Low contrast and radiation dose coronary CT angiography using a 320-row system and a refined contrast injection and timing method

Oda, Shigeto; Utsunomiya, Daisuke; Yuki, Hideaki; Kai, Noriyuki; Hatemura, Masahiro; Funama, Yoshinori; Kidoh, Masafumi; Yoshida, Morikatsu; Namimoto, Tomohiro; Yamashita, Yasuyuki

doi:10.1016/j.jcct.2014.12.002

Cited by 59 publications

(49 citation statements)

References 39 publications

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“…The main findings of our study are that, in patients with low body weight, image quality, coronary evaluability and diagnostic accuracy of low-dose lowiodine coronary CTA are high and similar to those reported in the literature for standard tube voltage and iodine load protocols. Accordingly with previous studies performed with low kV approach (until 70 kV) and iterative reconstruction (10,11), the present study showed good image quality and low radiation exposure. We rated 61.5% of coronary images of excellent quality.…”

Section: Discussionsupporting

confidence: 88%

Coronary CT angiography with 80 kV tube voltage and low iodine concentration contrast agent in patients with low body weight

Andreini

Mushtaq

Conte

et al. 2016

Journal of Cardiovascular Computed Tomography

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Section: Discussionsupporting

confidence: 88%

Coronary CT angiography with 80 kV tube voltage and low iodine concentration contrast agent in patients with low body weight

Andreini

Mushtaq

Conte

et al. 2016

Journal of Cardiovascular Computed Tomography

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“…22,23 However, image noise is also increased in the range of 16-81%, 22,24 which allows further decrease of the tube energy to 80 kV only in children and adults with low BMI. 21,25 A more extensive discussion falls outside the scope of this review.…”

Section: Image Quality Improvement Strategiesmentioning

confidence: 99%

Image quality in coronary CT angiography: challenges and technical solutions

Ghekiere

Salgado

Buls

et al. 2017

BJR

114

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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. INTRODUCTIONThe high negative-predictive value of coronary CT angiography (CTA) makes it a suitable tool for excluding significant coronary artery disease.1 Coronary CTA is technically complex and places a greater emphasis on scanning technologies than any other type of CT examination. Indeed, coronary arteries both have small calibre and varying degrees of motion during the cardiac cycle.2 Image quality can be degraded by many patient-and technique-related factors. Image artefacts are causes for misinterpretation, making the diagnostic accuracy of coronary CTA to a great extent dependent on their recognition and operator-awareness.2,3 Potential problems related to these artefacts include insufficient tissue contrast, limited spatial and temporal resolution and inadequate volume coverage. The aim of this review was to discuss these technical issues, important recent vendorspecific solutions as well as future directions.

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“…19,24 A further improvement in CNR could be achieved by alteration of reconstruction methods, for example, with the implementation of iterative reconstruction. [25][26][27] However, subjective image quality will not always be experienced as superior owing to possible loss of contrast between different densities.…”

Section: Discussionmentioning

confidence: 99%

“…Already some advancements have been made using lower kV settings in CTA. [25][26][27][36][37][38] A decrease in kV increases intraarterial CM attenuation, because the higher photon energy at lower kV settings is closer to the iodine k-edge of keV. 4,24,39,40 Many studies focused on low kV protocols; however, one must ensure to concordantly increase mAs to avoid excessive image noise.…”

Section: Discussionmentioning

confidence: 99%

Individually tailored contrast enhancement in CT pulmonary angiography

Hendriks

Kok

Mihl

et al. 2016

BJR

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Objective: The purpose was to evaluate individually shaped contrast media (CM) delivery in CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE). Methods: 100 consecutive emergency patients with clinical suspicion of PE were evaluated. High-pitch CTPA was performed on a second-generation dual-source CT using the following parameters: 100 kV, 200-250 mAsref, rotation time 0.28 s, 128 3 0.6 mm col. and image reconstruction 1.0/0.8 mm (B30f). Group 1 (n 5 50) then received a fixed CM bolus (300 5 mgI ml 21, volume 5 90 ml and flow rate 5 6 ml s 21 ); Group 2 (n 5 50) received a body weightadapted CM bolus determined by dedicated contrast injection software. For analysis, groups were further subdivided into low-weight (40-75 kg) and high-weight (76-117 kg) groups. Technical image quality was graded using a four-point Likert scale (1 5 non-diagnostic; 2 5 diagnostic; 3 5 good and 4 5 excellent image quality) at the level of the pulmonary trunk and pulmonary arteries. Objective image quality analysis was performed by measuring contrast enhancement in Hounsfield units (HU) at the same levels. Attenuation levels . 180 HU were considered diagnostic. Results: All examinations were graded as diagnostic at each level. The individual minimum pulmonary attenuation was 184 and 270 HU for Group 1 and 2, respectively. Mean attenuation was as follows: Group 1: 475 6 105 HU (40-75 kg) and 402 6 115 HU (76-117 kg), p , 0.03. Group 2: 424 6 76 HU (40-75 kg) and 418 6 100 HU (76-117 kg), p 5 0.8. For Group 2, CM volumes were: 55 6 5 ml (40-75 kg) and 66 6 5 ml (76-117 kg), leading to 16-51% CM reduction. Conclusion: Even under emergency conditions, individualized CM protocols can provide diagnostic and robust image quality in CTPA for PE with a substantial reduction of CM volume for lower weight patients, compared with a fixed CM protocol. Advances in knowledge: CM volume can substantially be reduced by using individualized CM protocols in CT angiography for PE without compromising the diagnostic image quality.

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Low contrast and radiation dose coronary CT angiography using a 320-row system and a refined contrast injection and timing method

Cited by 59 publications

References 39 publications

Coronary CT angiography with 80 kV tube voltage and low iodine concentration contrast agent in patients with low body weight

Coronary CT angiography with 80 kV tube voltage and low iodine concentration contrast agent in patients with low body weight

Image quality in coronary CT angiography: challenges and technical solutions

Individually tailored contrast enhancement in CT pulmonary angiography

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