary CT angiography (CCTA) for decreasing contrast dose and maintaining image quality. METHODS: 106 patients for CCTA on a 16-cm wide-detector CT were prospectively enrolled into groups A (n = 50) and B (n = 56) randomly. Patient weight-dependent contrast medium (Iopamiro, 370 mgI ml-1) at dose rate of 25 mgI/kg/s was used with 8 s and the standard 10 s injection time in groups A and B, respectively. CT values of the aortic sinus (AS), right coronary artery, left anterior descending and left circumflex at the proximal, middle and distal segments were measured and compared. Subjective image quality was evaluated and analyzed with Fisher exact test. Contrast dose, injection rate and enhancement duration (between the start of enhancement in AS and scan finish) were also compared. RESULTS: There was no difference in the injection rate and enhancement duration between the two groups (p > 0.05), while the total contrast dose in group A (36.2 ± 5.7 ml) was significantly lower than in group B (46.4 ± 6.3 ml) (p < 0.001). There was no difference for CT values in all major coronary vessels between the two groups and no difference in subjective image quality scores (all p > 0.05). CONCLUSION: It is feasible to shorten contrast injection to 8 s in CCTA on wide-detector CT systems to significantly reduce contrast dosage, maintain adequate enhancement and reduce contrast-related artifacts. ADVANCES IN KNOWLEDGE: (1) Coronary CT angiography (CCTA) scans with shortened contrast medium injection duration and late triggering are feasible with a 16-cm wide-detector CT system (2) Compared with the conventional CCTA with 10 s contrast injection duration, the new contrast injection protocol of using shortened injection duration (to 8 s) and late triggering reduces contrast dose to 36.2 ml, while maintaining adequate enhancement in vessels and reducing contrast-related artifacts.
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Affiliation(s)
- Ting-Ting Qu
- 1 Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , PR China
| | - Jian-Ying Li
- 2 CT Research Center, GE Healthcare China , Beijing , China
| | - Xi-Jun Jiao
- 1 Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , PR China
| | - Xiang-Li Zhang
- 1 Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , PR China
| | - Zhe-Fan Song
- 1 Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , PR China
| | - Yin-Xia Guo
- 1 Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , PR China
| | - Jian-Xin Guo
- 1 Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , PR China
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Tse JJ, Dunmore-Buyze J, Drangova M, Holdsworth DW. Dual-energy computed tomography using a gantry-based preclinical cone-beam microcomputed tomography scanner. J Med Imaging (Bellingham) 2018; 5:033503. [PMID: 30155511 PMCID: PMC6103383 DOI: 10.1117/1.jmi.5.3.033503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 07/30/2018] [Indexed: 11/14/2022] Open
Abstract
Dual-energy microcomputed tomography (DECT) can provide quantitative information about specific materials of interest, facilitating automated segmentation, and visualization of complex three-dimensional tissues. It is possible to implement DECT on currently available preclinical gantry-based cone-beam micro-CT scanners; however, optimal decomposition image quality requires customized spectral shaping (through added filtration), optimized acquisition protocols, and elimination of misregistration artifacts. We present a method for the fabrication of customized x-ray filters-in both shape and elemental composition-needed for spectral shaping. Fiducial markers, integrated within the sample holder, were used to ensure accurate co-registration between sequential low- and high-energy image volumes. The entire acquisition process was automated through the use of a motorized filter-exchange mechanism. We describe the design, implementation, and evaluation of a DECT system on a gantry-based-preclinical cone-beam micro-CT scanner.
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Affiliation(s)
- Justin J Tse
- Western University, Bone and Joint Institute, Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,Western University, Bone and Joint Institute, Departments of Medical Biophysics and Medical Imaging, London, Ontario, Canada
| | - Joy Dunmore-Buyze
- Western University, Bone and Joint Institute, Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Maria Drangova
- Western University, Bone and Joint Institute, Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,Western University, Bone and Joint Institute, Departments of Medical Biophysics and Medical Imaging, London, Ontario, Canada
| | - David W Holdsworth
- Western University, Bone and Joint Institute, Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.,Western University, Bone and Joint Institute, Departments of Medical Biophysics and Medical Imaging, London, Ontario, Canada.,Western University, Bone and Joint Institute, Department of Surgery, London, Ontario, Canada
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Impact of Contrast Media Concentration on Low-Kilovolt Computed Tomography Angiography. Invest Radiol 2018; 53:264-270. [DOI: 10.1097/rli.0000000000000437] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lubbers MM, Kock M, Niezen A, Galema T, Kofflard M, Bruning T, Kooij HS, van Valen H, Dijkshoorn M, Booij R, Padmos A, Vogels A, Budde RPJ, Nieman K. Iodixanol versus Iopromide at Coronary CT Angiography: Lumen Opacification and Effect on Heart Rhythm-the Randomized IsoCOR Trial. Radiology 2017; 286:71-80. [PMID: 28809582 DOI: 10.1148/radiol.2017162779] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To show that equal coronary lumen opacification can be achieved with iso- and low-osmolar contrast media when it is injected at the same iodine delivery rate with contemporary cardiac computed tomographic (CT) protocols and to investigate the cardiovascular effect of iso-osmolar contrast media and the image quality achieved. Materials and Methods Institutional review board approval and written informed consent were obtained for the Effect of Iso-osmolar Contrast Medium on Coronary Opacification and Heart Rhythm in Coronary CT Angiography, or IsoCOR, trial. Between November 2015 and August 2016, 306 patients (167 [55%] women) at least 18 years old (weight range, 50-125 kg), were prospectively randomized to receive iso-osmolar iodixanol 270 or low-osmolar iopromide 300 contrast media. All coronary segments were assessed for intraluminal opacification and image quality and were compared by using the Student t test. Heart rate, arrhythmia, patient discomfort, and adverse events also were monitored. Results Mean measured coronary attenuation values ± standard deviation were comparable between the iodixanol 270 and iopromide 300 contrast media groups (469 HU ± 167 vs 447 HU ± 166, respectively [P = .241]; 95% confidence interval: -15.1, 60.0), including those from subanalyses. Adjusted for the lower iodine concentration, the mean iodixanol 270 bolus was larger compared with that of iopromide 300 (76.8 mL ± 11.6 vs 69.7 mL ± 10.8, respectively; P < .001). The higher injection rate was associated with higher pressure (777 kPa ± 308 vs 630 kPa ± 252, respectively; P < .001). Although in the iodixanol 270 group patients experienced less heat discomfort (72% vs 86%, respectively; P < .001), no differences in heart rate or rhythm were observed. Conclusion If injected at comparable iodine delivery rates, the iso-osmolar contrast medium iodixanol 270 is not inferior to low-osmolar contrast medium iopromide 300 for assessment of coronary opacification. Iodixanol 270 was associated with less heat discomfort, but did not affect heart rate differently compared with iopromide 300. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Marisa M Lubbers
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Marc Kock
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - André Niezen
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Tjebbe Galema
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Marcel Kofflard
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Tobias Bruning
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Henriette S Kooij
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Hanneke van Valen
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Marcel Dijkshoorn
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Ronald Booij
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Anthony Padmos
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Alain Vogels
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Ricardo P J Budde
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Koen Nieman
- From the Departments of Cardiology (M.M.L., T.G., K.N.) and Radiology (M.M.L., M.D., R.B., A.P., A.V., R.P.J.B., K.N.), Erasmus Medical Center, 's-Gravendijkwal 230, Room Ca-207a, Rotterdam 3015 CE, the Netherlands; Departments of Radiology (M. Kock, S.K.) and Cardiology (M. Kofflard), Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; and Departments of Radiology (A.N., H.v.V.) and Cardiology (T.B.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
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21
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Ghekiere O, Salgado R, Buls N, Leiner T, Mancini I, Vanhoenacker P, Dendale P, Nchimi A. Image quality in coronary CT angiography: challenges and technical solutions. Br J Radiol 2017; 90:20160567. [PMID: 28055253 PMCID: PMC5605061 DOI: 10.1259/bjr.20160567] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 11/05/2022] Open
Abstract
Multidetector CT angiography (CTA) has become a widely accepted examination for non-invasive evaluation of the heart and coronary arteries. Despite its ongoing success and worldwide clinical implementation, it remains an often-challenging procedure in which image quality, and hence diagnostic value, is determined by both technical and patient-related factors. Thorough knowledge of these factors is important to obtain high-quality examinations. In this review, we discuss several key elements that may adversely affect coronary CTA image quality as well as potential measures that can be taken to mitigate their impact. In addition, several recent vendor-specific advances and future directions to improve image quality are discussed.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
- Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Nico Buls
- Department of Radiology, UZ Brussel, Brussels, Belgium
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Isabelle Mancini
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Liège, Belgium
| | | | - Paul Dendale
- Heart Center Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Alain Nchimi
- GIGA Cardiovascular Sciences, Liège University (ULg), Domaine Universitaire du Sart Tilman, Rue de l'hôpital, Liège, Belgium
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