Abstract
Objectives
To compare the diagnostic accuracy between low-kilovolt peak (kVp) (≤ 100) and high-kVp (> 100) third-generation dual-source coronary CT angiography (CCTA) using a kVp-tailored contrast media injection protocol.
Methods
One hundred twenty patients (mean age = 62.6 years, BMI = 29.0 kg/m2) who underwent catheter angiography and CCTA with automated kVp selection were separated into two cohorts (each n = 60, mean kVp = 84 and 117). Contrast media dose was tailored to the kVp level: 70 = 40 ml, 80 = 50 ml, 90 = 60 ml, 100 = 70 ml, 110 = 80 ml, and 120 = 90 ml. Contrast-to-noise ratio (CNR) was measured. Two observers evaluated image quality and the presence of significant coronary stenosis (> 50% luminal narrowing).
Results
Diagnostic accuracy (sensitivity/specificity) with ≤ 100 vs. > 100 kVp CCTA was comparable: per patient = 93.9/92.6% vs. 90.9/92.6%, per vessel = 91.5/97.8% vs. 94.0/96.8%, and per segment = 90.0/96.7% vs. 90.7/95.2% (all P > 0.64). CNR was similar (P > 0.18) in the low-kVp vs. high-kVp group (12.0 vs. 11.1), as ws subjective image quality (P = 0.38). Contrast media requirements were reduced by 38.1% in the low- vs. high-kVp cohort (53.6 vs. 86.6 ml, P < 0.001) and radiation dose by 59.6% (4.3 vs. 10.6 mSv, P < 0.001).
Conclusions
Automated tube voltage selection with a tailored contrast media injection protocol allows CCTA to be performed at ≤ 100 kVp with substantial dose reductions and equivalent diagnostic accuracy for coronary stenosis detection compared to acquisitions at > 100 kVp.
Key points
• Low-kVp coronary CT angiography (CCTA) enables reduced contrast and radiation dose.
• Diagnostic accuracy is comparable between ≤ 100 and > 100 kVp CCTA.
• Image quality is similar for low- and high-kVp CCTA.
• Low-kVp image acquisition is facilitated by automated tube voltage selection.
• Tailoring contrast injection protocols to the automatically selected kVp-level is feasible.
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The scientific guarantor of this publication is U. Joseph Schoepf, MD.
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The authors of this manuscript declare relationships with the following companies: U. Joseph Schoepf is a consultant for and/or receives research support from Astellas, Bayer, Bracco, GE, Guerbet, Medrad, and Siemens. Katharina Otani is an employee of Siemens. Akos Varga-Szemes is a consultant for and/or receives research support from Guerbet and Siemens. Carlo N. De Cecco is a consultant for and/or receives research support from Guerbet and Siemens.
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Katharina Otani, PhD, kindly provided statistical advice for this manuscript.
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Written informed consent was waived by the Institutional Review Board.
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Institutional Review Board approval was obtained.
Methodology
• retrospective
• diagnostic study
• performed at one institution
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Albrecht, M.H., Nance, J.W., Schoepf, U.J. et al. Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol. Eur Radiol 28, 2134–2142 (2018). https://doi.org/10.1007/s00330-017-5150-z
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DOI: https://doi.org/10.1007/s00330-017-5150-z