Low Dose Iodinated Contrast Material and Radiation for Virtual Monochromatic Imaging in Craniocervical Dual-Layer Spectral Detector Computed Tomography Angiography: A Prospective and Randomized Study

Xiuzhi Zhou; Manman Cui; Yan Liu; Yuanyuan Wu; Dongliang Hu; Duchang Zhai; Mingyu Qin; Junkang Shen; Shenghong Ju; Guohua Fan; Wu Cai

doi:10.1016/j.acra.2023.12.004

Low Dose Iodinated Contrast Material and Radiation for Virtual Monochromatic Imaging in Craniocervical Dual-Layer Spectral Detector Computed Tomography Angiography: A Prospective and Randomized Study

Acad Radiol. 2023 Dec 22:S1076-6332(23)00681-5. doi: 10.1016/j.acra.2023.12.004. Online ahead of print.

Authors

Xiuzhi Zhou¹, Manman Cui¹, Yan Liu¹, Yuanyuan Wu¹, Dongliang Hu¹, Duchang Zhai¹, Mingyu Qin², Junkang Shen¹, Shenghong Ju³, Guohua Fan¹, Wu Cai⁴

Affiliations

¹ Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.).
² Suzhou Medical College of Soochow University, Suzhou, 215026, Jiangsu, China (M.Q.).
³ Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, Jiangsu, China (S.J.).
⁴ Department of Radiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu, Suzhou, 215004, Jiangsu, China (X.Z., M.C., Y.L., Y.W., D.H., D.Z., J.S., G.F., W.C.). Electronic address: xwg608@126.com.

PMID: 38135625
DOI: 10.1016/j.acra.2023.12.004

Abstract

Rationale and objectives: To investigate the feasibility of virtual monochromatic imaging (VMI) of dual-layer spectral detector computed tomography (SDCT) to reduce iodinated contrast material (CM) and radiation dose in craniocervical computed tomography angiography (CTA).

Materials and methods: A total of 280 consecutively selected patients performed craniocervical CTA with SDCT were prospectively selected and randomly divided into four groups (A, DoseRight index (DRI) 31, iopromide 370mgI/mL, volume 0.8 mL/kg; B, DRI 26, iopromide 370mgI/mL, volume 0.4 mL/kg; C, DRI 26, ioversol 320mgI/mL, volume 0.4 mL/kg; D, DRI 26, iohexol 300mgI/mL, volume 0.4 mL/kg). 50-70 kiloelectron volts (keV) VMIs in group B were reconstructed and compared to group A to select the optimal keV. Then, the optimal keV in groups B, C and D was reconstructed and compared. Objective image quality, including vascular attenuation, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), was evaluated. Subjective image quality was assessed using a 5-point Likert scale. In addition, the effective dose (ED), iodine load and iodine delivery rate (IDR) were compared between groups A and D.

Results: 55 keV VMI was the optimal VMI in group B. The objective and subjective image quality of 55 keV VMI in group B were equal to or better than those of the CI in group A. The SNR, CNR and subjective image quality in group D were similar to those in group B (P > 0.05). The ED, iodine load and IDR of group D were reduced by 44%, 59% and 19%, respectively, when compared to those of group A.

Conclusion: Low dose iodinated CM and radiation for 55 keV VMI in craniocervical CTA using SDCT could still provide equivalent or better image quality than the conventional scanning protocol.

Keywords: Carotid artery; Cerebral artery; Computed tomography angiography; Dual-layer spectral detector CT; Image quality; Iodinated contrast material; Virtual monoenergetic imaging.