Health Faculty, Oslo Metropolitan University, Oslo, Norway.
Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway.
Eur Radiol. 2023 Sep;33(9):6033-6044. doi: 10.1007/s00330-023-09575-3. Epub 2023 Apr 18.
To compare vascular attenuation (VA) of an experimental half iodine-load dual-layer spectral detector CT (SDCT) lower limb computed tomography angiography (CTA) with control (standard iodine-load conventional 120-kilovolt peak (kVp) CTA).
Ethical approval and consent were obtained. In this parallel RCT, CTA examinations were randomized into experimental or control. Patients received 0.7 vs 1.4 mL/kg of iohexol 350 mgI/mL in the experimental- vs the control group. Two experimental virtual monoenergetic image (VMI) series at 40 and 50 kiloelectron volts (keV) were reconstructed.
VA.
image noise (noise), contrast- and signal-to-noise ratio (CNR and SNR), and subjective examination quality (SEQ).
A total of 106 vs 109 were randomized and 103 vs 108 were analyzed in the experimental vs, control groups, respectively. VA was higher on experimental 40 keV VMI than on control (p < 0.0001), but lower on 50 keV VMI (p < 0.022). Noise was higher on experimental 40 keV VMI than on control (p = 0.00022), but lower on 50 keV VMI (p = 0.0033). CNR and SNR were higher than the control on experimental 40 keV VMI (both p < 0.0001) and 50 keV (p = 0.0058 and p = 0.0023, respectively). SEQ was better on both VMIs in the experimental group than in the control (both p < 0.0001).
Half iodine-load SDCT lower limb CTA at 40 keV achieved higher VA than the control. CNR, SNR, noise, and SEQ were higher at 40 keV, while 50 keV showed lower noise.
Spectral detector CT with low-energy virtual monoenergetic imaging performed halved iodine contrast medium (CM) lower limb CT-angiography with sustained objective and subjective quality. This facilitates CM reduction, improvement of low CM-dosage examinations, and examination of patients with more severe kidney impairment.
Retrospectively registered 5 August 2022 at clinicaltrials.gov NCT05488899.
• Contrast medium dosage may be halved in lower limb dual-energy CT angiography with virtual monoenergetic images at 40 keV, which may reduce contrast medium consumption in the face of a global shortage. • Experimental half-iodine-load dual-energy CT angiography at 40 keV showed higher vascular attenuation, contrast-to-noise ratio, signal-to-noise ratio, and subjective examination quality than standard iodine-load conventional. • Half-iodine dual-energy CT angiography protocols may allow us to reduce the risk of PC-AKI, examine patients with more severe kidney impairment, and provide higher quality examinations or salvage poor examinations when impaired kidney function limits the CM dose.
比较实验性半碘负荷双层光谱探测器 CT（SDCT）下肢 CT 血管造影（CTA）的血管衰减（VA）与对照（标准碘负荷传统 120 千伏峰值（kVp）CTA）。
获得伦理批准和同意。在这项平行 RCT 中，CTA 检查随机分为实验组和对照组。实验组和对照组患者分别接受 0.7 与 1.4 ml/kg 的碘海醇 350 mgI/ml。重建了两个实验虚拟单能量图像（VMI）系列，能量分别为 40 和 50 千伏（keV）。
VA。
图像噪声（噪声）、对比噪声比（CNR）和信噪比（SNR）以及主观检查质量（SEQ）。
实验组和对照组分别有 106 例和 109 例随机分组，103 例和 108 例进行了分析。实验组 40 keV VMI 的 VA 高于对照组（p<0.0001），但 50 keV VMI 的 VA 较低（p<0.022）。实验组 40 keV VMI 的噪声高于对照组（p=0.00022），但 50 keV VMI 的噪声较低（p=0.0033）。实验组 40 keV VMI 的 CNR 和 SNR 均高于对照组（均 p<0.0001），50 keV 的 CNR 和 SNR 也高于对照组（p=0.0058 和 p=0.0023）。实验组两种 VMI 的 SEQ 均优于对照组（均 p<0.0001）。
40 keV 下的半碘负荷 SDCT 下肢 CTA 可获得比对照组更高的 VA。40 keV 时 CNR、SNR、噪声和 SEQ 更高，而 50 keV 时噪声更低。
低能量虚拟单能量成像的光谱探测器 CT 以半剂量对比剂（CM）进行下肢 CT 血管造影，保持了客观和主观的质量。这有助于减少 CM 用量，改善低 CM 剂量检查，并检查肾功能更严重受损的患者。
2022 年 8 月 5 日在 clinicaltrials.gov 上进行了回顾性注册（NCT05488899）。
下肢双能 CT 血管造影中，40 keV 虚拟单能量图像的对比剂剂量可减半，从而在全球短缺的情况下减少对比剂的消耗。
实验组半碘负荷双能 CT 血管造影在 40 keV 时显示出更高的血管衰减、对比噪声比、信噪比和主观检查质量，优于标准碘负荷常规。
半碘双能 CT 血管造影方案可能有助于降低 PC-AKI 风险，检查肾功能更严重受损的患者，并在肾功能受损限制 CM 剂量时提供更高质量的检查或挽救质量较差的检查。
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