Low-concentration Contrast Medium Research Articles

Impact of different concentration iodinated contrast media on pain and comfort in abdominal computed tomography

ObjectivesTo investigate whether high concentration iodinated contrast media (CM), compared with low concentration CM, could reduce pain and discomfort levels in patients who had level II and III venous conditions. MethodsThis prospective, single-center study enrolled patients who had level II and III venous conditions and underwent abdominal contrast-enhanced CT scan between July 2021 and February 2022. The venous condition to establish peripheral venous access for CM injection was graded using the Intravenous Access Scoring system, of which level II and III indicated poor venous condition and difficult venous access. Patients received iomeprol 400 in high concentration group and ioversol 320 in low group at an identical iodine delivery rate of 1.12 gI/s. The primary outcomes were pain and comfort levels. The secondary outcomes included adverse events and image quality. Patients rated pain intensity via Numerical Rating Scale and comfort level via Visual Analogue Scale with higher scores indicating higher levels of pain and discomfort. Quantitative and qualitative image assessment were compared between two groups. Continuous variables were compared using Student’s t test or Mann-Whitney U test. Categorical variables were compared using χ2 test, χ2 test for trend or Fisher’s exact test. ResultsA total of 206 patients (mean age, 60.13 ± 12.14 years; 81 males) were included with 99 in the high concentration group and 107 in the low concentration group. The high group had significantly lower pain scores (median 1 [IQR: 0–2] vs 2 (IQR 2–4), p < 0.001) and comfort scores (1 [IQR: 0–3] vs 3 [IQR: 2–5], p < 0.001) than the low group. Incidence of CM extravasation did not significantly differ (1.0 % vs 4.5 %, p = 0.214). No hypersensitivity reaction was observed. Qualitative assessment showed higher clarity scores of intrahepatic hepatic artery and portal vein in the high group. Quantitative assessment results were comparable between two groups. ConclusionHigh concentration iodinated CM could lower pain intensity and improve comfort levels without comprising image quality of CT scan. High concentration CM is a preferable choice in patients with poor venous conditions during contrast-enhanced CT scan.

Double low-dose computed tomography (CT) angiography of craniocervical arteries using a test bolus of diluted contrast medium and a personalized contrast protocol

To prospectively assess the value of a test bolus of diluted contrast medium (CM) combined with a personalized contrast protocol in craniocervical computed tomography angiography (cc-CTA) with low radiation and CM doses. Eighty-six consecutive subjects were divided into two groups at random (43 in each one): group A: 100/Sn140 kVp, filtered back-projection reconstruction, iopromide (370 mgI/ml) 50 ml; group B: 80/Sn140 kVp, iterative reconstruction, iodixanol (270 mgI/ml). In group B, the test bolus contained 27 ml of diluted CM, a personalized protocol with low-concentration CM was used for angiography, and the test bolus injection duration in angiography remained the same. Artery values over 200 Hounsfield units were considered significant. Image quality for all cases was found to be diagnostic. No significant differences were found in the arterial densities of the ascending aorta or basilar artery between the groups. The values of the common carotid artery, internal carotid artery, and middle cerebral artery in group B were significantly lower. The effective dose and average iodine uptake were significantly lower in group B. With double-low-dose cc-CTA, test bolus scanning based on diluted CM combined with a personalized contrast protocol can yield diagnostic-quality images and significantly reduce the radiation and CM doses.

Simultaneous Injection of Contrast and Saline Using Spiral Flow-Generating Tube for Hepatic Dynamic Computed Tomography: Effect on Enhancement of Liver Parenchyma and Metastases to the Liver.

Recently, there have been a few reports regarding the usefulness of a novel saline injection technique using a spiral flow-generating tube. The purpose of this study was to evaluate whether simultaneous saline injection using a spiral flow-generating tube was able to improve hepatic contrast enhancement and lesion conspicuity of metastatic liver tumors. We randomized a total of 411 patients with various liver diseases including metastases by total body weight (A, n = 204) and contrast dilution protocol (B, n = 207). Group A received 400 mgI/kg of contrast medium alone without a spiral flow-generating tube; group B received contrast medium 400 mgI/kg simultaneous with injection of a 0.57-ml/kg physiologic saline solution through a spiral flow-generating tube. Abdominal aorta computed tomography (CT) number, hepatic enhancement (ΔHU), percentage of tests demonstrating an enhancement effect of the liver parenchyma exceeding Δ50 HU in 3 measured segments (S2, S6, and S8), and the contrast-to-noise ratio of the metastatic liver tumors were measured. The mean aortic CT number of group B (417.0 HU ± 61.7; P < 0.01) was approximately 10% higher than that of group A (384.6 ± 79.1 HU). The average ΔHU was 59.8 ± 11.4 HU for group A and 61.7 ± 11.7 for group B. The ΔHU for group B was significantly higher than that for group A (P = 0.017). The percentage of tests demonstrating with the enhancement effect of group B was more than 80% in all subgroups; however, that of group A was less than 80% in all subgroups. The contrast-to-noise ratio of group B (7.8 ± 3.3 HU) was significantly higher compared to that of group A (6.5 ± 2.8 HU) (P < 0.05). Because of the volume effect, injecting a contrast medium diluted with normal saline improved the degree of hepatic and aortic contrast enhancement and achieved better visualization of liver metastases. The use of spiral flow-generating tube may help diagnostic of hepatic and aortic contrast enhancement and liver metastases. The use of a spiral flow-generating tube improved the degree of hepatic and aortic contrast enhancement and achieve better visualization of liver metastases. The use of low-concentration syringe formulations is limited by body weight. However, the use of spiral flow-generating tube provides low-concentration contrast medium regardless of body weight.

관상동맥 CT와 심근관류 CT 검사를 이용한 고농도 조영제와 저농도 조영제 간 비교 평가

With the advancement of CT technology, the use of low tube voltages, and the clinical efficacy of low-concentration contrast media are gradually being demonstrated. In this study, we compared the differences between high- and low-concentration contrast media using Coronary Computed Tomography Angiography (CCTA) and Computed Tomography-Myocardial Perfusion Imaging (CT-MPI). These imaging techniques can simultaneously evaluate the patient's hemodynamic distribution and myocardium. The study results indicated that the quantitative analysis of tissues and blood vessels in CCTA showed that high-concentration contrast media led to a 5 to 10% increase in Hounsfield Units (HU), but the probability of significance was greater than 0.05. As a result of myocardial evaluation using CCTA and CT-MPI, the difference between the two contrast agents was within 5%, and the probability of significance was greater than 0.05. Qualitative analysis utilized nominal measurements in five categories and did not reveal significant differences between low- and high-concentration contrast media with a significance probability greater than 0.05. This study differed from existing studies by utilizing high- and low-concentration contrast media for CCTA and CT-MPI examinations. Analysis using CCTA and CT-MPI shows that low-concentration images are not inferior to images obtained using high-concentration contrast media.

A feasibility study of different GSI noise indexes and concentrations of contrast medium in hepatic CT angiography of overweight patients: image quality, radiation dose, and iodine intake.

To conduct a comparative study of image quality, radiation dose, and iodine intake in hepatic computed tomographic angiography (CTA) of overweight patients with different Gemstone Spectral Imaging (GSI) noise indexes combined with different concentrations of contrast medium. Ninety patients with a body mass index of ≥ 25kg/m2 were divided into three groups (A, B and C), each with 30 patients. The three groups underwent hepatic CTA with different NI of 7, 11 and 15, respectively, and were injected with different iodine concentrations of 370, 350 and 320mgI/mL, respectively. Five sets of images at 40-60keV (interval, 5keV) were reconstructed in each group. The CT value, image noise, contrast-to-noise ratio (CNR) and subjective score of the hepatic artery and vein, and portal vein in different monochromatic image sets were analyzed to select the optimal energy level in each group. The differences in CT value, image noise, CNR and a subjective score of hepatic artery and vein, portal vein in the optimal monochromatic images among the three groups were compared, the volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded, and the effective dose and iodine intake were calculated. The 40keV was determined to be the optimal energy level for the monochromatic image sets in each group. No significant group differences were noted in the CT value, image noise, CNR, and subjective image scores of the hepatic artery and vein, and portal vein for the optimal monochromatic images (P > 0.05). Compared with group A, the effective dose and iodine intake in group B were reduced by 50.18% and 9.3%, and by 58.12% and 14.23% in group C, respectively. A low-concentration contrast medium combined with a high-noise GSI index in hepatic CTA of overweight patients can reduce the radiation dose and iodine intake while ensuring image quality.

Value of CT Angiography Using Low Tube Voltage and Low Contrast Combined with Iterative Model Reconstruction in Patients with Coronary Artery Bypass Grafts

Objective To assess the value of CT angiography using low-voltage and low-concentration contrast media (CM) combined with knowledge-based iterative model reconstruction (IMR) in patients with coronary artery bypass grafts (CABG).Methods Totally 71 patients after CABG undergoing CT angiography in our center from June to November 2016 were prospectively enrolled and randomly assigned into groups A and B. The scan protocol for group A was 80 kVp with 300 mgI/ml contrast at an injection rate of 4 ml/s;images were reconstructed by IMR algorithm. The scan protocol for group B was 100 kVp with 370 mgI/ml contrast at an injection rate of 5 ml/s;images were reconstructed by hybrid iterative reconstruction technique. Aorta,left ventricular,and grafts were chosen as regions of interest. The image quality,radiation dose,and contrast load were compared between two groups.Results The signal to noise ratio (SNR) and contrast to noise ratio (CNR) of the ascending aorta,descending aorta,left ventricular,and venous bridge in group A [SNR:19±5,20±5.7,19.1±4.9,and 37±34;CNR:17±4.7,18±5,16±5.4,and 34±32] were significantly higher than those in group B [SNR:16±6 (P=0.012),15.6±5.5 (P=0.002),15±6 (P=0.002),24±8.3 (P=0.035);CNR:14±5.5 (P=0.010),13.8±5(P=0.002),13±5.7 (P=0.014),21±7.8 (P=0.031)],except for left internal mammary artery graft (LIMA),which was not inferior to that in group B. An effective radiation dose reduction of 49% was achieved in group A [(2.3±0.4) mSv,compared with group B (4.5±0.5) mSv (P=0.000)]. The iodine load of group A was (20±1.4) g compared with (29±1.6) g in group B,resulting in a reduction of 31% (P=0.000).Conclusions The low tube voltage (80 kVp) and low contrast protocol combined with IMR in patients with CABG can reduce radiation dose and improve image quality of aorta,left ventricular and venous graft. The image quality of LIMA graft in low dose group is not inferior to that in regular dose group.

An open label, prospective, multicenter, non-interventional study of iodixanol 270 mg I/mL for use in individuals undergoing computed tomography angiography in real-world clinical practice.

Concern about radiation exposure is leading to an increasing interest in low-concentration contrast medium administration. To evaluate the image quality and safety profile after administration of iodixanol 270 mg I/mL at 100-kVp tube voltage with iterative reconstruction in subjects undergoing computed tomography angiography (CTA). Patients who completed CTA examination using iodixanol 270 mg I/mL and 100-kVp tube voltage along with iterative reconstruction for coronary, aortic, head and neck, renal, or pulmonary arteries were included. Image quality was qualitatively and quantitatively evaluated. Incidence of adverse events (AEs) and adverse drug reactions (ADRs) within seven days and radiation dose were also analyzed. A total of 4513 individuals in 42 centers in China were enrolled, among which 4367 were included in efficacy analysis. The mean image quality score was 4.8 ± 0.45 across all arteries (all above 4.6) and 99.7% of the individuals' images were classified as evaluable. The CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the regions of interest (ROIs) were 431.79 ± 99.018, 18.29 ± 11.947, and 28.21 ± 19.535 HU, respectively. Of all the participants, 68 (1.5%) and 65 (1.4%) experienced AEs and ADRs, respectively. No serious AEs or AEs leading to discontinuation occurred. The average effective radiation dose was 3.13 ± 2.550 mSv. Iodixanol 270 mg I/mL in combination with 100-kVp tube voltage and iterative reconstruction could be safely applied in CTA and yield high-quality and evaluable images with reduced radiation dose.

Assessment of an advanced virtual monoenergetic reconstruction technique in cerebral and cervical angiography with third-generation dual-source CT: Feasibility of using low-concentration contrast medium.

To investigate the feasibility of low-concentration contrast media (LC-CM) in cerebral and cervical dual-energy CT angiography (DE-CTA) using an advanced monoenergetic (Mono+) reconstruction technique. Sixty-five consecutive patients prospectively selected to undergo cerebral and cervical DE-CTA were randomised into two groups: 32 patients (63.7 ± 9.7 years) in the high-concentration contrast medium (HC-CM) group with iopromide 370 and 33 patients (60.7 ± 10.8 years) in the low-concentration contrast medium (LC-CM) group with iodixanol 270. Traditional monoenergetic (Mono) and Mono+ images from 40 to 100 keV levels (at 10-keV intervals) and the standard mixed (Mixed, 120 kVp equivalent) images were reconstructed. Subjective image quality parameters included the contrast-to-noise ratio (CNR) and objective image quality parameters were evaluated and compared between the two groups. The 40-keV Mono+ images in the LC-CM group showed comparable objective CNR (common carotid arteries: 83.7 ± 24.5 vs. 78.1 ± 23.2; internal carotid arteries: 82.2 ± 26.8 vs. 76.8 ± 24.1; middle cerebral arteries: 72.5 ± 24.6 vs. 70.6 ± 19.2; all p > 0.05) and subjective image scores (3.95 ± 0.19 vs. 3.83 ± 0.35; p > 0.05) compared with Mixed images in the HC-CM group. The Mono+ reconstruction technique could reduce the concentration of iodinated CM in the diagnosis of cerebral and cervical angiography. • Mono+ shows decreased noise and superior CNR compared with Mono. • The 40-keV Mono+ images show the highest CNR in the LC-CM group. • The Mono+ reconstruction technique could reduce the concentration of iodinated CM.

Evaluation of a High Concentrated Contrast Media Injection Protocol in Combination with Low Tube Current for Dose Reduction in Coronary Computed Tomography Angiography: A Randomized, Two-center Prospective Study

The study aimed to prospectively evaluate the radiation dose reduction potential and image quality (IQ) of a high-concentration contrast media (HCCM) injection protocol in combination with a low tube current (mAs) in coronary computed tomography angiography. Eighty-one consecutive patients (mean age: 62 years; 34 females; body mass index: 18-31) were included and randomized-assigned into two groups. All computed tomography (CT) examinations were performed in two groups with the same tube voltage (100 kV), flow rate of contrast medium (5.0 mL/s), and iodine dose (22.8 g). An automatic mAs and low concentration contrast medium (300 mgI/mL) were used in group A, whereas effective mAs was reduced by a factor 0.6 along with HCCM (400 mgI/mL) in group B. Radiation dose was assessed (CT dose index [CTDIvol] and dose length product), and vessel-based objective IQ for various regions of interest (enhancement, noise, signal-to-noise ratio, and contrast-to-noise ratio), subjective IQ, noise, and motion artifacts were analyzed overall and vessel-based with a 5-point Likert scale. The CT attenuation of coronary arteries and image noise in group B were significantly higher than those in group A (ranges: 507.5-548.1 Hounsfield units vs 407.5-444.5 Hounsfield units; and 20.3 ± 8.6 vs 17.7 ± 8.0) (P ≤ 0.0166). There was no significant difference between the two groups in signal-to-noise ratio, contrast-to-noise ratio, and subjective IQ of coronary arteries (29.4-31.7, 30.0-37.0, and medium score of 5 in group A vs 29.4-32.4, 27.7-36.3, and medium score of 5 in group B, respectively, P ≥ 0.1859). Both mean CTDIvol and dose length product in group B were 58% of those of group A. HCCM combined with low tube current allows dose reduction in coronary computed tomography angiography and does not compromise IQ.

Overall evaluability of low dose protocol for computed tomography angiography of thoracic aorta using 80kV and iterative reconstruction algorithm using different concentration contrast media.

Multidetector Computed Tomography Angiography (MDCTA) is presently the imaging modality of choice for aortic disease. However, the effective radiation dose and the risk related to the use of contrast agents associated with MDCTA is an issue of concern. Aim of this study was to assess image quality of a low dose ECG-gated MDCTA of thoracic aorta using different concentration contrast media without tailored injection protocol. Two-hundred patients were randomised into four different scan protocols: Group A (Iodixanol 320 and 80 Kvp tube voltage), Group B (Iodixanol 320 and 100Kvp tube voltage), Group C (Iomeprol 400 and 80Kvp tube voltage) and Group D (Iomeprol 400 and 100Kvp tube voltage). Image quality, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and effective dose (ED) were compared among groups. No significant differences in image noise, SNR and CNR between groups with the same tube voltage. Significant differences in SNR and CNR were found among groups with 80kV versus groups using 100kV but without differences in terms of image quality. ED was significantly lower in groups with 80kV. Multidetector Computed Tomography Angiography protocols using 80kV and low concentration contrast media are feasible without need of tailored injection protocols.

Prospective ECG-triggering cardiac CT for infants with complex congenital heart disease using low-dose contrast medium, low tube voltage, and adaptive statistical iterative reconstruction

To demonstrate the clinical value of prospective electrocardiography (ECG)-triggered cardiac computed tomography (CT) with low concentration contrast medium, low tube voltage, and adaptive statistic iterative reconstruction (ASIR) to reduce both radiation and contrast dose in examining infants with complex congenital heart disease (CHD). Forty-four consecutive infants (19 male, 25 female, age: 8.06±4.33 months, weight: 7.31±1.36kg) with complex CHD underwent prospective ECG-triggered low-dose cardiac CT using 80 kVp and 120mA. The contrast agent was iodixanol (270mg iodine/ml, Visipaque, GE Healthcare, Co. Cork, Ireland). Cardiac CT images were reconstructed with 70% ASIR. The quantitative CT image quality was assessed by image noise in adipose tissue and contrast-to-noise ratio (CNR) in the aorta. The qualitative image analysis was performed on a five-point grading scale by two independent reviewers and interobserver variability was calculated. The results of 32 CT examinations were also compared with the available surgical results for diagnostic accuracy evaluation. The effective dose was 0.55±0.10mSv for the patient population. The iodine load was 3.95±0.73g iodine. Image noise in adipose tissue was 16.24±1.42 HU and CNR in aorta was 21.90±7.10. All images were acceptable for diagnosis with an average score of 4.52±0.38 and good agreement between reviewers (kappa=0.75). Compared to the surgery results in 32 cases, CT was 97% and 88% accurate diagnosing extracardiac and intracardiac defects, respectively. Prospective ECG-triggered cardiac CT using 80 kVp, low-concentration iodinated contrast agent (270mg iodine/ml) and 70% ASIR reconstruction provides excellent image quality and accurate diagnosis for complex congenital heart disease in infants with reduced contrast medium dose and low radiation dose.

Application of low concentration contrast medium in spectral CT imaging for CT portal venography.

To investigate the effect of low-concentration contrast medium on spectral computed tomography (CT) image quality for portal venography CT. 150 patients with suspected portal diseases were divided into three groups and had spectral CT examination using aGE Discovery CT 750 HD scanner. The patients in three groups were injected with different concentrations of iodine (350 mgI/mL, 315 mgI/mL and 280 mgI/mL) at an injection rate of 4.0-5.0 mL/s with 1.2 mL/kg (body weight) of contrast medium, respectively. During the portal vein imaging phase, 0.625 mm-slice-thickness monochromatic images and optimal monochromatic images were obtained. Optimal keV mono-energy was achieved using the optimal contrast-to-noise ratio (CNR) in the portal vein relative to the erector spinae muscle. Volume rendering and maximum intensity projection methods were applied to generate portal venography. The CT values and standard deviations were measured at the portal vein, the erector spinae muscle, and the abdomen fat, respectively. These values were used to calculate the signal-to-noise ratio (SNR); while CNR was calculated using CT values of the portal vein and erector spinae muscle. The overall imaging quality was evaluated on afive-point scale by two radiologists with at least five years' experience. Comparisons among the three groups were performed using One-Way ANOVA test. Monochromatic images at 50-53 keV demonstrated the best CNR for both the portal vein and erector spinae muscle. SNR and CNR of images with different contrast medium concentrations were similar (P > 0.05). The five-point scores were also similar (P > 0.05) for the three groups. The total iodine intake at 280 mgI/mL was 25.4% lower than that at 350 mgI/mL. Spectral CT with monochromatic images at 50-53 keV allows significant reduction in iodine load while improving portal vein signal intensity and maintaining image quality.

Application of low dose radiation and low concentration contrast media in enhanced CT scans in children with congenital heart disease.

The aim of this study was to explore the feasibility of using low dose radiation and low concentration contrast media in enhanced CT examinations in children with congenital heart disease. Ninety patients with congenital heart disease were randomly divided into three groups of 30 patients each who underwent contrast-enhanced cardiac scans on a Discovery CT750 HD scanner. Group A received 270mgI/mL iodixanol, and group B received 320mgI/mL iodixanol contrast media and was scanned with prospective ECG triggering mode. Group C received 320mgI/mL iodixanol and was scanned with conventional retrospective ECG gating mode. The same weight-based contrast injection protocol was used for all three groups. Images were reconstructed using a 30% adaptive statistical iterative reconstruction (ASIR) algorithm and a 50% ASIR in groups A and B and a 30% ASIR in group C. The subjective and objective image quality evaluations, diagnostic accuracies, radiation doses and amounts of contrast media in the three groups were measured and compared. All images in the three groups met the diagnostic requirements, with the same diagnostic accuracy and image quality scores greater than 3 in a 4-point scoring system. However, ventricular enhancement and the objective noise, signal-to-noise ratio, contrast-to-noise ratio and subjective image quality scores in group C were better than those in groups A and B (all P<.001). The effective radiation dose in groups A and B was 84% lower than that in group C (P<.001); group A received the lowest contrast dose (14% lower than that of groups B and C). Enhanced CT scan images with low dose radiation and low concentration contrast media can meet the diagnostic requirements for examining children with congenital heart disease while reducing the potential risk of radiation damage and contrast-induced nephropathy.

Application of 80-kVp tube voltage, low-concentration contrast agent and iterative reconstruction in coronary CT angiography: evaluation of image quality and radiation dose

To evaluate image quality and radiation dosage in coronary CT angiography using 80-kVp tube voltage combined with low-concentration contrast media (CM) and iterative reconstruction (IR) for coronary CT angiography (CCTA) and employing dual-source CT without heart-rate control. 154 patients were randomly assigned to Group A (Control Group, 120-kVp tube voltage, high-concentration CM and filtered back projection reconstruction) and Group B (Low-Dose Group, 80kVp, low-concentration CM and iterative construction). Two experienced radiologists double-blindly evaluated the following parameters: CT attenuation, signal-noise ratio (SNR), contrast-noise ratio (CNR), radiation dose, size-specific dose estimates (SSDE) and total iodine intake. Pearson correlation analysis was used to assess the relationship between SSDE and BMI. 98.1% vessel segments in Group A and 97.6% in Group B passed diagnostics, indicating no significant differences; the average aorta scores and CT attenuation values showed no significant differences between groups. Similar SNR and CNR results were obtained for the two groups, although values were slightly lower in Group A compared with Group B. The Effective Dose in Group B was 63% lower than that in Group A (P<.001). SSDE results were significantly different between the two groups (P<.001) but did not correlate with BMI. Finally, the total iodine intake in Group B was 22.9% lower than that in Group A. Coronary CTA conducted with a low tube voltage of 80kVp, a low-concentration CM and IR without heart rate control can achieve images of similar quality to those obtained using standard procedures, significantly reducing the associated radiation dose and iodine intake.

Monochromatic Spectral Computed Tomography with Low Iodine Concentration Contrast Medium in a Rabbit VX2 Liver Model:: Investigation of Image Quality and Detection Rate

This study aimed to validate the feasibility of using virtual monochromatic spectral computed tomography (CT) with isotonic low iodine concentration contrast medium for VX2 hepatic tumors. Sixty New Zealand white rabbits with implanted VX2 hepatic tumors underwent two-phase contrast-enhanced spectral CT imaging on the 14th day after tumor implantation. They were randomly divided into groups A, B, and C, with 20 rabbits each (group A: 270 mg I/mL, monochromatic spectral images; group B: 370 mg I/mL, conventional 120 kVp images, 100% filtered back projection [FBP]; group C: 270 mg I/mL, conventional 120 kVp images, 100% FBP). Group A was further divided into two subgroups (subgroup A1: 100% FBP; subgroup A2: 50% FBP + 50% adaptive statistical iterative reconstruction). Objective evaluation (signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR], and image noise), subjective rating score (image noise score, anatomical details score, overall image quality score, and lesion conspicuity score), CT dose index volume, and dose length product were compared between groups during two-phase contrast enhancement. The detection rates of the four groups were calculated as percentages. Image noise (SNR and CNR) among the four groups was statistically significant (P <0.05). The image noise in group A2 was lower than in group A1, but higher than that in groups B and C (P <0.05). SNR and CNR in group A2 were the highest, followed by group A1, and group C was the lowest (P <0.05 for all). The image noise score of group A2 was higher than that of the other three groups. In terms of the anatomic details score, the overall image quality score, and the lesion conspicuity score, the images of group A2 were superior to that of groups A1 and C. For hepatic tumor diameters more than or equal to 1.0 cm and less than 3.0 cm, group A achieved a higher detection rate than groups B and C. The CT dose index volume, dose length product, and effective dose in group A were significantly lower than that in groups B and C (P <0.05). On average, group A reduced the effective radiation dose by 27.2% compared to group B, whereas group B reduced the effective radiation dose by 28% compared to group C. Group A reduced the iodine load by 22.86% compared to group B. The use of monochromatic images combined with 50% adaptive statistical iterative reconstruction with an isotonic low concentration contrast medium of 270 mg I/mL can optimize image quality, reduce image noise, increase detection rate for small tumors, and decrease radiation dose and iodine load in hepatic tumor CT examinations.

Low tube voltage computed tomography urography using low-concentration contrast media: Comparison of image quality in conventional computed tomography urography

PurposeThe aim of the present study was to investigate the feasibility and image quality of excretory CT urography performed using low iodine-concentration contrast media and low tube voltage. Materials and methodsThis prospective study enrolled 63 patients who undergoing CT urography. The subjects were randomized into two groups of an excretory phase CT urography protocol and received either 240mg I/mL of contrast media and 80kVp of tube voltage (low-concentration protocol, n=32) or 350mg I/mL and 120kVp (conventional protocol, n=31). Two readers qualitatively evaluated images for sharpness of the urinary tract, image noise, streak artifact and overall diagnostic acceptability. The mean attenuation, signal-to-noise ratio, contrast-to-noise ratio and figure of merit were measured in the urinary tract. The non-inferiority test assessed the diagnostic acceptability between the two protocol groups. ResultsThe low-concentration protocol showed a significantly lower effective radiation dose (3.44 vs. 5.70 mSv, P<.001). The diagnostic acceptability was significantly lower in the low-concentration protocol with iterative reconstruction algorithm than in the conventional protocol (4.06±0.45 vs. 4.50±0.37, P<.001), however, all subjects showed at least more than standard diagnostic acceptability and the difference resided in the predefined non-inferiority margin. The signal-to-noise ratio, contrast-to-noise ratio and figure of merit were significantly higher in the low-concentration protocol along the entire urinary tract (P<.001). ConclusionCT urography using 240mg I/mL iodine contrast media, 80kVp tube voltage and an iterative reconstruction algorithm is beneficial to reduce radiation dose and iodine load, and its objective image quality and subjective diagnostic acceptability is not inferior to that of conventional CT urography.

3D CT Angiography of Infrarenal Abdominal Aortic Aneurysm with Associated Ectopic Pelvic Kidney: A Case Report of Rare Concomitance

The abdominal aortic aneurysm (AAA) associated with congenital pelvic kidney is a rare clinical finding. We present a case of an infrarenal AAA with associated congenital left pelvic kidney followed up for 5 years, which was managed by regular surveillance. We describe this case to assist physicians and radiologists to recognize small aneurysms by computed tomography angiography (CTA) with low radiation dose and low iodine dose. To the best of our knowledge, this case is the first report by using CTA with the combination of low-concentration contrast medium, low radiation dose and iterative reconstruction. Keywords: Abdommen, aortic aneurysm, computed tomography angiography, congenital anomaly, pelvic kidney.

The initial experience of the upper abdominal CT angiography using low-concentration contrast medium on dual energy spectral CT.

To investigate the feasibility of using Spectral CT imaging with low contrast medium in abdominal CT angiography (CTA). 70 consecutive patients (40 men, 42.6±20.4years; 30 women, 46.7±18.8years) with suspected abdominal focal lesions were referred to CTA exam. They were randomly assigned into two groups. Group A: 35 patients underwent conventional CT scan of Tube voltage 120kVp, automatic current modulation with a Noise Index of 12, ASIR 30%, and injected with Iohexol (350mgI/ml). Group B: 35 patients underwent Spectral CT Imaging, with Tube current of 600mA, injected with Iodixanol (270mgI/ml). The optimal mono-energy keV was achieved using the optimal contrast noise ratio in abdominal aorta at the renal artery level relative to the erector spine muscle. Both groups were injected with an injection rate of 3.5ml/s, and a contrast volume of 1.5ml/kg body weight. The Hounsfield units (HU) and noise of the bilateral renal arteries and muscle of both groups, as well as the optimal monochromatic image set of Group B were measured. Two radiologists assessed all images with a 5-points scale. CTDIvol and DLP were recorded. Data were analyzed using student t test. The total iodine intake of Group B was 28% lower than that of Group A. The CNR of abdomen artery, celiac trunk, superior mesenteric artery, and renal artery in spectral group (at the best mono-energy of 53.0keV) were higher than those in conventional CTA group (p<0.001). The subjective image quality score of spectral CTA group was also rated higher than conventional CTA group (p<0.001). CTDIvol, DLP, and effective dose of spectral group were all lower than conventional group, but there were no significant differences (p>0.05). With 28% contrast medium reduction and reduced radiation dose, CT angiography using spectral imaging and lower concentration contrast agent provided better image quality than conventional CTA.

Imaging quality evaluation of low tube voltage coronary CT angiography using low concentration contrast medium.

PurposeTo compare the image quality of prospectively ECG-gated low voltage coronary computed tomography angiography (CTA) with an administration of low concentration contrast medium.Method and MaterialsA total of 101 patients, each with a heart rate below 65 beats per minute (BPM), underwent a prospectively ECG-gated axial scan in CT coronary angiography on a 64-slice CT scanner. All patients were allocated in three groups (group A: n=31, 80kVp, 300 mgI/ml; group B: n=34, 100kVp, 300 mgI/ml; group C: n=36, 120kVp, 370 mgI/ml). The CT attenuation values of aortic root (AR), left main coronary artery (LMA), right main coronary artery (RMA) and chest subcutaneous fat tissue were measured. The contrast-to-noise ratio (CNR) of AR, LMA and RMA were calculated according to the formulas below. The values of computed tomography dose index (CTDI) and dose-length product (DLP) were recorded. Image quality was assessed on a 5-point scale. The results were compared using the one-way ANOVA and rank sum tests.ResultsThe values of CNR and SNR for vessels in group A and group B were not significantly different from group C (each p > 0.05). The effective radiation dose in group A (1.51±0.70 mSv) and group B (2.59±1.24 mSv) were both lower than group C (4.92±2.82 mSv) (each p < 0.05). There was no significant difference among the image quality scores of group A (4.10±0.41), group B (3.90±0.48) and group C (4.04±0.36) (each P > 0.05).ConclusionLow tube voltage coronary CT angiography using low concentration contrast medium does not affect the imaging quality for assessing the coronary arteries compared with high voltage coronary CT angiography using high concentration contrast medium. Meanwhile low concentration contrast medium allowed 47-69% of radiation dose reduction.

Preliminary study of improved quality of computed tomographic angiography on tumor blood supply arteries of gastrointestinal tract malignant tumors with low tube voltage and low concentration contrast medium

To assess the image quality of gastrointestinal tract malignant tumors arteries using low tube voltage, low contrast medium concentration and 50% adaptive statistical iterative reconstruction (ASiR) algorithm. A total of 58 patients with pathologically confirmed gastrointestinal tract malignant tumors and body mass index (BMI) under 22 kg/m² undergoing computed tomography (CT) scanning during March-December 2013. They were randomly divided into group A (270 mgI/ml of contrast medium, 80 kVp tube voltage scanning and 50% ASiR; 21 males and 11 females with an age range of 40-90 years) and group B (350 mgI/ml of contrast medium, 120 kVp routine tube voltage; 22 males and 4 females with an age range of 40-76 years). The inter-group differences of age and gender ratio were compared with Mann-Whitney U and Fisher exact tests respectively. Two independent radiologists reviewed reconstructions and separated the reconstructed image into 5 points according to image quality. The CT value of tumor blood supplying artery (CT1 value) and fat in anterior abdominal wall (SD value) were measured and image noise, contrast-to-noise ratio (CNR) and figure of merit (FOM) calculated. The interobserver variation was estimated by weighted kappa statistics and intra-class correlation coefficients (ICC) test. The point of image quality of two groups was compared by Mann-Whitney U test. The paired Student t test was used to compare the inter-group differences in CT1, SD, CNR, FOM and CT dose index (CTDIvol). No inter-group difference existed in patient age or gender ratio. The consistency of two radiologists was excellent (kappa value > 0.80; ICC value > 0.75). The subjective image quality scores of tumor blood supplying arteries showed no inter-group difference (P = 0.09). The tumor blood supply arteries CT value, CNR and FOM of group A (459 ± 69 HU, 20.2 ± 3.3 and 85 ± 37) were significantly higher than those of group B (250 ± 42 HU, 9.3 ± 1.9 and 9 ± 4) (both P < 0.01). The SD value of group A (20.0 ± 1.7) was obviously lower than that of group B (22.4 ± 3.2) (P < 0.01). And the CTDIvol of group A (5.2 ± 1.2 mGy) was obviously lower than that of group B (13.5 ± 4.7 mGy) (P < 0.01). For patients of BMI ≤ 22 kg/m², low tube voltage and low contrast medium concentration scan condition with 50% ASiR algorithm is feasible for acquiring better quality image and ensuring significant reduction in effective dose.