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Lower tube voltage reduces contrast material and radiation doses on 16-MDCT aortography
Yoshiharu Nakayama1, Kazuo Awai, Yoshinori Funama
1Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. yoshiharu156@lily.ocn.ne.jp
Objective:
The purpose of our study was to compare aortic CT angiography performed at a low tube voltage and reduced dose of contrast material with standard-voltage, standard-contrast-dose CT angiography.
Subjects And Methods:
We evaluated 74 patients for aortic disease on MDCT angiography (collimation, 16 x 1.5 mm; beam pitch, 0.9). In 36 patients, we used the standard tube voltage (120 kVp) and a contrast dose of 100 mL (300 mg I/mL) (protocol 1), and in the remaining 38 patients we applied a reduced tube voltage (90 kVp) and a contrast dose of 40 mL (300 mg I/mL) (protocol 2). The patients' weights, CT attenuation of the aorta, visualization of the celiac axis and renal artery, and graininess and streak artifacts on transverse CT scans were evaluated and recorded for each data set. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also measured. For statistical analysis, we used the two-tailed Student's t test and logistic regression; agreement between measurements recorded independently by two blinded reviewers was assessed using Cohen kappa statistics.
Results:
In both protocols a negative correlation was seen between patient weight and CT attenuation. In three protocol 1 patients weighing more than 70 kg, CT attenuation was less than 200 H. No difference was seen between the two protocols with respect to mean attenuation of the aorta (p = 0.13) or visualization of the celiac axis and renal artery (p = 0.35 and 0.60, respectively). Although the SNR and CNR were significantly higher in protocol 1 than in protocol 2, qualitative evaluation of graininess and streak artifacts showed no statistically significant difference (p = 0.15 and 0.48, respectively). Interobserver agreement for quality assessments was within an acceptable range (kappa = 0.42-0.80).
Conclusion:
Low-contrast and low-voltage scans are appropriate for lighter patients (< 70 kg in body weight) with aortic disease. Moreover, this method is particularly valuable for follow-up studies of heavier patients (> 70 kg) with renal dysfunction.
Insights
Low-dose CT angiography is effective for lighter patients (<70kg) with aortic disease. This reduced voltage and contrast method is also beneficial for heavier patients with renal issues.
Area of Science:
- Medical Imaging
- Radiology
- Cardiovascular Imaging
Background:
- Aortic diseases require accurate imaging for diagnosis and management.
- CT angiography (CTA) is a key tool, but contrast material dose and radiation exposure are concerns.
Purpose of the Study:
- To compare low-tube voltage, reduced-contrast-dose aortic CTA with standard-protocol CTA.
- To assess image quality and diagnostic adequacy of the reduced-dose protocol.
Main Methods:
- 74 patients underwent MDCT angiography using either standard (120 kVp, 100 mL contrast) or reduced (90 kVp, 40 mL contrast) protocols.
- Evaluated parameters included aortic CT attenuation, visualization of visceral arteries, image noise (graininess), streak artifacts, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR).
- Statistical analysis included t-tests, logistic regression, and Cohen kappa for interobserver agreement.
Main Results:
- No significant difference in mean aortic attenuation or visualization of the celiac axis and renal arteries between protocols.
- Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were significantly higher with the standard protocol.
- Qualitative assessment showed no significant difference in graininess or streak artifacts between the two protocols.
Conclusions:
- Low-voltage, low-contrast CTA is suitable for patients under 70 kg with aortic disease.
- This approach is particularly valuable for follow-up imaging in heavier patients with renal dysfunction.
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