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

Moritz H. Albrecht; John W. Nance; U. Joseph Schoepf; Brian E. Jacobs; Richard R. Bayer; Sheldon E. Litwin; Michael A. Reynolds; Katharina Otani; Stefanie Mangold; Akos Varga-Szemes; Domenico De Santis; Marwen Eid; Georg Apfaltrer; Christian Tesche; Markus Goeller; Thomas J. Vogl; Carlo N. De Cecco

doi:10.1007/s00330-017-5150-z

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

Moritz H. Albrecht, John W. Nance, U. Joseph Schoepf, Brian E. Jacobs, Richard R. Bayer, Sheldon E. Litwin, Michael A. Reynolds, Katharina Otani, Stefanie Mangold, Akos Varga-Szemes, Domenico De Santis, Marwen Eid, Georg Apfaltrer, Christian Tesche, Markus Goeller, Thomas J. Vogl, Carlo N. De Cecco

Houston Methodist

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

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.

Original language	English (US)
Pages (from-to)	2134-2142
Number of pages	9
Journal	European Radiology
Volume	28
Issue number	5
DOIs	https://doi.org/10.1007/s00330-017-5150-z
State	Published - May 1 2018

Keywords

Contrast media dose
Coronary CT angiography
Diagnostic accuracy
Radiation dose
Tube voltage

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1007/s00330-017-5150-z

Cite this

Albrecht, M. H., Nance, J. W., Schoepf, U. J., Jacobs, B. E., Bayer, R. R., Litwin, S. E., Reynolds, M. A., Otani, K., Mangold, S., Varga-Szemes, A., De Santis, D., Eid, M., Apfaltrer, G., Tesche, C., Goeller, M., Vogl, T. J., & 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://doi.org/10.1007/s00330-017-5150-z

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, Goeller, M, Vogl, TJ & De Cecco, CN 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, vol. 28, no. 5, pp. 2134-2142. https://doi.org/10.1007/s00330-017-5150-z

@article{83f4f7a4d1184fab8eaf300985df8b23,

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

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.",

keywords = "Contrast media dose, Coronary CT angiography, Diagnostic accuracy, Radiation dose, Tube voltage",

author = "Albrecht, {Moritz H.} and Nance, {John W.} and Schoepf, {U. Joseph} and Jacobs, {Brian E.} and Bayer, {Richard R.} and Litwin, {Sheldon E.} and Reynolds, {Michael A.} and Katharina Otani and Stefanie Mangold and Akos Varga-Szemes and {De Santis}, Domenico and Marwen Eid and Georg Apfaltrer and Christian Tesche and Markus Goeller and Vogl, {Thomas J.} and {De Cecco}, {Carlo N.}",

note = "Funding Information: The authors of this manuscript declare relationships with the following companies: U. Joseph Schoepf is a consultant for and/or receives research support from Astellas, Bayer, Bracco, GE, Guerbet, Medrad, and Siemens. Katharina Otani is an employee of Siemens. Akos Varga-Szemes is a consultant for and/or receives research support from Guerbet and Siemens. Carlo N. De Cecco is a consultant for and/or receives research support from Guerbet and Siemens. Publisher Copyright: {\textcopyright} 2017, European Society of Radiology.",

year = "2018",

month = may,

day = "1",

doi = "10.1007/s00330-017-5150-z",

language = "English (US)",

volume = "28",

pages = "2134--2142",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "5",

}

TY - JOUR

T1 - Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol

AU - Albrecht, Moritz H.

AU - Nance, John W.

AU - Schoepf, U. Joseph

AU - Jacobs, Brian E.

AU - Bayer, Richard R.

AU - Litwin, Sheldon E.

AU - Reynolds, Michael A.

AU - Otani, Katharina

AU - Mangold, Stefanie

AU - Varga-Szemes, Akos

AU - De Santis, Domenico

AU - Eid, Marwen

AU - Apfaltrer, Georg

AU - Tesche, Christian

AU - Goeller, Markus

AU - Vogl, Thomas J.

AU - De Cecco, Carlo N.

N1 - Funding Information: The authors of this manuscript declare relationships with the following companies: U. Joseph Schoepf is a consultant for and/or receives research support from Astellas, Bayer, Bracco, GE, Guerbet, Medrad, and Siemens. Katharina Otani is an employee of Siemens. Akos Varga-Szemes is a consultant for and/or receives research support from Guerbet and Siemens. Carlo N. De Cecco is a consultant for and/or receives research support from Guerbet and Siemens. Publisher Copyright: © 2017, European Society of Radiology.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

KW - Contrast media dose

KW - Coronary CT angiography

KW - Diagnostic accuracy

KW - Radiation dose

KW - Tube voltage

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

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