Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol

Albrecht MH, Nance JW, Schoepf UJ, Jacobs BE, Bayer RR, Litwin SE, Reynolds MA, Otani K, Mangold S, Varga-Szemes A, De Santis D, Eid M, Apfaltrer G, Tesche C, Göller M, Vogl TJ, De Cecco CN (2018)

Publication Type: Journal article

Publication year: 2018

Journal

European Radiology Springer Verlag (Germany)

Book Volume: 28

Pages Range: 2134-2142

Journal Issue: 5

DOI: 10.1007/s00330-017-5150-z

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.

Authors with CRIS profile

Markus Göller Department of Medicine 2 – Cardiology and Angiology

Involved external institutions

Medical University of South Carolina (MUSC) US United States (USA) (US) Siemens Healthcare KK JP Japan (JP) Universitätsklinikum Frankfurt am Main (KGU) DE Germany (DE)

How to cite

APA:

Albrecht, M.H., Nance, J.W., Schoepf, U.J., Jacobs, B.E., Bayer, R.R., Litwin, S.E.,... De Cecco, C.N. (2018). Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol. European Radiology, 28(5), 2134-2142. https://dx.doi.org/10.1007/s00330-017-5150-z

MLA:

Albrecht, Moritz H., et al. "Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol." European Radiology 28.5 (2018): 2134-2142.

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