Abstract
Adverse effects of intravenous contrast media (CM) in patients with renal risk factors and acute kidney injury are still controversially discussed. The aim of this study was to investigate whether dual-energy (DE) pulmonary CT angiography (CTPA) in combination with a noise optimized virtual monoenergetic imaging algorithm allows for a reduction of CM. This IRB-approved study comprised 150 patients with suspected pulmonary embolism (78 male; mean age 65 ± 17years). 50 patients with acute/chronic renal failure were examined on a 3rd generation dual-source CT with an optimized DE CTPA protocol and a low CM injection protocol (5.4 g iodine). 100 further patients were either examined with a standard CTPA protocol or a standard DE CTPA (32 g iodine). For the DE CTPA virtual monoenergetic spectral datasets (40–100 keV) were reconstructed. Main pulmonary arteries at 50 keV and peripheral pulmonary arteries at 40 keV datasets provided the highest contrast-to-noise-ratio (CNR) for both the standard DE CTPA and the optimized protocol, with significantly higher CNR values for the standard DE CTPA protocol (p < 0.05). No pulmonary embolism was missed on the optimized CM protocol. DE CTPA utilizing image reconstruction at 40/50 keV allowed for a reduction of 84% in iodine load while maintaining CNR, which is especially important in patients with acute/chronic renal failure.
Highlights
CT pulmonary angiography (CTPA), which requires the injection of iodinated contrast material (CM), is considered the gold-standard diagnostic modality in patients with suspected acute pulmonary embolism (PE)[1]
Dual-energy (DE) CTPA, which allows the calculation of virtual monoenergetic spectral (VMS) images at various kilo-electron volt levels with a minimum of 40 keV, can be used to promote iodine based contrast enhancement as an
The aim of this study was to investigate whether DE CTPA in combination with a recently introduced noise optimized VMS algorithm allows for a further reduction of contrast media (CM) in CTPA studies of patients with renal risk factors
Summary
CT pulmonary angiography (CTPA), which requires the injection of iodinated contrast material (CM), is considered the gold-standard diagnostic modality in patients with suspected acute pulmonary embolism (PE)[1]. Guidelines of the European Society of Urogenital Radiology recommend to use the lowest amount of contrast medium necessary[2] This may be subject to change since administration of intravenous CM in patients with renal risk factors is part of an ongoing controversial discussion and several recent studies have uniformly reported promising results regarding adverse renal reactions such as contrast induced nephropathy (CIN) or acute kidney injury (AKI). Studies have evaluated the feasibility of DE CTPA using a standard CM-, as well as a reduced CM-protocol[10,11,12] These studies have used a first generation VMS software technique, which lacks noise compensation at low keV levels, limiting diagnostic image quality below 60 keV. The aim of this study was to investigate whether DE CTPA in combination with a recently introduced noise optimized VMS algorithm allows for a further reduction of CM in CTPA studies of patients with renal risk factors
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