Skip to main content
Log in

Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

We explored whether dual-energy computed tomography (DECT) can allow a significant reduction in iodinated contrast volume during computed tomography angiography (CTA) without hampering image quality or assessibility. We prospectively randomized patients clinically referred to CTA to single energy computed tomography (SECT) with full iodine volume load (group A), DECT with 50 % iodine volume load (group B), DECT with 40 % iodine volume load (group C), and DECT with 30 % iodine volume load (group D); and compared image quality and assessibility. Eighty patients were enrolled and prospectively randomized. The mean age was 61.7 ± 15.0 years and 56 (71 %) patients were male. The demographical characteristics, body mass index, or mean radiation dose did not differ between groups. Significant reductions in total contrast volume were achieved in groups B, C, and D; with mean administrated contrast volumes of 90.3 ± 10.1, 39.5 ± 4.6, 28.3 ± 6.5, and 23.9 ± 6.0 mL, respectively, in groups A to D (p < 0.0001). With regard to image quality, no significant decrease in the Likert scale was observed with reductions of up to 60 % of the contrast volume (groups B and C). DECT at 50–60 keV in association with up to 60 % iodine load reduction, allowed similar signal density, image noise, and signal to noise ratio that SECT imaging with full iodine load. In this pilot, prospective, randomized study, dual energy CTA with up to 60 % iodine volume load reduction provided similar image quality and assessibility than full iodine load with conventional SECT imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Thomsen HS (2008) ESUR guidelines on contrast media, version 7.0. Heidelberg, Germany: European Society of Urogenital Radiology

  2. Toprak O (2007) Conflicting and new risk factors for contrast-induced nephropathy. J Urol 178:2277–2283

    Article  PubMed  Google Scholar 

  3. Tepel M, Aspelin P, Lameire N (2006) Contrast-induced nephropathy: a clinical and evidence-based approach. Circulation 113:1799–1806

    Article  PubMed  Google Scholar 

  4. Laville M, Juillard L (2010) Contrast-induced acute kidney injury: how should at-risk patients be identified and managed? J Nephrol 23(04):387–398

    PubMed  Google Scholar 

  5. de Agustín JA, Carda R, Manzano MC, Ruiz-Mateos B, García-Rubira JC, Fernández-Ortiz A, Vilacosta I, Macaya C (2007) Creatinine clearance and contrast nephropathy in patients with normal creatinine levels. Rev Esp Cardiol 60(7):772–776

    Article  PubMed  Google Scholar 

  6. So A, Lee TY, Imai Y et al (2011) Quantitative myocardial perfusion imaging using rapid kVp switch dual-energy CT: preliminary experience. J Cardiovasc Comput Tomogr 5(6):430–442

    Article  PubMed  Google Scholar 

  7. Yuan R, Shuman WP, Earls JP et al (2012) Reduced iodine load at CT pulmonary angiography with dual-energy monochromatic imaging: comparison with standard CT pulmonary angiography—a prospective randomized trial. Radiology 262(1):290–297

    Article  PubMed  Google Scholar 

  8. Boxt LM (2012) Coronary computed tomography angiography: a practical guide to performance and interpretation. Semin Roentgenol 47(3):204–219

    Article  PubMed  Google Scholar 

  9. Mitchell AM, Jones AE, Tumlin JA, Kline JA (2010) Incidence of contrast-induced nephropathy after contrast-enhanced computed tomography in the outpatient setting. Clin J Am Soc Nephrol 5:4–9

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kane GC, Doyle BJ, Lerman A, Barsness GW, Best PJ, Rihal CS (2008) Ultra-low contrast volumes reduce rates of contrast-induced nephropathy in patients with chronic kidney disease undergoing coronary angiography. J Am Coll Cardiol 51:89–90

    Article  PubMed  Google Scholar 

  11. Faggioni L, Neri E, Sbragia P, Pascale R, D’Errico L, Caramella D, Bartolozzi C (2012) 80-kV pulmonary CT angiography with 40 mL of iodinated contrast material in lean patients: comparison of vascular enhancement with iodixanol (320 mg I/mL) and iomeprol (400 mg I/mL). AJR Am J Roentgenol 199(6):1220–1225

    Article  PubMed  Google Scholar 

  12. Delesalle MA, Pontana F, Faivre JB, Flohr T, Tacelli N, Remy J, Remy-Jardin M (2013) Spectral optimization of chest CT angiography with reduced iodine load: experience in 80 patients evaluated with dual-source, dual-energy CT. Radiology 267(1):256–266

    Article  PubMed  Google Scholar 

  13. Nance JW Jr, Henzler T, Meyer M et al (2012) Optimization of contrast material delivery for dual-energy computed tomography angiography in patients with suspected pulmonary embolism. Invest Radiol 47(1):78–84

    Article  CAS  PubMed  Google Scholar 

  14. Manske CL, Sprafka JM, Strony JT, Wang Y (1990) Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 89:615–620

    Article  CAS  PubMed  Google Scholar 

  15. Baker ME, Dong F, Primak A, Obuchowski NA, Einstein D, Gandhi N, Herts BR, Purysko A, Remer E, Vachhani N (2012) Contrast-to-noise ratio and low-contrast object resolution on full- and low-dose MDCT: SAFIRE versus filtered back projection in a low-contrast object phantom and in the liver. AJR Am J Roentgenol 199(1):8–18

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

We declare that Drs. Patricia Carrascosa and Jonathon Leipsic are Consultants of GE. There are no competing interests related to the manuscript for any of the other authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gaston A. Rodriguez-Granillo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carrascosa, P., Capunay, C., Rodriguez-Granillo, G.A. et al. Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study. Int J Cardiovasc Imaging 30, 1613–1620 (2014). https://doi.org/10.1007/s10554-014-0501-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-014-0501-1

Keywords

Navigation