Low concentration contrast medium for dual-source computed tomography coronary angiography by a combination of iterative reconstruction and low-tube-voltage technique: Feasibility study

Objectives

To assess the impact of low-concentration contrast medium on vascular enhancement, image quality and radiation dose of coronary CT angiography (cCTA) by using a combination of iterative reconstruction (IR) and low-tube-voltage technique.

Materials and methods

One hundred patients were prospectively randomized to two types of contrast medium and underwent prospective electrocardiogram-triggering cCTA (Definition Flash, Siemens Healthcare; collimation: 128 mm × 0.6 mm; tube current: 300 mA s). Fifty patients received Iopromide 370 were scanned using the conventional tube setting (100 kVp or 120 kVp if BMI ≥ 25 kg/m²) and reconstructed with filtered back projection (FBP). Fifty patients received Iodixanol 270 were scanned using the low-tube-voltage (80 kVp or 100 kVp if BMI ≥ 25 kg/m²) technique and reconstructed with IR. CT attenuation was measured in coronary artery and other anatomical regions. Noise, image quality and radiation dose were compared.

Results

Compared with two Iopromide 370 subgroups, Iomeprol 270 subgroups showed no significant difference in CT attenuation (576.63 ± 95.50 vs. 569.51 ± 118.93 for BMI < 25 kg/m², p = 0.647 and 394.19 ± 68.09 vs. 383.72 ± 63.11 for BMI ≥ 25 kg/m², p = 0.212), noise (in various anatomical regions of interest) and image quality (3.5 vs. 4.0, p = 0.13), but significantly (0.41 ± 0.17 vs. 0.94 ± 0.45 for BMI < 25 kg/m², p < 0.001 and 1.14 ± 0.24 vs. 2.37 ± 0.69 for BMI ≥ 25 kg/m², p < 0.001) lower radiation dose, which reflects dose saving of 56.4% and 51.9%, respectively.

Conclusions

Combined IR with low-tube-voltage technique, a low-concentration contrast medium of 270 mg I/ml can still maintain the contrast enhancement without impairing image quality, as well as significantly lower the radiation dose.