Low-contrast-dose protocol in cardiac CT: 20% contrast dose reduction using 100 kVp and high-tube-current-time setting in 256-slice CT.

BACKGROUND: The use of the smallest contrast dose is highly desirable in performing cardiac computed tomography (CT), especially for patients with cardiovascular diseases to prevent contrast-induced nephropathy. PURPOSE: To evaluate the feasibility of 20% reduced contrast dose protocol in cardiac CT using 100 kVp and high-tube-current-time product setting. MATERIAL AND METHODS: Fifty patients were scanned with our conventional 120 kVp protocol, and the other 50 patients underwent scans using a tube voltage of 100 kVp, a high-tube-current-time product, and a 20% reduced contrast dose. We evaluated estimated effective dose (ED), CT attenuation, image noise, and contrast-to-noise ratio (CNR) of the ascending aorta. We also evaluated CT attenuation of the coronary arteries. Two radiologists independently assessed image quality of coronary arteries. RESULTS: There was no significant difference in the ED between the 100 kVp and 120 kVp protocols (21.7 mSv ± 1.6 vs. 21.8 mSv ± 1.1, P=0.65). There was no significant difference in the CNR of the ascending aorta between the 100 kVp and 120 kVp protocols (18.8 ± 3.5 vs. 18.7 ± 3.8, P=0.98). Mean CT attenuation of the coronary arteries of the 100 kVp protocols was significantly higher than that of 120 kVp protocols (P<0.05). There was no significant difference in the overall image quality of the coronary artery between the 100 kVp and 120 kVp protocols (3.7 ± 0.4 vs. 3.7 ± 0.5, P=0.65). CONCLUSION: For cardiac CT a voltage setting of 100 kVp and a high-tube-current-time product enable 20% reduction in the contrast dose without affecting the quality of coronary artery images compared with a 120 kVp and standard-contrast-dose CT protocol.

Subtracted 3D CT angiography for the evaluation of intracranial aneurysms in 256-slice multidetector CT: usefulness of the 80-kVp plus compact contrast medium bolus protocol.

OBJECTIVES: To evaluate the usefulness of an 80-kVp and compact contrast material protocol for arterial phase subtracted cerebral 3D-CTA using 256-slice multidetector CT. METHODS: Thirty-two patients underwent CT with 100 kVp and received a contrast dose of 370 mgI/kg body weight over 15 s (protocol A). Thirty-three patients underwent CT with 100 kVp and received a contrast dose of 296 mgI/kg body weight over 10 s (protocol B). Thirty-three other patients underwent CT with 80 kVp and received a contrast medium dose of 296 mgI/kg body weight over 10 s (protocol C). We compared the arterial attenuation and contrast noise ratio (CNR) of each protocol. Two independent readers assessed overall image quality. RESULTS: Arterial attenuation was significantly higher under protocols A (418.6 ± 71.1 HU) and C (442.7 ± 79.3 HU) than under protocol B (355.8 ± 107.2 HU; P < 0.05). The CNR of protocol C (26.1 ± 6.1) was higher than that of protocol A (20.7 ± 8.4; P < 0.05). The overall image quality of protocol A was higher than that of protocol C (P < 0.01). CONCLUSION: The 80-kVp plus compact contrast protocol is well suited to arterial phase subtracted cerebral 3D-CTA without confounding venous enhancement. KEY POINTS: • Subtracted 3D CT angiography is useful in the evaluation of intracranial aneurysms. • A compact contrast material protocol increased arterial attenuation without venous contamination. • Low-kVp CT compensated for the decreased amount of contrast medium. • An 80-kVp CT with a compact enhancement bolus provides good intracranial 3D-CT angiography.

Low-contrast dose protection protocol for diagnostic computed tomography in patients at high-risk for contrast-induced nephropathy.

OBJECTIVE: To evaluate the safety of a low-contrast dose computed tomography (CT) protocol for patients with renal insufficiency for contrast-induced nephropathy. METHODS: One hundred forty-three patients with renal insufficiency who underwent low-contrast dose-enhanced abdominal CT were reviewed. Another group of 327 patients who received unenhanced CT was reviewed as a control group. Baseline serum creatinine and estimated glomerular filtration rate (eGFR) levels were obtained for all patients to determine the contrast dosing (1.6 and 1.0 mL/kg for patients with eGFR levels 30-59 and 15-29). We compared the incidence of acute kidney injury between the groups. RESULTS: There were no significant differences in the incidence of acute kidney injury between the low-contrast dose and unenhanced CT protocols (9.1% vs 8.3%, P = 0.77). None of the patients with renal dysfunction required postprocedure dialysis. CONCLUSION: The low-contrast dose CT protocol might enable us to perform a contrast-enhanced study without any major safety concerns.

Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256-detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality.

PURPOSE: To evaluate the effect on image quality of a low contrast agent dose and radiation dose protocol at abdominal dynamic computed tomography (CT) with a low tube voltage, hybrid iterative reconstruction algorithm, and a 256- detector row scanner. MATERIALS AND METHODS: This prospective study received institutional review board approval, and prior informed written consent was obtained from all patients. Seventy-four patients undergoing hepatic dynamic CT were randomly assigned to one of two protocols: Thirty-nine patients underwent scanning with the conventional 120-kVp protocol and the other 35 patients underwent scanning with an 80-kVp tube voltage and a 40% reduction in contrast agent dose. The 80-kVp images were also postprocessed with a hybrid iterative reconstruction algorithm. The estimated effective radiation dose of each protocol was compared and the image noise and contrast-to-noise-ratio (CNR) of the 120-kVp, 80-kVp, and hybrid iterative reconstructed 80-kVp images were evaluated by using the Student t test. RESULTS: The effective radiation dose was 51% lower during the hepatic arterial phase (HAP) and 48% lower during the portal venous phase (PVP) with the 80-kVp protocol than with the 120-kVp protocol (HAP: 5.6 mSv ± 1.0 [standard deviation] vs 11.6 mSv ± 3.3; PVP: 5.8 mSv ± 0.7 vs 11.2 mSv ± 3.2, respectively). The hybrid iterative reconstruction decreased image noise by 23% during the HAP (9.2 ± 1.9 vs 12.0 ± 2.6) and by 24% during the PVP (9.4 ± 1.8 vs 12.3 ± 2.6). There were no significant differences in the CNR of any of the regions of interest between 80-kVp with iterative reconstruction and 120-kVp protocols (P = .46-.85). CONCLUSION: A low tube voltage and the hybrid iterative reconstruction algorithm can dramatically decrease radiation and contrast agent doses with adequate image quality at hepatic dynamic CT of thin adults with use of a 256-detector row scanner.

Abdominal dynamic CT in patients with renal dysfunction: contrast agent dose reduction with low tube voltage and high tube current-time product settings at 256-detector row CT.

PURPOSE: To evaluate the feasibility of a low-contrast agent dose protocol at abdominal dynamic computed tomography (CT) with a low tube voltage high tube current-time product technique and a 256-detector row CT unit. MATERIALS AND METHODS: This prospective study received institutional review board approval; written informed consent to participate was obtained from all patients. The study included 151 patients; 117 had an estimated glomerular filtration rate (eGFR) greater than or equal to 60 mL/min/1.73 m(2). These patients were examined with the conventional 120-kVp protocol. The other 34 patients underwent scanning with an 80-kVp tube voltage, a high tube current-time product, and a 40% reduction in contrast agent dose. Effective dose (ED), image noise, attenuation, contrast-to-noise ratio (CNR), and figure of merit of the aorta in the arterial phase and of the portal vein and hepatic parenchyma in the portal venous phase in the two groups were compared with the Student t test. RESULTS: Estimated ED was about 20% lower with the 80-kVp protocol than with the 120-kVp protocol. There were no significant differences in CNR in any region of interest between the 80-kVp protocol and the 120-kVp protocol (abdominal aorta: 36.9 ± 9.7 [standard deviation] vs 36.1 ± 8.1, P = .63; portal vein: 13.4 ± 3.2 vs 13.1 ± 3.2, P = .65; hepatic parenchyma: 6.4 ± 2.6 vs 6.7 ± 2.3, P = .51). CONCLUSION: Contrast dose at hepatic dynamic 256-detector row CT in patients with renal dysfunction can be decreased by 40% with this protocol by using the 80-kVp setting and a high tube current-time product.

Low-kilovoltage, high-tube-current MDCT of liver in thin adults: pilot study evaluating radiation dose, image quality, and display settings.

OBJECTIVE: The purpose of our study was to evaluate the effect of a low tube voltage-high tube current-time product technique for portal phase abdominal CT of thin adults. SUBJECTS AND METHODS: This study included 25 patients who had undergone portal phase abdominal CT at 120 kVp in the preceding 6 months. All were scanned using 80 kVp and high tube-current time products. We assessed the estimated effective dose (ED), image noise, attenuation, contrast-to-noise ratio (CNR), and figure of merit of the liver and portal vein. Two radiologists evaluated the quality of scans for image contrast and streak artifacts at 80 kVp, 120 kVp, and 80 kVp with wide window width display presets (W-80). RESULTS: The estimated ED was 33% lower at 80 than at 120 kVp. CNR of the portal vein was 36.8% higher at 80 than 120 kVp, and for the liver it was 17.7% higher at 80 than 120 kVp. The visual score of image contrast was significantly higher for W-80 than for 120 kVp; however, there was no significant difference in the visual score of streak artifacts. CONCLUSION: At portal phase abdominal CT, 80 kVp and a high tube current-time product setting significantly improved image quality and reduced the radiation dose compared with 120 kVp.

A low-kilovolt (peak) high-tube current technique improves venous enhancement and reduces the radiation dose at indirect multidetector-row CT venography: initial experience.

OBJECTIVE: The purpose was to evaluate the image noise, contrast-to-noise ratio, and radiation dose at indirect multidetector-row computed tomographic venography (CTV) using a low-kilovolt (peak) (kV[p]) high-tube current technique. MATERIALS AND METHODS: Thirty patients underwent indirect CTV of the lower extremity at 120 kV(p) with 170 mA and at 80 kV(p) with 426 mA (CT dose index volumes 11.8 and 9.0 mGy, respectively) on a 64-detector CT scanner. We assessed CT numbers, image noise, and contrast-to-noise ratio of deep (femoral and popliteal) veins. RESULTS: The mean (SD) CT numbers of the femoral and popliteal veins were significantly greater at 80 kV(p) than at 120 kV(p) (142.8 [24.5] and 147.0 [19.4] Hounsfield units [HU], respectively, vs 93.1 [15.5] and 105.0 [14.9] HU, respectively; P < 0.01). The mean (SD) image noise was significantly higher at 80 kV(p) than at 120 kV(p) (11.6 [2.6] and 7.4 [1.4] HU, respectively, vs 8.9 [1.6] and 6.2 [1.5] HU, respectively; P < 0.01). Contrast-to-noise ratios at the femoral and popliteal veins were significantly higher at 80 kV(p) than at 120 kV(p) (6.0 [2.2] and 9.7 [2.4], respectively vs 3.3 [1.8] and 6.9 [2.5], respectively; P < 0.01). CONCLUSION: At indirect CTV, 80 kV(p) and a high tube current setting yielded significantly improved image quality at a reduced radiation dose compared with 120 kV(p).

Effects of a high-pitch protocol and a hybrid iterative reconstruction algorithm on image quality of cerebral subtracted 3D CT angiography.

PURPOSE: To evaluate the image quality and the radiation dose of 3D-computed tomography angiography (3D-CTA) with a high-pitch protocol and a hybrid iterative reconstruction (HIR). MATERIALS AND METHODS: This was a prospective study and thirty patients were scanned at a 0.51-helical pitch with filtered back-projection (FBP, protocol-A), and 30 patients were scanned at a 0.91-helical pitch with FBP and HIR (protocol-B and C). The mean volume CT dose index (CTDI(vol)), image noise, and mean cerebral arterial and venous attenuation were compared between the three protocols. Two readers assessed image noise, arterial contrast and venous overlap. RESULTS: The mean CTDI(vol) of protocol-B/C (38.9 mGy) was lower than that of protocol-A (49.7 mGy). Mean image noise of protocol-B [12.6 ± 1.3 Hounsfield units (HU)] was higher than that of protocol-A (10.3 ± 1.2 HU). There was no significant difference in arterial attenuation between protocol-A (327.5 ± 57.5 HU) and C (327.7 ± 59.4 HU). Venous attenuation of protocol-C (148.5 ± 50.4 HU) was lower than that of protocol-A (185.9 ± 50.6 HU). In qualitative analysis, the image noise of protocol-B was higher than that of protocol-A/C. Venous enhancement of protocol-B/C was more inconspicuous than that of protocol-A. CONCLUSIONS: 3D-CTA with a high-pitch protocol and HIR can reduce radiation dose while decreasing venous enhancement and image noise to an adequate level for diagnosis.

Compact-bolus dynamic CT protocol with a test bolus technique in 64-MDCT coronary angiography: comparison of fixed injection rate and duration protocol.

PURPOSE: We compared the fixed injection rate protocol (P2) with the fixed injection duration protocol (P1) for coronary CT angiography using the test bolus technique. MATERIALS AND METHODS: We randomly assigned 100 patients to one of two protocols. In P1, they received 0.7 mL/kg Iohexol-350 in an injection duration of 9 s, and we selected a delay of 3 s after peak enhancement of test bolus scan. In P2, they received 0.7 mL/kg Iohexol-350 at an injection rate of 5 mL/s, and we selected a delay after peak enhancement of test bolus scan using the following formula: TID/2-2 s, where TID is the injection duration of full bolus. We compared attenuation values in the ascending aorta and coronary arteries and patient-to-patient enhancement variability at each segment. RESULTS: At all segments, CT attenuations of P2 were significantly greater than those of P1 (ascending aorta 400 ± 64 vs. 368 ± 60, P = 0.01; left main trunk 399 ± 67 vs. 369 ± 55, P = 0.02; proximal-RCA 393 ± 66 vs. 363 ± 56, P = 0.01). There was no significant difference in patient-to-patient enhancement variability at all segments between the two groups (P > 0.05). CONCLUSION: P2 yielded superior vessel enhancement and comparable patient-to-patient enhancement variability compared with P1 in thin patients.

MR diagnosis of vertebral artery dissection: value of 3D time-of-flight and true fast imaging with steady-state precession fusion imaging.

OBJECTIVES: We hypothesized that 3D time-of-flight (TOF) and true fast imaging with steady-state precession (true-FISP) fusion imaging could provide more information regarding the arterial vessel wall. The purpose of this study was to compare the accuracy of lesion detection and the diagnostic confidence of VAD between TOF images alone and fused TOF and true-FISP images. METHODS: Fifty patients were studied: 17 had VAD and 33 had vertebral artery hypoplasia. Fusion images of the vertebral artery were reconstructed using a workstation. A receiver-operating characteristic (ROC) analysis was conducted with a continuous rating scale from 1 to 100 to compare observer performance in VAD detection. Five radiologists participated in the observer performance test, and their performances with TOF images were compared with those using fused images. RESULT: The observers found that the mean areas under the best-fit ROC curve for TOF images alone and fused TOF images were 0.66 ± 0.05 and 0.93 ± 0.04, which were significantly different (P < 0.01). CONCLUSION: The fusion images provided more information regarding the arterial vessel wall. Fused images aided distinction between vertebral artery dissection versus vertebral artery hypoplasia. KEY POINTS : • New MR techniques can help to differentiate flowing blood from static blood products. • Fused TOF and true-FISP images differentiate the lumen and the arterial wall, improving diagnostic performance. • Fused images may be superior to time-of-flight MR angiography alone.