European Radiology

, Volume 28, Issue 5, pp 2134–2142 | Cite as

Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol

  • Moritz H. Albrecht
  • John W. Nance
  • U. Joseph Schoepf
  • Brian E. Jacobs
  • Richard R. BayerII
  • Sheldon E. Litwin
  • Michael A. Reynolds
  • Katharina Otani
  • Stefanie Mangold
  • Akos Varga-Szemes
  • Domenico De Santis
  • Marwen Eid
  • Georg Apfaltrer
  • Christian Tesche
  • Markus Goeller
  • Thomas J. Vogl
  • Carlo N. De Cecco
Cardiac
  • 158 Downloads

Abstract

Objectives

To compare the diagnostic accuracy between low-kilovolt peak (kVp) (≤ 100) and high-kVp (> 100) third-generation dual-source coronary CT angiography (CCTA) using a kVp-tailored contrast media injection protocol.

Methods

One hundred twenty patients (mean age = 62.6 years, BMI = 29.0 kg/m2) who underwent catheter angiography and CCTA with automated kVp selection were separated into two cohorts (each n = 60, mean kVp = 84 and 117). Contrast media dose was tailored to the kVp level: 70 = 40 ml, 80 = 50 ml, 90 = 60 ml, 100 = 70 ml, 110 = 80 ml, and 120 = 90 ml. Contrast-to-noise ratio (CNR) was measured. Two observers evaluated image quality and the presence of significant coronary stenosis (> 50% luminal narrowing).

Results

Diagnostic accuracy (sensitivity/specificity) with ≤ 100 vs. > 100 kVp CCTA was comparable: per patient = 93.9/92.6% vs. 90.9/92.6%, per vessel = 91.5/97.8% vs. 94.0/96.8%, and per segment = 90.0/96.7% vs. 90.7/95.2% (all P > 0.64). CNR was similar (P > 0.18) in the low-kVp vs. high-kVp group (12.0 vs. 11.1), as ws subjective image quality (P = 0.38). Contrast media requirements were reduced by 38.1% in the low- vs. high-kVp cohort (53.6 vs. 86.6 ml, P < 0.001) and radiation dose by 59.6% (4.3 vs. 10.6 mSv, P < 0.001).

Conclusions

Automated tube voltage selection with a tailored contrast media injection protocol allows CCTA to be performed at ≤ 100 kVp with substantial dose reductions and equivalent diagnostic accuracy for coronary stenosis detection compared to acquisitions at > 100 kVp.

Key points

• Low-kVp coronary CT angiography (CCTA) enables reduced contrast and radiation dose.

• Diagnostic accuracy is comparable between ≤ 100 and > 100 kVp CCTA.

• Image quality is similar for low- and high-kVp CCTA.

• Low-kVp image acquisition is facilitated by automated tube voltage selection.

• Tailoring contrast injection protocols to the automatically selected kVp-level is feasible.

Keywords

Coronary CT angiography Diagnostic accuracy Tube voltage Radiation dose Contrast media dose 

Notes

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is U. Joseph Schoepf, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: U. Joseph Schoepf is a consultant for and/or receives research support from Astellas, Bayer, Bracco, GE, Guerbet, Medrad, and Siemens. Katharina Otani is an employee of Siemens. Akos Varga-Szemes is a consultant for and/or receives research support from Guerbet and Siemens. Carlo N. De Cecco is a consultant for and/or receives research support from Guerbet and Siemens.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Katharina Otani, PhD, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Moritz H. Albrecht
    • 1
    • 2
  • John W. Nance
    • 1
  • U. Joseph Schoepf
    • 1
    • 3
  • Brian E. Jacobs
    • 1
  • Richard R. BayerII
    • 1
    • 3
  • Sheldon E. Litwin
    • 1
    • 3
  • Michael A. Reynolds
    • 1
  • Katharina Otani
    • 4
  • Stefanie Mangold
    • 1
  • Akos Varga-Szemes
    • 1
  • Domenico De Santis
    • 1
    • 5
  • Marwen Eid
    • 1
  • Georg Apfaltrer
    • 1
    • 6
  • Christian Tesche
    • 1
    • 7
  • Markus Goeller
    • 8
  • Thomas J. Vogl
    • 2
  • Carlo N. De Cecco
    • 1
  1. 1.Division of Cardiovascular Imaging, Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany
  3. 3.Division of Cardiology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  4. 4.Diagnostic Imaging Research & Collaboration DepartmentSiemens Healthcare K.K.TokyoJapan
  5. 5.Department of Radiological SciencesOncological and Pathological Sciences University of Rome “Sapienza”LatinaItaly
  6. 6.Division of Pediatric Radiology, Department of RadiologyMedical University of GrazGrazAustria
  7. 7.Department of Cardiology and Intensive Care MedicineHeart Center Munich-BogenhausenMunichGermany
  8. 8.Biomedical Imaging Research InstituteCedars-Sinai Medical CenterLos AngelesUSA

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