Assessment of an advanced virtual monoenergetic reconstruction technique in cerebral and cervical angiography with third-generation dual-source CT: Feasibility of using low-concentration contrast medium
- 120 Downloads
To investigate the feasibility of low-concentration contrast media (LC-CM) in cerebral and cervical dual-energy CT angiography (DE-CTA) using an advanced monoenergetic (Mono+) reconstruction technique.
Sixty-five consecutive patients prospectively selected to undergo cerebral and cervical DE-CTA were randomised into two groups: 32 patients (63.7 ± 9.7 years) in the high-concentration contrast medium (HC-CM) group with iopromide 370 and 33 patients (60.7 ± 10.8 years) in the low-concentration contrast medium (LC-CM) group with iodixanol 270. Traditional monoenergetic (Mono) and Mono+ images from 40 to 100 keV levels (at 10-keV intervals) and the standard mixed (Mixed, 120 kVp equivalent) images were reconstructed. Subjective image quality parameters included the contrast-to-noise ratio (CNR) and objective image quality parameters were evaluated and compared between the two groups.
The 40-keV Mono+ images in the LC-CM group showed comparable objective CNR (common carotid arteries: 83.7 ± 24.5 vs. 78.1 ± 23.2; internal carotid arteries: 82.2 ± 26.8 vs. 76.8 ± 24.1; middle cerebral arteries: 72.5 ± 24.6 vs. 70.6 ± 19.2; all p > 0.05) and subjective image scores (3.95 ± 0.19 vs. 3.83 ± 0.35; p > 0.05) compared with Mixed images in the HC-CM group.
The Mono+ reconstruction technique could reduce the concentration of iodinated CM in the diagnosis of cerebral and cervical angiography.
• Mono+ shows decreased noise and superior CNR compared with Mono.
• The 40-keV Mono+ images show the highest CNR in the LC-CM group.
• The Mono+ reconstruction technique could reduce the concentration of iodinated CM.
KeywordsCerebral arteries Carotid arteries Computed tomography angiography Monoenergetic imaging Low-concentration contrast medium
Common carotid arteries
Computed tomographic angiography
High-concentration contrast medium
Internal carotid arteries
Low-concentration contrast medium
Middle cerebral arteries
Region of interest
This study has received funding by the Tianjin Research Program of Application Foundation and Advanced Technology (grant 14JCZDJC57000) and National Natural Science Foundation of China (grant 81301217).
Compliance with ethical standards
The scientific guarantor of this publication is Dong Li.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Gu Jun is on the speakers' bureau of Siemens Healthineers, Computed Tomography division. The other authors of this manuscript declare no relationships with any 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.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• case-control study
• performed at one institution
- 4.Silver SA, Shah PM, Chertow GM, Harel S, Wald R, Harel Z (2015) Risk prediction models for contrast induced nephropathy: systematic review. BMJ 351Google Scholar
- 17.Grant KL, Flohr TG, Krauss B, Sedlmair M, Thomas C, Schmidt B (2014) Assessment of an advanced image-based technique to calculate virtual monoenergetic computed tomographic images from a dual-energy examination to improve contrast-to-noise ratio in examinations using iodinated contrast media. Invest Radiol 49:586–592CrossRefPubMedGoogle Scholar
- 23.Albrecht MH, Trommer J, Wichmann JL et al (2016) Comprehensive comparison of virtual monoenergetic and linearly blended reconstruction techniques in third-generation dual-source dual-energy computed tomography angiography of the thorax and abdomen. Invest Radiol 51:582–590CrossRefPubMedGoogle Scholar
- 34.Fu W, Marin D, Ramirez-Giraldo JC et al (2017) Optimizing window settings for improved presentation of virtual monoenergetic images in dual-energy computed tomography. Med PhysGoogle Scholar