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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

  • Lukas LengaEmail author
  • Franziska Trapp
  • Moritz H. Albrecht
  • Julian L. Wichmann
  • Addison A. Johnson
  • Ibrahim Yel
  • Tommaso D’Angelo
  • Christian Booz
  • Thomas J. Vogl
  • Simon S. Martin
Computed Tomography
  • 31 Downloads

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.

Keywords

Computed tomography angiography Pulmonary embolism Radiation dosage Diagnostic imaging Thorax 

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

Notes

Funding

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

Compliance with ethical standards

Guarantor

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.

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.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

References

  1. 1.
    Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315CrossRefGoogle Scholar
  2. 2.
    Stein PD, Fowler SE, Goodman LR et al (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354:2317–2327CrossRefGoogle Scholar
  3. 3.
    Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC (2004) CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 24:1219–1238CrossRefGoogle Scholar
  4. 4.
    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 51:582–590CrossRefGoogle Scholar
  5. 5.
    Beeres M, Trommer J, Frellesen C et al (2016) Evaluation of different keV-settings in dual-energy CT angiography of the aorta using advanced image-based virtual monoenergetic imaging. Int J Cardiovasc Imaging 32:137–144CrossRefGoogle Scholar
  6. 6.
    Weiss J, Notohamiprodjo M, Bongers M et al (2017) Effect of noise-optimized monoenergetic postprocessing on diagnostic accuracy for detecting incidental pulmonary embolism in portal-venous phase dual-energy computed tomography. Invest Radiol 52:142–147PubMedGoogle Scholar
  7. 7.
    Leithner D, Wichmann JL, Vogl TJ et al (2017) Virtual monoenergetic imaging and iodine perfusion maps improve diagnostic accuracy of dual-energy computed tomography pulmonary angiography with suboptimal contrast attenuation. Invest Radiol 52:659–665CrossRefGoogle Scholar
  8. 8.
    Schenzle JC, Sommer WH, Neumaier K et al (2010) Dual energy CT of the chest: how about the dose? Invest Radiol 45:347–353PubMedGoogle Scholar
  9. 9.
    Krauss B, Grant KL, Schmidt BT, Flohr TG (2015) The importance of spectral separation: an assessment of dual-energy spectral separation for quantitative ability and dose efficiency. Invest Radiol 50:114–118CrossRefGoogle Scholar
  10. 10.
    Wichmann JL, Hardie AD, Schoepf UJ et al (2017) Single- and dual-energy CT of the abdomen: comparison of radiation dose and image quality of 2nd and 3rd generation dual-source CT. Eur Radiol 27:642–650CrossRefGoogle Scholar
  11. 11.
    De Cecco CN, Darnell A, Macías N et al (2013) Second-generation dual-energy computed tomography of the abdomen: radiation dose comparison with 64- and 128-row single-energy acquisition. J Comput Assist Tomogr 37:543–546CrossRefGoogle Scholar
  12. 12.
    Shrimpton PC, Hillier MC, Lewis MA, Dunn M (2006) National survey of doses from CT in the UK: 2003. Br J Radiol 79:968–980CrossRefGoogle Scholar
  13. 13.
    (2007) The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37:1–332Google Scholar
  14. 14.
    Christner JA, Kofler JM, McCollough CH (2010) Estimating effective dose for CT using dose-length product compared with using organ doses: consequences of adopting International Commission on Radiological Protection publication 103 or dual-energy scanning. AJR Am J Roentgenol 194:881–889CrossRefGoogle Scholar
  15. 15.
    Schindera ST, Nelson RC, Mukundan S Jr et al (2008) Hypervascular liver tumors: low tube voltage, high tube current multi-detector row CT for enhanced detection--phantom study. Radiology 246:125–132CrossRefGoogle Scholar
  16. 16.
    Sullivan GM, Artino AR Jr (2013) Analyzing and interpreting data from likert-type scales. J Grad Med Educ 5:541–542CrossRefGoogle Scholar
  17. 17.
    Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290Google Scholar
  18. 18.
    Mahmood U, Horvat N, Horvat JV et al (2018) Rapid switching kVp dual energy CT: value of reconstructed dual energy CT images and organ dose assessment in multiphasic liver CT exams. Eur J Radiol 102:102–108CrossRefGoogle Scholar
  19. 19.
    Schmidt D, Söderberg M, Nilsson M, Lindvall H, Christoffersen C, Leander P (2018) Evaluation of image quality and radiation dose of abdominal dual-energy CT. Acta Radiol 59:845–852CrossRefGoogle Scholar
  20. 20.
    Primak AN, Giraldo JC, Eusemann CD et al (2010) Dual-source dual-energy CT with additional tin filtration: dose and image quality evaluation in phantoms and in vivo. AJR Am J Roentgenol 195:1164–1174CrossRefGoogle Scholar
  21. 21.
    Bauer RW, Kramer S, Renker M et al (2011) Dose and image quality at CT pulmonary angiography-comparison of first and second generation dual-energy CT and 64-slice CT. Eur Radiol 21:2139–2147CrossRefGoogle Scholar
  22. 22.
    Meyer M, Haubenreisser H, Schoepf UJ et al (2014) Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 273:373–382CrossRefGoogle Scholar
  23. 23.
    Gordic S, Morsbach F, Schmidt B et al (2014) Ultralow-dose chest computed tomography for pulmonary nodule detection: first performance evaluation of single energy scanning with spectral shaping. Invest Radiol 49:465–473CrossRefGoogle Scholar
  24. 24.
    Nam SB, Jeong DW, Choo KS et al (2017) Image quality of CT angiography in young children with congenital heart disease: a comparison between the sinogram-affirmed iterative reconstruction (SAFIRE) and advanced modelled iterative reconstruction (ADMIRE) algorithms. Clin Radiol 72:1060–1065CrossRefGoogle Scholar
  25. 25.
    Schmid AI, Uder M, Lell MM (2017) Reaching for better image quality and lower radiation dose in head and neck CT: advanced modeled and sinogram-affirmed iterative reconstruction in combination with tube voltage adaptation. Dentomaxillofac Radiol 46:20160131CrossRefGoogle Scholar
  26. 26.
    Winklehner A, Gordic S, Lauk E et al (2015) Automated attenuation-based tube voltage selection for body CTA: performance evaluation of 192-slice dual-source CT. Eur Radiol 25:2346–2353CrossRefGoogle Scholar
  27. 27.
    Graser A, Johnson TR, Hecht EM et al (2009) Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images? Radiology 252:433–440CrossRefGoogle Scholar
  28. 28.
    Mangold S, De Cecco CN, Wichmann JL et al (2016) Effect of automated tube voltage selection, integrated circuit detector and advanced iterative reconstruction on radiation dose and image quality of 3rd generation dual-source aortic CT angiography: an intra-individual comparison. Eur J Radiol 85:972–978CrossRefGoogle Scholar
  29. 29.
    Mayo-Smith WW, Hara AK, Mahesh M, Sahani DV, Pavlicek W (2014) How I do it: managing radiation dose in CT. Radiology 273:657–672CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Lukas Lenga
    • 1
    Email author
  • Franziska Trapp
    • 2
  • Moritz H. Albrecht
    • 1
  • Julian L. Wichmann
    • 1
  • Addison A. Johnson
    • 3
  • Ibrahim Yel
    • 1
  • Tommaso D’Angelo
    • 1
    • 4
  • Christian Booz
    • 1
  • Thomas J. Vogl
    • 2
  • Simon S. Martin
    • 1
    • 3
  1. 1.Division of Experimental Imaging, Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany
  3. 3.Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  4. 4.Department of Biomedical Sciences and Morphological and Functional ImagingUniversity Hospital MessinaMessinaItaly

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