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Single- and dual-energy CT pulmonary angiography using second- and third-generation dual-source CT systems: comparison of radiation dose and image quality

Abstract

Objectives

To evaluate radiation exposure and image quality in matched patient cohorts for CT pulmonary angiography (CTPA) acquired in single- and dual-energy mode using second- and third-generation dual-source CT (DSCT) systems.

Methods

We retrospectively included 200 patients (mean age, 65.5 years ± 15.7 years) with suspected pulmonary embolism—equally divided into four study groups (n = 50) and matched by gender and body mass index. CTPA was performed with vendor-predefined second-generation (group A, 100-kV single-energy computed tomography (SECT); group B, 80/Sn140-kV dual-energy computed tomography (DECT)) or third-generation DSCT (group C, 100-kV SECT; group D, 90/Sn150-kV DECT) devices. Radiation metrics were assessed using a normalized scan range of 27.5 cm. For objective image quality evaluation, dose-independent figure-of-merit (FOM) contrast-to-noise ratios (CNRs) were calculated. Subjective image analysis included ratings for overall image quality, reader confidence, and image artifacts using five-point Likert scales.

Results

Calculations of the effective dose (ED) of radiation for a normalized scan range of 27.5 cm showed nonsignificant differences between SECT and DECT acquisitions for each scanner generation (p ≥ 0.253). The mean effective radiation dose was lower for third-generation groups C (1.5 mSv ± 0.8 mSv) and D (1.4 mSv ± 0.7 mSv) compared to second-generation groups A (2.5 mSv ± 0.9 mSv) and B (2.3 mSv ± 0.6 mSv) (both p ≤ 0.013). FOM-CNR measurements were highest for group D. Qualitative image parameters of overall image quality, reader confidence, and image artifacts showed nonsignificant differences among the four groups (p ≥ 0.162).

Conclusions

Third-generation DSCT systems show lower radiation dose parameters for CTPA compared to second-generation DSCT. DECT can be performed with both scanner generations without radiation dose penalty or detrimental effects on image quality compared to SECT.

Key Points

• Radiation exposure showed nonsignificant differences between SECT and DECT for both DSCT scanner devices.

• Dual-energy CTPA provides equivalent image quality compared to standard image acquisition.

• Subjective image quality assessment was similar among the four study groups.

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Abbreviations

ADMIRE:

Advanced modeled iterative reconstruction

ATVS:

Automated attenuation-based tube voltage selection

BMI:

Body mass index

CNR:

Contrast-to-noise ratio

CT:

Computed tomography

CTDIvol :

Volume CT dose index

DECT:

Dual-energy computed tomography

DLP:

Dose-length product

DSCT:

Dual-source computed tomography

ED:

Effective dose

FOM:

Figure-of-merit

HU:

Hounsfield units

ROI:

Region of interest

SAFIRE:

Sinogram-affirmed iterative reconstruction

SD:

Standard deviation

SECT:

Single-energy computed tomography

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

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Correspondence to Lukas Lenga.

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The scientific guarantor of this publication is Lukas Lenga.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Julian L. Wichmann received speakers’ fees from GE Healthcare and Siemens Healthcare. Moritz H. Albrecht received speakers’ fees from Siemens Healthcare. However, all other authors report no potential conflict of interest. Data was controlled by authors with no potential conflict of interest.

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• retrospective

• cross-sectional study

• performed at one institution

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Lenga, L., Trapp, F., Albrecht, M.H. et al. Single- and dual-energy CT pulmonary angiography using second- and third-generation dual-source CT systems: comparison of radiation dose and image quality. Eur Radiol 29, 4603–4612 (2019). https://doi.org/10.1007/s00330-018-5982-1

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Keywords

  • Computed tomography angiography
  • Pulmonary embolism
  • Radiation dosage
  • Diagnostic imaging
  • Thorax