Reduced iodine load with CT coronary angiography using dual-energy imaging: A prospective randomized trial compared with standard coronary CT angiography |
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| Affiliation: | 1. Department of Radiology and Division of Cardiology, St Paul''s Hospital, 1081 Burrard Street, Vancouver V6Z 1Y6, BC, Canada;2. Fairfax Radiology, Virginia, USA;3. New York Presbyterian/Weil Cornell Medical College, New York, NY, USA;4. Department of Radiology, Buenos Aires University School of Medicine, Buenos Aires, Argentina;1. Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002, China;2. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA;1. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;2. Multi-dimension Biomedical Imaging and Information Laboratory in Research Park, Keio University School of Medicine, Tokyo, Japan;3. Department of Preventive Medicine and Public Health, Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan;1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA;1. Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA;2. Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Brazil;3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;4. Department of Radiology, Brigham and Women''s Hospital and Harvard Medical School, Boston, MA, USA;5. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA;6. Department of Radiology, Division of Cardiovascular CT/MR, Heart Hospital (HCOR), São Paulo, Sao Paulo, Brazil |
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| Abstract: | BackgroundThere is concern regarding the administration of iodinated contrast to patients with impaired renal function because of the increased risk of contrast-induced nephropathy.ObjectiveEvaluate image quality and feasibility of a protocol with a reduced volume of iodinated contrast and utilization of dual-energy coronary CT angiography (DECT) vs a standard iodinated contrast volume coronary CT angiography protocol (SCCTA).MethodsA total of 102 consecutive patients were randomized to SCCTA (n = 53) or DECT with rapid kVp switching (n = 49). Eighty milliliters and 35 mL of iodinated contrast were administered in the SCCTA and DECT cohorts, respectively. Two readers measured signal and noise in the coronary arteries; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A 5-point signal/noise Likert scale was used to evaluate image quality; scores of <3 were nondiagnostic. Agreement was assessed through kappa analyses.ResultsDemographics and radiation dose were not significantly different; there was no difference in CNR between both cohorts (P = .95). A significant difference in SNR between the groups (P = .02) lost significance (P = .13) when adjusted for body mass index. The median Likert score was inferior for DECT for reader 1 (3.6 ± 0.6 vs 4.3 ± 0.6; P < .001) but not reader 2 (4.1 ± 0.6 vs 4.3 ± 0.5; P = .06). Agreement in diagnostic interpretability in the DECT and SCCTA groups was 91% (95% confidence interval, 86%–100%) and 96% (95% confidence interval, 90%–100%), respectively.ConclusionDECT resulted in inferior image quality scores but demonstrated comparable SNR, CNR, and rate of diagnostic interpretability without a radiation dose penalty while allowing for >50% reduction in contrast volume compared with SCCTA. |
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| Keywords: | Coronary CT angiography Dual energy CT Reduced iodinated contrast Image quality Diagnostic Efficacy |
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