Patricia Carrascosa1, Jonathon A Leipsic2, Carlos Capunay3, Alejandro Deviggiano3, Javier Vallejos3, Alejandro Goldsmit4, Gaston A Rodriguez-Granillo3. 1. Department of Computed Tomography, Diagnostico Maipu, Buenos Aires, Argentina. Electronic address: investigacion@diagnosticomaipu.com.ar. 2. Medical Imaging, St. Paul's Hospital, Vancouver, BC, Canada. 3. Department of Computed Tomography, Diagnostico Maipu, Buenos Aires, Argentina. 4. Department of Interventional Cardiology, Sanatorio Guemes, Buenos Aires, Argentina.
Abstract
PURPOSE: To compare image interpretability and diagnostic performance of dual-energy CT coronary angiography (DE-CTCA) performed with 50% iodine load reduction versus single energy acquisitions (SE-CTCA) with full iodine load. MATERIALS AND METHODS: The present prospective study involved patients with suspected coronary artery disease (CAD) clinically referred for CTCA. DE-CTCA with 50% iodine volume load was performed first, and after heart rate returned to baseline SE-CTCA was performed using full iodine volume load. The primary endpoint was to compare image interpretability between groups. DE-CTCA was performed by rapid switching between low and high tube potentials (80-140 kV) from a single source, allowing the generation of monochromatic image reconstructions ranging from 40 to 140 keV. Image quality assessment was performed using a 5-point Likert scale. RESULTS: Thirty-six patients constituted the study population. The mean heart rate before the CT scan (DE-CTCA 57.3 ± 10.7 bpm vs. SE-CTCA 58.5 ± 11.2 bpm, p=0.29) and the mean effective radiation dose (3.5 ± 1.9 mSv vs. 3.8 ± 0.9 mSv, p=0.48) did not differ between groups. Likert image quality scores were similar between groups (DE-CTCA 4.42 ± 0.98 vs. SE-CTCA 4.43 ± 0.84, p=0.67). Signal-to-noise and contrast-to-noise ratios were significantly lower with DE-CTCA, driven by lower signal density levels at 60 keV compared to SE-CTCA. The sensitivity and specificity for the detection of stenosis >50% was indistinguishable between groups (DE-CTCA 84.4% (69.9-93.0%), 87.1% (81.6-91.2%); SE-CTCA 84.4% (69.9-93.0%), 87.1% (81.6-91.2%). CONCLUSIONS: In this pilot, prospective study, dual energy CTCA imaging with half iodine load achieved comparable interpretability than full iodine load with single energy CTCA.
PURPOSE: To compare image interpretability and diagnostic performance of dual-energy CT coronary angiography (DE-CTCA) performed with 50% iodine load reduction versus single energy acquisitions (SE-CTCA) with full iodine load. MATERIALS AND METHODS: The present prospective study involved patients with suspected coronary artery disease (CAD) clinically referred for CTCA. DE-CTCA with 50% iodine volume load was performed first, and after heart rate returned to baseline SE-CTCA was performed using full iodine volume load. The primary endpoint was to compare image interpretability between groups. DE-CTCA was performed by rapid switching between low and high tube potentials (80-140 kV) from a single source, allowing the generation of monochromatic image reconstructions ranging from 40 to 140 keV. Image quality assessment was performed using a 5-point Likert scale. RESULTS: Thirty-six patients constituted the study population. The mean heart rate before the CT scan (DE-CTCA 57.3 ± 10.7 bpm vs. SE-CTCA 58.5 ± 11.2 bpm, p=0.29) and the mean effective radiation dose (3.5 ± 1.9 mSv vs. 3.8 ± 0.9 mSv, p=0.48) did not differ between groups. Likert image quality scores were similar between groups (DE-CTCA 4.42 ± 0.98 vs. SE-CTCA 4.43 ± 0.84, p=0.67). Signal-to-noise and contrast-to-noise ratios were significantly lower with DE-CTCA, driven by lower signal density levels at 60 keV compared to SE-CTCA. The sensitivity and specificity for the detection of stenosis >50% was indistinguishable between groups (DE-CTCA 84.4% (69.9-93.0%), 87.1% (81.6-91.2%); SE-CTCA 84.4% (69.9-93.0%), 87.1% (81.6-91.2%). CONCLUSIONS: In this pilot, prospective study, dual energy CTCA imaging with half iodine load achieved comparable interpretability than full iodine load with single energy CTCA.
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