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Prospective randomised comparison of diagnostic confidence and image quality with normal-dose and low-dose CT pulmonary angiography at various body weights

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Abstract

Objectives

To find a threshold body weight (BW) below 100 kg above which computed tomography pulmonary angiography (CTPA) using reduced radiation and a reduced contrast material (CM) dose provides significantly impaired quality and diagnostic confidence compared with standard-dose CTPA.

Methods

In this prospectively randomised study of 501 patients with suspected pulmonary embolism and BW <100 kg, 246 were allocated into the low-dose group (80 kVp, 75 ml CM) and 255 into the normal-dose group (100 kVp, 100 ml CM). Contrast-to-noise ratio (CNR) in the pulmonary trunk was calculated. Two blinded chest radiologists independently evaluated subjective image quality and diagnostic confidence. Data were compared between the normal-dose and low-dose groups in five BW subgroups.

Results

Vessel attenuation did not differ between the normal-dose and low-dose groups within each BW subgroup (P = 1.0). The CNR was higher with the normal-dose compared with the low-dose protocol (P < 0.006) in all BW subgroups except for the 90-99 kg subgroup (P = 0.812). Subjective image quality and diagnostic confidence did not differ between CT protocols in all subgroups (P between 0.960 and 1.0).

Conclusions

Subjective image quality and diagnostic confidence with 80 kVp CTPA is not different from normal-dose protocol in any BW group up to 100 kg.

Key Points

• 80 kVp CTPA is safe in patients weighing <100 kg

• Reduced radiation and iodine dose still provide high vessel attenuation

• Image quality and diagnostic confidence with low-dose CTPA is good

• Diagnostic confidence does not deteriorate in obese patients weighing <100 kg

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Acknowledgements

The scientific guarantor of this publication is Zsolt Szucs-Farkas, M.D. The authors of this manuscript declare relationships with the following companies: J.T.H.—research grants from Bracco SA, Siemens AG and Guerbet; S.T.S.—research grant from Siemens AG. This study has received funding from the Stanley Thomas Johnson Foundation. Mr. Samuel Iff, M.D., M.Sc. kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported by Szucs-Farkas et al. [26]. Methodology: prospective, randomised controlled trial, performed at one institution.

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Authors and Affiliations

  1. University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, Berne, 3010, Switzerland

    Zsolt Szucs-Farkas, Andreas Christe, Peter Vock, Johannes T. Heverhagen & Sebastian T. Schindera

  2. Institute of Radiology, Hospital Centre of Biel, Vogelsang 84, Biel/Bienne, 2501, Switzerland

    Zsolt Szucs-Farkas

  3. Department of Anaesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Centre, Nagyerdei krt. 98, Debrecen, 4012, Hungary

    Boglarka Megyeri

  4. Department of Radiology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland

    Sebastian T. Schindera

Authors
  1. Zsolt Szucs-Farkas
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  2. Boglarka Megyeri
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  3. Andreas Christe
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  4. Peter Vock
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  5. Johannes T. Heverhagen
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  6. Sebastian T. Schindera
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Correspondence to Zsolt Szucs-Farkas.

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Szucs-Farkas, Z., Megyeri, B., Christe, A. et al. Prospective randomised comparison of diagnostic confidence and image quality with normal-dose and low-dose CT pulmonary angiography at various body weights. Eur Radiol 24, 1868–1877 (2014). https://doi.org/10.1007/s00330-014-3208-8

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  • DOI: https://doi.org/10.1007/s00330-014-3208-8

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