A prospective evaluation of the contrast, radiation dose and image quality of contrast-enhanced CT scans of paediatric abdomens using a low-concentration iodinated contrast agent and low tube voltage combined with 70% ASIR algorithm

Wang, Xiaoxia; Ye, Zhong; Hu, Liwei; Xue, Lianyan; Meihua, Shi; Qiu, Hai-Sheng; Li, Jianying

doi:10.1111/ijcp.12853

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…As mentioned previously, the recommendations regarding CA application protocols in this patient population are heterogeneous, but 2 ml/kg body weight CA volume is commonly advised 15–17,26–34 . Literature data also suggest several alternatives regarding contrast injection protocols.…”

Section: Discussionmentioning

confidence: 99%

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Chest CTA in children younger than two years – a retrospective comparison of three contrast injection protocols

Nagy

Tschauner

Marterer

et al. 2019

Sci Rep

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To obtain the highest diagnostic information with least side effects when performing thoracic CT angiography (CTA) is challenging in young children. The current study aims to compare three contrast agent (CA) injection protocols regarding image quality and CA characteristic: a standard CTA, a fixed-bolus delay protocol, and the “microbolus technique (MBT)” developed in our institution. Seventy chest CTA scans of patients (<2 years) were divided into three groups. MBT was applied in group I, the standard protocol in group II and a fixed bolus delay in group III. Objective image quality was assessed by measuring peak enhancement, image noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Two observers scored subjective image quality and artifacts. Significantly lower amounts of CA (mean ± SD) were used in the MBT group compared to Group II (9.0 ± 3.7 ml vs. 12.9 ± 4.5 ml). A lower, but still diagnostic (>400 HU) enhancement was registered in all major thoracic vessels in group I without significant differences regarding SNR and CNR in most regions (p < 0.05). The best scores for image quality and artifacts were reached in group I. All three chest CTA contrast injection protocols offered diagnostic vessel enhancement in young patients. MBT was associated with reduced image artifacts and less injected CA.

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Section: Discussionmentioning

confidence: 99%

“…An alternative option to reduce side effects is the usage of low-concentrated iodinated CA (e.g. 270 mgI/ml) 21,33,34 . However, this concentration is still considerably higher than those used in MBT (CA dilution to 100 mg Iodine/ml).…”

Section: Discussionmentioning

confidence: 99%

Chest CTA in children younger than two years – a retrospective comparison of three contrast injection protocols

Nagy

Tschauner

Marterer

et al. 2019

Sci Rep

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“…With the increase in adoption of scanners with ATVS and dual-energy CT capability, more studies are being performed with low kVp/low keV, and, at our practice, more than 80% of oncologic abdominopelvic CT studies are performed with these techniques. These techniques have attracted an interest in modifying intravenous contrast media protocols, and independent investigations have reported the feasibility of reducing intravenous iodine dose by up to 70% for abdominal CT or CT angiography (10)(11)(12)28). However, there is also a need to modify existing OCM protocols.…”

Section: Discussionmentioning

confidence: 99%

Low-keV and Low-kVp CT for Positive Oral Contrast Media in Patients with Cancer: A Randomized Clinical Trial

et al. 2019

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ositive oral contrast medium (OCM) is routinely used in the imaging of patients undergoing oncologic treatment and in patients after surgery for detecting extraluminal lesions and collections, defining anatomy, and assessing bowel integrity, especially in patients with insufficient visceral fat (1-3). Current oncology and American College of Radiology guidelines advocate the use of positive OCM, despite its influence on workflow (4,5). The latest-generation CT scanners provided by major manufacturers are equipped with two increasingly adopted techniques-namely, automated tube voltage (in kilovolt peaks) selection (ATVS) and dual-energy CT. This is because of well-established applications of these techniques that provide diagnostic image quality with high image contrast and enable material characterization (6-9). Both low-kVp and low-keV virtual monochromatic images (low-keV image reconstructions from dual-energy CT) augment the attenuation of iodine by two-to fourfold, and this property is being leveraged to reduce the dose of intravenous contrast medium (10-12). To achieve the average accepted enteral attenuation of 200 HU, a concentration of 13-15 mg iodine per milliliter (mg I/mL) iohexol or less than 3% wt/vol barium is routinely used in adults (13-16). At such OCM concentrations, low-kVp and low-keV images increase the intestinal luminal attenuation by up to 103% (17,18). This substantially higher attenuation of OCM creates challenges that may hinder adequate visualization of the bowel wall or adjacent structures and

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“…A few studies have demonstrated that the low voltage and adaptive statistical iterative reconstruction algorithm could reduce the radiation dose and contrast agent dosage in abdominal angiography; however, the conditions were applied only in pediatric patients and lower weight population ( 18 19 ). After studying the relationship between tube voltage and CT attenuation value of iodine, Huda et al ( 20 ) confirmed that the attenuation value of iodinated enhancement increased at a lower tube voltage, leading to higher enhancement.…”

Section: Discussionmentioning

confidence: 99%

Optimal Monochromatic Imaging of Spectral Computed Tomography Potentially Improves the Quality of Hepatic Vascular Imaging

Yin

Gao

et al. 2018

Korean J Radiol

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ObjectiveTo investigate the efficiency of spectral computed tomography (CT) optimal monochromatic images in improving imaging quality of liver vessels.Materials and MethodsThe imaging data of 35 patients with abdominal CT angiography were retrospectively analyzed. Hepatic arteries, portal veins, and hepatic veins were reconstructed with mixed energy (quality check, QC), 70 keV and optimal monochromatic mode. Comparative parameters were analyzed including CT value, image noise (IN), contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and subjective qualitative analysis.ResultsThe optimal monochromatic value for assessment of the common hepatic artery, portal vein, and hepatic vein ranged between 49 keV and 53 keV, with a mean of 51 keV. There were statistically significant differences (p < 0.001) among the optimal monochromatic, 70 keV and QC images with regards to the hepatic vascular CT value, IN, CNR, SNR, and subjective qualitative score. CNR of the common hepatic artery in the optimal monochromatic, 70 keV and QC groups was 24.6 ± 10.9, 18.1 ± 8.3, and 11.6 ± 4.6, respectively (p < 0.001) with subjective scores of 4.7 ± 0.2, 4.0 ± 0.3, and 3.6 ± 0.4, respectively (p < 0.001). CNR of the hepatic portal vein was 6.9 ± 2.7, 4.3 ± 1.9, and 3.0 ± 2.1, respectively (p < 0.001) with subjective scores of 4.5 ± 0.3, 3.9 ± 0.4, and 3.3 ± 0.3, respectively (p < 0.001). CNR of the hepatic vein was 5.7 ± 2.3, 4.2 ± 1.9, and 2.7 ± 1.4, respectively with subjective scores of 4.3 ± 0.3, 3.8 ± 0.4, and 3.2 ± 0.3, respectively (p < 0.001).ConclusionOptimal monochromatic images can lead to improvement in the imaging parameters and optimization of the image quality of the common hepatic artery, hepatic portal vein and hepatic vein compared with conventional mixed kV and with 70 keV datasets.

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A prospective evaluation of the contrast, radiation dose and image quality of contrast-enhanced CT scans of paediatric abdomens using a low-concentration iodinated contrast agent and low tube voltage combined with 70% ASIR algorithm

Abstract: The scanning protocol using a low tube voltage (80 kVp) together with 70% ASIR and a low-concentration iodinated contrast agent (270 mg I/mL) enables a 37% reduction in iodine load and a 30% reduction in radiation dose while maintaining compatible image quality.

Cited by 6 publications

References 21 publications

Chest CTA in children younger than two years – a retrospective comparison of three contrast injection protocols

Chest CTA in children younger than two years – a retrospective comparison of three contrast injection protocols

Low-keV and Low-kVp CT for Positive Oral Contrast Media in Patients with Cancer: A Randomized Clinical Trial

Optimal Monochromatic Imaging of Spectral Computed Tomography Potentially Improves the Quality of Hepatic Vascular Imaging

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