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Low-dose triple-rule-out using 320-row-detector volume MDCT – less contrast medium and lower radiation exposure

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Abstract

Objectives

To investigate image quality of triple-rule-out (TRO) computed tomography (CT) using a 320-row-detector CT system with substantially reduced contrast medium volume at 100 kV.

Methods

Forty-six consecutive patients with noncritical, acute chest pain underwent 320-row-detector CT using a two-step TRO protocol consisting of a non-spiral, non-gated chest CT acquisition (150 mA) followed by a non-spiral, electrocardiography-gated cardiac acquisition (200–500 mA based on body mass index (BMI)). Data were acquired using a biphasic injection protocol with a total iodinated contrast medium volume of 60 ml (370 mg/ml). Vessel attenuation and effective doses were recorded. Image quality was scored independently by two readers.

Results

Mean attenuation was 584 ± 114 Hounsfield units (HU) in the ascending aorta, 335 ± 63HU in the aortic arch, 658 ± 136HU in the pulmonary trunk, and 521 ± 97HU and 549 ± 102HU in the right and left coronary artery, respectively. In all but one patient, attenuation and image quality allowed accurate visualization of the pulmonary arteries, thoracic aorta, and coronary arteries in a single examination. Ninety-six percent of all coronary artery segments were rated diagnostic. Radiation exposure ranged between 2.0 and 3.3 mSv.

Conclusion

Using 320-row-detector CT the investigated low-dose TRO protocol resulted in excellent opacification and image quality with substantial reduction of contrast medium volume compared to recently published TRO protocols.

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References

  1. Frauenfelder T, Appenzeller P, Karlo C, Scheffel H, Desbiolles L, Stolzmann P, Marincek B, Alkadhi H, Schertler T (2009) Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings. Eur Radiol 19:789–799

    Article  PubMed  Google Scholar 

  2. Ladapo JA, Hoffmann U, Bamberg F, Nagurney JT, Cutler DM, Weinstein MC, Gazelle GS (2008) Cost-effectiveness of coronary MDCT in the triage of patients with acute chest pain. AJR Am J Roentgenol 191:455–463

    Article  PubMed  Google Scholar 

  3. Dewey M, Hamm B (2007) Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease. Eur Radiol 17:1301–1309

    Article  PubMed  Google Scholar 

  4. Lell M, Hinkmann F, Anders K, Deak P, Kalender WA, Uder M, Achenbach S (2009) High-pitch electrocardiogram-triggered computed tomography of the chest: initial results. Invest Radiol 44:728–733

    Article  PubMed  Google Scholar 

  5. Sommer WH, Schenzle JC, Becker CR, Nikolaou K, Graser A, Michalski G, Neumaier K, Reiser MF, Johnson TR (2009) Saving dose in triple-rule-out computed tomography examination using a high-pitch dual spiral technique. Invest Radiol 45:64–71

    Article  Google Scholar 

  6. Lee HY, Yoo SM, White CS (2009) Coronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography. Int J Cardiovasc Imaging 25:319–326

    Article  PubMed  Google Scholar 

  7. Takakuwa KM, Halpern EJ, Gingold EL, Levin DC, Shofer FS (2009) Radiation dose in a “triple rule-out” coronary CT angiography protocol of emergency department patients using 64-MDCT: the impact of ECG-based tube current modulation on age, sex, and body mass index. AJR Am J Roentgenol 192:866–872

    Article  PubMed  Google Scholar 

  8. Schertler T, Frauenfelder T, Stolzmann P, Scheffel H, Desbiolles L, Marincek B, Kaplan V, Kucher N, Alkadhi H (2009) Triple rule-out CT in patients with suspicion of acute pulmonary embolism: findings and accuracy. Acad Radiol 16:708–717

    Article  PubMed  Google Scholar 

  9. Hein PA, Romano VC, Lembcke A, May J, Rogalla P (2009) Initial experience with a chest pain protocol using 320-slice volume MDCT. Eur Radiol 19:1148–1155

    Article  PubMed  Google Scholar 

  10. Lembcke A, Wiese TH, Schnorr J, Wagner S, Mews J, Kroencke TJ, Enzweiler CN, Hamm B, Taupitz M (2004) Image quality of noninvasive coronary angiography using multislice spiral computed tomography and electron-beam computed tomography: intraindividual comparison in an animal model. Invest Radiol 39:357–364

    Article  PubMed  Google Scholar 

  11. Leschka S, Stolzmann P, Schmid FT, Scheffel H, Stinn B, Marincek B, Alkadhi H, Wildermuth S (2008) Low kilovoltage cardiac dual-source CT: attenuation, noise, and radiation dose. Eur Radiol 18:1809–1817

    Article  PubMed  Google Scholar 

  12. Bongartz G, Golding SJ, Jurik AG, Leonardi M, van Persijn van Meerten E, Rodríguez R, Schneider K, Calzado A, Geleijns J, Jessen KA, Panzer W, Shrimpton PC, Tosi G (2004) European Guidelines for Multislice Computed Tomography. Funded by the European Commission. Appendix C; Available via http://www.msct.eu/CT_Quality_Criteria.htm. Accessed February 9, 2011

  13. Hendel RC (2009) Is computed tomography coronary angiography the most accurate and effective noninvasive imaging tool to evaluate patients with acute chest pain in the emergency department? CT coronary angiography is the most accurate and effective noninvasive imaging tool for evaluating patients presenting with chest pain to the emergency department: antagonist viewpoint. Circ Cardiovasc Imaging 2:264–275, discussion 275

    Article  PubMed  Google Scholar 

  14. Achenbach S, Daniel WG (2010) Cardiac imaging in the patient with chest pain: coronary CT angiography. Heart 96:1241–1246

    Article  PubMed  Google Scholar 

  15. Halpern EJ (2009) Triple-rule-out CT angiography for evaluation of acute chest pain and possible acute coronary syndrome. Radiology 252:332–345

    Article  PubMed  Google Scholar 

  16. McMahon MA, Squirrell CA (2010) Multidetector CT of aortic dissection: a pictorial review. Radiographics 30:445–460

    Article  PubMed  Google Scholar 

  17. Murayama T, Funabashi N, Uehara M, Takaoka H, Komuro I (2010) New classification of aortic dissection during the cardiac cycle as pulsating type and static type evaluated by electrocardiogram-gated multislice CT. Int J Cardiol 142:177–186

    Article  PubMed  Google Scholar 

  18. Ganten MK, Weber TF, von Tengg-Kobligk H, Bockler D, Stiller W, Geisbusch P, Kauffmann GW, Delorme S, Bock M, Kauczor HU (2009) Motion characterization of aortic wall and intimal flap by ECG-gated CT in patients with chronic B-dissection. Eur J Radiol 72:146–153

    Article  PubMed  Google Scholar 

  19. Matsuoka S, Hunsaker AR, Gill RR, Oliva IB, Trotman-Dickenson B, Jacobson FL, Hatabu H (2009) Vascular enhancement and image quality of MDCT pulmonary angiography in 400 cases: comparison of standard and low kilovoltage settings. AJR Am J Roentgenol 192:1651–1656

    Article  PubMed  Google Scholar 

  20. Szucs-Farkas Z, Strautz T, Patak MA, Kurmann L, Vock P, Schindera ST (2009) Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients. Eur Radiol 19:1914–1922

    Article  PubMed  Google Scholar 

  21. Alkadhi H, Stolzmann P, Desbiolles L, Baumueller S, Goetti R, Plass A, Scheffel H, Feuchtner G, Falk V, Marincek B, Leschka S (2010) Low-dose, 128-slice, dual-source CT coronary angiography: accuracy and radiation dose of the high-pitch and the step-and-shoot mode. Heart 96:933–938

    Article  PubMed  Google Scholar 

  22. Leschka S, Stolzmann P, Desbiolles L, Baumueller S, Goetti R, Schertler T, Scheffel H, Plass A, Falk V, Feuchtner G, Marincek B, Alkadhi H (2009) Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience. Eur Radiol 19:2896–2903

    Article  PubMed  Google Scholar 

  23. Johnson TR, Nikolaou K, Becker A, Leber AW, Rist C, Wintersperger BJ, Reiser MF, Becker CR (2008) Dual-source CT for chest pain assessment. Eur Radiol 18:773–780

    Article  PubMed  Google Scholar 

  24. Schertler T, Scheffel H, Frauenfelder T, Desbiolles L, Leschka S, Stolzmann P, Seifert B, Flohr TG, Marincek B, Alkadhi H (2007) Dual-source computed tomography in patients with acute chest pain: feasibility and image quality. Eur Radiol 17:3179–3188

    Article  PubMed  Google Scholar 

  25. Hein PA, May J, Rogalla P, Butler C, Hamm B, Lembcke A (2010) Feasibility of contrast material volume reduction in coronary artery imaging using 320-slice volume CT. Eur Radiol 20:1337–1343

    Article  PubMed  Google Scholar 

  26. Goetti R, Feuchtner G, Stolzmann P, Desbiolles L, Fischer MA, Karlo C, Baumueller S, Scheffel H, Alkadhi H, Leschka S (2010) High-pitch dual-source CT coronary angiography: systolic data acquisition at high heart rates. Eur Radiol 20:2565–2571

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Charité – University Hospital Berlin, Campus Mitte, 10117, Berlin, Germany

    Tahir Durmus, Alexander Lembcke, Matthias R. Mühler, Bernd Hamm & Patrick A. Hein

  2. Department of Medical Imaging, Universitiy of Toronto, Toronto, ON, Canada

    Patrik Rogalla

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  1. Tahir Durmus
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  2. Patrik Rogalla
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  3. Alexander Lembcke
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  4. Matthias R. Mühler
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  5. Bernd Hamm
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  6. Patrick A. Hein
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Correspondence to Tahir Durmus.

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Durmus, T., Rogalla, P., Lembcke, A. et al. Low-dose triple-rule-out using 320-row-detector volume MDCT – less contrast medium and lower radiation exposure. Eur Radiol 21, 1416–1423 (2011). https://doi.org/10.1007/s00330-011-2088-4

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  • DOI: https://doi.org/10.1007/s00330-011-2088-4

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