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Single-source dual-energy CT angiography with reduced iodine load in patients referred for aortoiliofemoral evaluation before transcatheter aortic valve implantation: impact on image quality and radiation dose

  • Cardiac
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Abstract

Objectives

To compare image quality and radiation dose of pre-transcatheter aortic valve implantation (TAVI) aortoiliofemoral CT angiography (AICTA) provided by standard vs. dual-energy mode with reduced iodine load protocols.

Methods

One hundred and sixty-one patients underwent a two-step CTA protocol before TAVI including cardiac CTA with injection of 65 mL of iodinated contrast agent (ICA), immediately followed by AICTA. From this second acquisition, the following three different patient groups were identified: Group 1: 52 patients with standard AICTA (60 mL ICA, 100 kVp, mA automodulation); Group 2: 48 patients with dual-energy AICTA with 50 % iodine load reduction (30 mL ICA, fast kVp switching, 600 mA); Group 3: 61 patients with an identical protocol to Group 2, but exposed to 375 mA. The qualitative/subjective image quality (13-point score) and quantitative/objective image quality (contrast attenuation and image noise) were evaluated. The radiation dose was recorded.

Results

There was no significant difference in non-diagnostic images between the three protocols. Contrast attenuation, signal-to-noise ratio and contrast-to-noise ratio were significantly higher, whereas noise was significantly lower in the standard protocol (all P < 0.05). The radiation dose was lower in the dual-energy protocol at 375 mA (P < 0.05).

Conclusions

Dual-energy AICTA before TAVI results in a reduction of iodine load while maintaining sufficient diagnostic information despite increased noise.

Key Points

• Dual-energy AICTA before TAVI results in a 50 % reduction of iodine load.

•The reduction of iodine load maintains sufficient image quality despite increased noise.

• Using 375 mA in dual-energy mode results in a reduction of radiation dose.

• A high tube current setting (600 mA) should be used in overweight patients.

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Abbreviations

AICTA:

Aortoiliofemoral CT angiography.

BMI:

Body Mass Index.

CA:

Contrast Attenuation.

CNR:

Contrast to Noise Ratio.

CTA:

CT Angiography

CTDIvol :

CT Dose Index.

DLP:

Dose Length Product.

ICA:

Iodinated Contrast Agent.

keV:

Kiloelectron Volts.

kVp:

Kilovolt Peak.

PACS:

Picture Archiving and Communication system.

SNR:

Signal to Noise Ratio.

TAVI:

Transcatheter Aortic Valve Implantation.

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Acknowledgement

The authors thank Annick Troniou for her invaluable assistance.

The scientific guarantor of this publication is Pr. Jean-Nicolas Dacher, MD, PhD. The authors of this manuscript declare relationships with the following companies: Pr. Jean-Nicolas Dacher is consultant for GE HealthCare. No other conflict of interest is to disclose. The authors state that this work has not received any funding. Dr. Michael Bubenheim kindly provided statistical advice for this manuscript. One of the authors (Michael Bubenheim) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study.

This work was presented at the Annual Meeting of the European Society of Cardiac Radiology in London (October 2013). It has been selected for presentation within the EPOS highlighted poster presentations session and has received a Certificate of Merit Award.

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Authors and Affiliations

  1. Department of Radiology, Rouen University Hospital, Cardiac MR/CT Unit, 1 Rue de Germont, 76031, Rouen CEDEX, France

    Benjamin Dubourg, Jérôme Caudron, Jean-Pierre Lestrat, Valentin Lefebvre & Jean-Nicolas Dacher

  2. Department of Cardiology, Rouen University Hospital, 1 Rue de Germont, 76031, Rouen CEDEX, France

    Matthieu Godin, Christophe Tron, Hélène Eltchaninoff & Fabrice Bauer

  3. INSERM U1096, UFR Médecine Pharmacie, 22 Boulevard Gambetta, 76183, Rouen CEDEX 1, France

    Benjamin Dubourg, Jérôme Caudron, Valentin Lefebvre, Hélène Eltchaninoff, Fabrice Bauer & Jean-Nicolas Dacher

  4. Department of Biostatistics, Rouen University Hospital, 1 Rue de Germont, 76031, Rouen CEDEX, France

    Michael Bubenheim

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  1. Benjamin Dubourg
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Dubourg, B., Caudron, J., Lestrat, JP. et al. Single-source dual-energy CT angiography with reduced iodine load in patients referred for aortoiliofemoral evaluation before transcatheter aortic valve implantation: impact on image quality and radiation dose. Eur Radiol 24, 2659–2668 (2014). https://doi.org/10.1007/s00330-014-3263-1

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  • DOI: https://doi.org/10.1007/s00330-014-3263-1

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