Abstract
Objectives: To evaluate multiphase low kV computed tomography (CT) imaging of the abdomen with reduced contrast media (CM) dose using different injection protocols. Methods: Two injection protocols were evaluated for use with low kV (80 kV) multiphase abdominal imaging in comparison to the standard procedure acquired at 120 kV (500 mgI/kg; 5 mL/s). This evaluation was conducted in a highly standardized animal study (5 Goettingen minipigs). The low kV protocols consisted of (a) a single-flow (SF) injection with 40% reduced CM dose and injection rate (300 mgI/kg; 3 mL/s) and (b) a DualFlow (DF) injection protocol consisting of 60%/40% contrast to saline ratio administered at 5 mL/s. Dynamic CT was first performed within representative liver regions to determine optimal contrast phases, followed by evaluation of the three protocols in multiphase abdominal CT imaging. The evaluation criteria included contrast enhancement (CE) of abdominal organs and vasculature. Results: The 80 kV DF injection protocol showed similar CE of the abdominal parenchymatous organs and vessels to the 120 kV reference and the 80 kV SF protocol. Hepatic parenchyma showed comparable CT values for all contrast phases. In particular, in the portal venous parenchymal phase, the 80 kV DF protocol demonstrated higher hepatic parenchymal enhancement; however, results were statistically non-significant. Similarly, CE of the kidney, pancreas, and abdominal arterial/venous vessels showed no significant differences between injection protocols. Conclusions: Adapted SF and DF injection protocols with reduced IDR/iodine load offer the potential to calibrate optimal CM doses to the tube voltage in abdominal multiphase low kV CT imaging. The data suggest that the DF approach allows the use of predefined injection protocols and adaption of the contrast to saline ratio to an individualized kV setting and yields the potential for patient-individualized CM adaption.
Highlights
Low kV imaging in computed tomography (CT) offers the possibility of both a significant reduction in radiation dose and a significant reduction in the amount of contrast medium (CM) to be administered
Within these region of interest (ROI), no obvious differences in the bolus shape among injection protocols were observed for any of these structures, i.e., the two 80 kV injection protocols led to almost identical time attenuation curves (TAC) when compared to the 120 kV reference
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Summary
Low kV imaging in CT offers the possibility of both a significant reduction in radiation dose and a significant reduction in the amount of contrast medium (CM) to be administered. Due to the specific absorption properties of iodine, with increasing attenuation at lower kV levels, the possibility of up to a 50% reduction in CM dose in CTA at 70 kV has been shown [3,4] This can be combined with low radiation dose scan protocols [5]. Initial clinical studies have investigated hepatic pathologies such as HCC in low kV imaging in CT mostly in Asian populations with lower body weight [6,7,8] Recent technological innovations such as increased X-ray tube power and improved reconstruction techniques may allow for low kV abdominal CT to be utilized in an increasing patient population (6)
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