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Image quality of spectral brain computed tomography angiography using halved dose of iodine contrast medium

Fransson, Veronica LU orcid ; Mellander, Helena LU orcid ; Ramgren, Birgitta LU ; Andersson, Henrik LU orcid ; Arena, Francesco ; Ydström, Kristina LU ; Ullberg, Teresa LU and Wassélius, Johan LU (2023) In Neuroradiology 65(9). p.1333-1342
Abstract

Purpose: Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing. Methods: Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing. Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the... (More)

Purpose: Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing. Methods: Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing. Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the middle cerebral artery, and white matter for conventional images (CI) and VMI (40–200 keV). Qualitative image quality for CI and VMI (50 and 60 keV) was rated by 4 experienced reviewers. Results: Qualitatively and quantitatively, VMI (40–60 keV) improved image quality within each group. Significantly higher attenuation and CNR was found for group 3 VMI 40–50 keV, with unchanged SNR, compared to group 1 CI. Group 3 VMI 50 keV also received significantly higher rating scores than group 1 CI. Group 2 VMI (40–50 keV) had significantly higher CNR compared to group 3 CI, but the subjective image quality was similar. Conclusion: VMI of 50 keV with 50% CM dose increases qualitative and quantitative image quality over CI with full CM dose. Using VMI reduces non-diagnostic examinations and may salvage CTA examinations deemed non-diagnostic due to suboptimal timing.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Computed tomography angiography, Contrast material reduction, Contrast-induced nephropathy, Dual-energy CT, Spectral CT, Virtual monoenergetic images
in
Neuroradiology
volume
65
issue
9
pages
10 pages
publisher
Springer
external identifiers
  • pmid:37452885
  • scopus:85164782149
ISSN
0028-3940
DOI
10.1007/s00234-023-03190-1
language
English
LU publication?
yes
id
e74288eb-6ae8-44c2-8913-b6b73c24589e
date added to LUP
2023-09-22 14:32:47
date last changed
2024-04-19 01:33:29
@article{e74288eb-6ae8-44c2-8913-b6b73c24589e,
  abstract     = {{<p>Purpose: Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing. Methods: Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing. Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the middle cerebral artery, and white matter for conventional images (CI) and VMI (40–200 keV). Qualitative image quality for CI and VMI (50 and 60 keV) was rated by 4 experienced reviewers. Results: Qualitatively and quantitatively, VMI (40–60 keV) improved image quality within each group. Significantly higher attenuation and CNR was found for group 3 VMI 40–50 keV, with unchanged SNR, compared to group 1 CI. Group 3 VMI 50 keV also received significantly higher rating scores than group 1 CI. Group 2 VMI (40–50 keV) had significantly higher CNR compared to group 3 CI, but the subjective image quality was similar. Conclusion: VMI of 50 keV with 50% CM dose increases qualitative and quantitative image quality over CI with full CM dose. Using VMI reduces non-diagnostic examinations and may salvage CTA examinations deemed non-diagnostic due to suboptimal timing.</p>}},
  author       = {{Fransson, Veronica and Mellander, Helena and Ramgren, Birgitta and Andersson, Henrik and Arena, Francesco and Ydström, Kristina and Ullberg, Teresa and Wassélius, Johan}},
  issn         = {{0028-3940}},
  keywords     = {{Computed tomography angiography; Contrast material reduction; Contrast-induced nephropathy; Dual-energy CT; Spectral CT; Virtual monoenergetic images}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{1333--1342}},
  publisher    = {{Springer}},
  series       = {{Neuroradiology}},
  title        = {{Image quality of spectral brain computed tomography angiography using halved dose of iodine contrast medium}},
  url          = {{http://dx.doi.org/10.1007/s00234-023-03190-1}},
  doi          = {{10.1007/s00234-023-03190-1}},
  volume       = {{65}},
  year         = {{2023}},
}