Abstract
To evaluate the influence of low-concentration contrast agents and low-tube-voltage computed tomography on chest enhancement examinations, we conducted a multicenter prospective study. A total of 216 inpatients enrolled from 12 different hospitals were randomly divided into four groups: A: voltage, 120 kVp; iohexol, 350 mgI/mL; B: voltage, 100 kVp, iohexol, 350 mgI/mL; C: voltage, 120 kVp, iodixanol, 270 mgI/mL; and D: voltage, 100 kVp, iodixanol, 270 mgI/mL. Subjective image quality was assessed by two radiologists and compared by weighted kappa test. The objective image scores, scanning radiation doses, and pathological coincidence rates were analyzed. There were no significant differences in gender, age, height, weight, and body mass index between the four groups (p > 0.05). The consistency of the radiologists' ratings were good, with kappa value ranging from 0.736 (95% confidence interval: 0.54-0.933) to 0.809 (95% confidence interval: 0.65-0.968), and there was no difference in subjective image score between the four groups. The computed tomography value of group D had no difference with group A. The volume computed tomography dose index, dose length product, and effective dose of group D (6.93 ± 3.03, 241.55 ± 104.75, and 3.38 ± 1.47, respectively) were all significantly lower than those of group A (10.30 ± 4.37, 359.70 ± 152.65, and 5.04 ± 2.14, respectively). There was no significant difference in the imaging diagnosis accuracy rate between the four groups (p > 0.05). The results indicated that low-concentration contrast agents (270 mgI/mL) and low-tube-voltage (100 kVp) computed tomography can not only decrease radiation dose but also guarantee the image quality and meet the needs of imaging diagnosis in chest enhancement examinations, which make it possible for its generalization and application.
Highlights
For example,[8] as early lesions of lung adenocarcinoma, preinvasive and minimally invasive adenocarcinoma lesions are less invasive to local structures, and many common signs of lung adenocarcinoma are rarely seen in these lesions
Exclusion criteria: 1 patients with a history of other tumours; 2 patients who underwent a plain chest scan with non-isolated nodules; 3 patients with nodules >3cm; 4 patients with a body mass index (BMI) ≥28.0 or ≤18.0; 5 pregnant or lactating women; 6 patients suffering from severe organ failure; 7 patients suffering from moderate to severe renal impairment, which was defined as GFR/eGFR
The contrast-to-noise ratio (CNR) was calculated with the following equation: CNR = (SI vascular 2 SI muscle)/noise, where SI blood vessels are the average computed tomography (CT) values (HU) of the three different layers of blood vessels measured, and noise is defined as the mean of the measured region of interest (ROI) standard deviations (SD)
Summary
Multidetector row computed tomography (CT) imaging is widely used as the valuable imaging method for diagnosing lung diseases.[1,2] It can make a clear judgment on the size, shape, density, and location of the disease and has become an indispensable imaging mode in a wide range of clinical applications.[3,4] in some cases, routine CT examinations do not meet diagnostic needs.[5,6,7] For example,[8] as early lesions of lung adenocarcinoma, preinvasive and minimally invasive adenocarcinoma lesions are less invasive to local structures, and many common signs of lung adenocarcinoma are rarely seen in these lesions (burrs, lobes, empty bubbles, and pleural depression). Enhanced CT examination through the body injection of contrast agents can clearly show the blood supply of space-occupying lesions, as well as a good and malignant judgment of its pathological properties, providing an important basis for the determination of the treatment.[9,10,11] as the number of enhanced CT scans in the lungs increases, the radiation dose problem has become a focus of attention.[12] How to reduce the scanning dose is a clinical hot spot, and it is difficult without affecting the quality of CT images. The purpose of our study is to prospectively determine, with a multicenter study, the feasibility of applying low-concentration contrast agents and low-tubevoltage CT to the examination of chest and to make it possible for its generalization and application
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