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

Background Substantial gain in the attenuation of iodine on low-kVp and dual-energy CT processed low-keV virtual monochromatic images provides an opportunity for customization of positive oral contrast media administration. Purpose To perform an intrapatient comparison of bowel labeling, opacification, and taste preference with iodinated oral contrast medium (ICM) in standard (sICM) and 25%-reduced (rICM) concentrations at low tube voltage (100 kVp) or on low-energy (50-70 keV) virtual monochromatic images compared with barium-based oral contrast medium (BCM) at 120 kVp. Materials and Methods In this prospective clinical trial, 200 adults (97 men, 103 women; mean age, 63 years ± 13 [standard deviation]) who weighed less than 113 kg and who were undergoing oncologic surveillance (from April 2017 to July 2018) and who had previously undergone 120-kVp abdominopelvic CT with BCM randomly received sICM (7.2 g iodine) or rICM (5.4 g iodine) and underwent 100-kVp CT or dual-energy CT (80/140 kVp) scans to be in one of four groups (n = 50 each): sICM/100 kVp, rICM/100 kVp, sICM/dual-energy CT, and rICM/dual-energy CT. Qualitative analysis was performed for image quality (with a five-point scale), extent of bowel labeling, and homogeneity of opacification (with a four-point scale). Intraluminal attenuation of opacified small bowel was measured. A post-CT patient survey was performed to indicate contrast medium preference, taste of ICM (with a five-point scale), and adverse effects. Data were analyzed with analogs of analysis of variance. Results All CT studies were of diagnostic image quality (3.4 ± 0.3), with no difference in the degree of bowel opacification between sICM and rICM (P > .05). Compared with BCM/120 kVp (282 HU ± 73), mean attenuation was 78% higher with sICM/100 kVp (459 HU ± 282) and 26%-121% higher at sICM/50-65 keV (50 keV = 626 HU ± 285; 65 keV = 356 HU ± 171). With rICM, attenuation was 46% higher for 100 kVp (385 HU ± 215) and 19%-108% higher for 50-65 keV (50 keV = 567 HU ± 270; 65 keV = 325 HU ± 156) compared with BCM (P < .05). A total of 171 of 200 study participants preferred ICM to BCM, with no taste differences between sICM and rICM (3.9 ± 0.6). Fifteen participants had diarrhea with BCM, but none had diarrhea with ICM. Conclusion A 25%-reduced concentration of iodinated oral contrast medium resulted in acceptable bowel labeling while yielding substantially higher luminal attenuation at low-kVp and low-keV CT examinations with improved preference in patients undergoing treatment for cancer. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Laghi in this issue.