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Clinical effectiveness of contrast medium injection protocols for 80-kV coronary and craniocervical CT angiography—a prospective multicenter observational study

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Background and objective

Decreasing X-ray tube voltage is an effective way to reduce radiation and contrast dose, especially in non-obese patients. The current study focuses on CTA in non-obese patients to evaluate image quality and feasibility of 80-kV acquisition protocols with varying iodine delivery rates (IDR) and contrast concentrations in routine clinical practice.

Methods

A prospective observational study in patients ≥ 18 years and ≤ 90 kg referred for coronary or craniocervical CTA at 10 centers in China (ClinicalTrials.gov: NCT02840903). Patients were divided into four groups: a standard 100-kV protocol (370 mgI/ml, IDR 1.48 gI/s), and three 80-kV protocols (370 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 0.96gI/s). The primary outcome was contrast opacification of target vascular segments. Secondary outcomes were image quality (contrast-to-noise ratio, signal-to-noise ratio, visual image quality, and diagnostic confidence assessment), radiation, and iodine dose.

Results

From July 2016 to July 2017, 1213 patients were enrolled: 614 coronary and 599 craniocervical CTA. The mean contrast opacification was ≥ 300 HU for 80-kV 1.2 gI/s IDR scanned segments; IDR 0.96 gI/s led to lower opacification. Image quality and diagnostic confidence were fair to excellent (≥ 98% of images), despite lower contrast-to-noise ratios and signal-to-noise ratios in 80-kV images. Compared to the standard protocol, 80-kV protocols led to 44–52% radiation dose reductions (p < 0.001) and 19% iodine dose reductions (p < 0.001).

Conclusion

Eighty-kilovolt 1.2 gI/s IDR protocols can be recommended for coronary and craniocervical CTA in non-obese patients, reducing radiation and iodine dose without compromising image quality.

Key Points

• Using low-voltage scanning CTA protocols, in which tube voltage and iodine delivery rate are reduced proportionally (voltage: 80 kV, IDR: 1.2 gI/s), reduces radiation and contrast dose without compromising image quality in routine clinical practice.

• Reducing iodine delivery rate beyond direct proportionality to tube voltage is not beneficial.

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Abbreviations

AB:

Coronary CTA segment: branch of atrioventricular node

ACA:

Craniocervical CTA segment: A1 segment of anterior cerebral arteries

AE:

Adverse event

CCA:

Craniocervical CTA segment: common carotid arteries

CNR:

Contrast-to-noise ratio

CTA:

Computed tomography angiography

CTDIvol:

Volume CT dose index

D1:

Coronary CTA segment: first diagonal branch

D2:

Coronary CTA segment: second diagonal branch

DLP:

Dose-length product

HU:

Hounsfield units

IDR:

Iodine delivery rate

LAD:

Coronary CTA segment: proximal left anterior descending artery

LCX:

Coronary CTA segment: proximal left circumflex artery

LMCA:

Coronary CTA segment: left main coronary artery

MCA:

Craniocervical CTA segment: M1 segment of middle cerebral arteries

PDA:

Coronary CTA segment: posterior descending artery

RCA:

Coronary CTA segment: proximal right coronary artery

ROI:

Region of interest

SNR:

Signal-to-noise ratio

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Acknowledgements

We are grateful to all the patients who participated in the RIGHT study. We thank Dr. Alexander Boreham and Dr. Michael Wördehoff (co.medical, Berlin, Germany) for medical writing support, including work on formatting and polishing tables and charts. We thank Dr. Philipp Lengsfeld and Dr. Peter Seidensticker (Bayer) for the thorough review of the manuscript. We thank Dr. Carsten Schwenke (SCO:SSiS, Berlin, Germany) and Dr. Hanqing Ma (Bayer) for additional statistical analysis during the review process. We also thank investigators in Shantou Central Hospital and the other investigators who participated in the RIGHT study, including Yun Wang, Yumei Li, Hongzhong Mo, Mingdong Chen, Yankui Li, Jing Yu, Zhaocheng Cai, Weiwei Zhao, Zhiwei Han, Caicai Ma, Bei E, Yi Yang, Xiaofeng Wang, Jian Li, Ya Cai, YanWang, Dandan Zhang, Dai ying Lin, Guangzhou Du, Danfeng Wang, Xiangling Zhang, Xiaoyu Li, Yin Yuan, and Xiangshui Meng. We thank the reviewers for their thorough reviews that substantially improved the manuscript.

Funding

This study was sponsored by Bayer AG as a phase IV study.

Author information

Authors and Affiliations

  1. Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China

    Yining Wang, Yu Chen, Peijun Liu, Huadan Xue & Zhengyu Jin

  2. The First People’s Hospital of Yulin, # 495, JiaoYu Central Road, Yulin, 537000, Guangxi, China

    Wan Lv

  3. Affiliated Zhongshan Hospital of Dalian University, # 6, Jiefang Road Zhongshan District, Dalian, 116001, Liaoning, China

    Jianlin Wu

  4. The First Affiliated Hospital of Air Force Medical University, # 15 Changle West Road, Xian, 710032, Shanxi, China

    Mengqi Wei

  5. Henan Provincial People’s Hospital, # 7, Weiwu Road, Zhengzhou, 450000, Henan, China

    Dapeng Shi

  6. The Second People’s Hospital of Shantou, # 28, Waimalu Road, Shantou, 515031, Guangdong, China

    Xianheng Wu

  7. The First Affiliated Hospital of Xinjiang Medical University, # 137, Liyushan South Road, Urumqi, 830054, Xinjiang, China

    Wenya Liu

  8. Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, # 639, Zaoju Road, Shanghai, 200011, China

    Xiaofeng Tao

  9. Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun East Road, Hangzhou, 310016, Zhejiang, China

    Hongjie Hu

  10. Qilu Hospital of Shandong University (Qingdao), North District, # 758, Hefei Road, Qingdao, 266035, Shandong, China

    Xiangxing Ma

  11. Medical Affairs, Bayer Healthcare Co. Ltd, Dongshanhuan Central Road, Beijing, 100010, China

    Xiaozheng Yang

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  1. Yining Wang
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Correspondence to Zhengyu Jin.

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Guarantor

The scientific guarantor of this publication is Prof. Zhengyu Jin.

Conflict of interest

Xiaozheng Yang is an employee of Bayer China. The other authors of this manuscript were the investigators of the study and declare no relationships with other companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional review board approval was obtained.

Methodology

• prospective

• observational

• multicenter study

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Authors from all study sites contributed equally to this study. 

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Wang, Y., Chen, Y., Liu, P. et al. Clinical effectiveness of contrast medium injection protocols for 80-kV coronary and craniocervical CT angiography—a prospective multicenter observational study. Eur Radiol 32, 3808–3818 (2022). https://doi.org/10.1007/s00330-021-08505-5

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