European Radiology

, Volume 28, Issue 10, pp 4379–4388 | Cite as

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

  • Lu Zhao
  • Fengtan Li
  • Zewei Zhang
  • Zhang Zhang
  • Yingjian Jiang
  • Xinyu Wang
  • Jun Gu
  • Dong LiEmail author
Computed Tomography



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.

Key Points

• 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.


Cerebral arteries Carotid arteries Computed tomography angiography Monoenergetic imaging Low-concentration contrast medium 



Ascending aorta


Common carotid arteries


Contrast-induced nephropathy


Contrast medium


Contrast-to-noise ratio


Computed tomographic angiography


Dual-energy CT


Dual-source CT


High-concentration contrast medium


Hounsfield units


Internal carotid arteries


Low-concentration contrast medium


Middle cerebral arteries


Standard mixed


Traditional monoenergetic


Advanced monoenergetic


Region of interest


Standard deviation



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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• case-control study

• performed at one institution

Supplementary material

330_2018_5407_MOESM1_ESM.docx (137 kb)
ESM 1 (DOCX 136 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Lu Zhao
    • 1
  • Fengtan Li
    • 1
  • Zewei Zhang
    • 1
  • Zhang Zhang
    • 1
  • Yingjian Jiang
    • 1
  • Xinyu Wang
    • 1
  • Jun Gu
    • 2
  • Dong Li
    • 1
    Email author
  1. 1.Department of RadiologyTianjin Medical University General HospitalTianjinChina
  2. 2.Siemens HealthineersBeijingChina

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