Impact of iodine delivery rate with varying flow rates on image quality in dual-energy CT of patients with suspected pulmonary embolism

Jan Hansmann; Christian Fink; Gregor Jost; Hubertus Pietsch; Mathias Meyer; John W. Nance; Uwe J. Schoepf; Ulrike I. Attenberger; Stefan O. Schoenberg; Thomas Henzler

doi:10.1016/j.acra.2013.02.013

Impact of iodine delivery rate with varying flow rates on image quality in dual-energy CT of patients with suspected pulmonary embolism

Jan Hansmann, Christian Fink, Gregor Jost, Hubertus Pietsch, Mathias Meyer, John W. Nance, Uwe J. Schoepf, Ulrike I. Attenberger, Stefan O. Schoenberg, Thomas Henzler

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

20 Scopus citations

Abstract

Rationale and Objectives: To prospectively compare four contrast material injection protocols for dual-energy computed tomography (CT) pulmonary angiography (DE-CTPA) in patients with suspected pulmonary embolism (PE). Materials and Methods: One hundred twenty consecutive patients were randomized to contrast material injection protocols defined by different iodine concentrations and iodine delivery rates (IDRs): (A) 80mL iopromide 370/4mL/sec=IDR 1.4 gI/sec; (B) 80mL iopromide 370 at 3mL/sec=IDR 1.1 gI/sec; (C) 98mL iopromide 300 at 4.9mL/sec=IDR 1.4 gI/sec; and (D) 98mL iopromide 300 at 3.7mL/sec=IDR 1.1 gI/sec. Attenuation values were measured in the inflow tract (subclavian vein-superior vena cava-right atrium), target tract (rightventricle-pulmonary trunk-pulmonary arteries), and outflow tract (left atrium-left ventricle-ascending aorta). Two readers assessed subjective image quality of CTPA images and iodine perfusion maps. The number of artifacts due to hyperdense contrast material on iodine perfusion maps was recorded. Results: Target tract attenuation was highest for protocol A with 374 ± 98 Hounsfield units (HU) (highly concentrated contrast material/high IDR). This was significant compared to protocols B and D (P = .0118, P = .0427) but not compared to protocol C (P = .3395). Nosignificant difference in target tract attenuation was found between protocols B (309 ± 80 HU), protocol C (352 ± 119 HU), and D (325 ± 74 HU). CTPA and iodine perfusion map image quality for protocol A was rated significantly higher compared to all other protocols (median score=5/4; P < .0001 for both) with moderate interreader agreement (κ=0.58/0.47). Protocols A and B displayed increased artifacts on iodine perfusion maps compared to protocols C and D (3 versus 2). Conclusion: Despite increased artifacts on iodine perfusion maps, highly concentrated iodinated contrast material combined with high flow rates provides improved diagnostic image quality and has the highest target-tract attenuation for DE-CTPA protocols.

Original language	English (US)
Pages (from-to)	962-971
Number of pages	10
Journal	Academic Radiology
Volume	20
Issue number	8
DOIs	https://doi.org/10.1016/j.acra.2013.02.013
State	Published - Aug 2013

Keywords

Dual-energy CT
Iodine delivery rate
Pulmonary embolism
Pulmonary perfusion

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1016/j.acra.2013.02.013

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@article{f720d6653c464b2d8316376c959eb7ad,

title = "Impact of iodine delivery rate with varying flow rates on image quality in dual-energy CT of patients with suspected pulmonary embolism",

abstract = "Rationale and Objectives: To prospectively compare four contrast material injection protocols for dual-energy computed tomography (CT) pulmonary angiography (DE-CTPA) in patients with suspected pulmonary embolism (PE). Materials and Methods: One hundred twenty consecutive patients were randomized to contrast material injection protocols defined by different iodine concentrations and iodine delivery rates (IDRs): (A) 80mL iopromide 370/4mL/sec=IDR 1.4 gI/sec; (B) 80mL iopromide 370 at 3mL/sec=IDR 1.1 gI/sec; (C) 98mL iopromide 300 at 4.9mL/sec=IDR 1.4 gI/sec; and (D) 98mL iopromide 300 at 3.7mL/sec=IDR 1.1 gI/sec. Attenuation values were measured in the inflow tract (subclavian vein-superior vena cava-right atrium), target tract (rightventricle-pulmonary trunk-pulmonary arteries), and outflow tract (left atrium-left ventricle-ascending aorta). Two readers assessed subjective image quality of CTPA images and iodine perfusion maps. The number of artifacts due to hyperdense contrast material on iodine perfusion maps was recorded. Results: Target tract attenuation was highest for protocol A with 374 ± 98 Hounsfield units (HU) (highly concentrated contrast material/high IDR). This was significant compared to protocols B and D (P = .0118, P = .0427) but not compared to protocol C (P = .3395). Nosignificant difference in target tract attenuation was found between protocols B (309 ± 80 HU), protocol C (352 ± 119 HU), and D (325 ± 74 HU). CTPA and iodine perfusion map image quality for protocol A was rated significantly higher compared to all other protocols (median score=5/4; P < .0001 for both) with moderate interreader agreement (κ=0.58/0.47). Protocols A and B displayed increased artifacts on iodine perfusion maps compared to protocols C and D (3 versus 2). Conclusion: Despite increased artifacts on iodine perfusion maps, highly concentrated iodinated contrast material combined with high flow rates provides improved diagnostic image quality and has the highest target-tract attenuation for DE-CTPA protocols.",

keywords = "Dual-energy CT, Iodine delivery rate, Pulmonary embolism, Pulmonary perfusion",

author = "Jan Hansmann and Christian Fink and Gregor Jost and Hubertus Pietsch and Mathias Meyer and Nance, {John W.} and Schoepf, {Uwe J.} and Attenberger, {Ulrike I.} and Schoenberg, {Stefan O.} and Thomas Henzler",

year = "2013",

month = aug,

doi = "10.1016/j.acra.2013.02.013",

language = "English (US)",

volume = "20",

pages = "962--971",

journal = "Academic Radiology",

issn = "1076-6332",

publisher = "Elsevier",

number = "8",

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TY - JOUR

T1 - Impact of iodine delivery rate with varying flow rates on image quality in dual-energy CT of patients with suspected pulmonary embolism

AU - Hansmann, Jan

AU - Fink, Christian

AU - Jost, Gregor

AU - Pietsch, Hubertus

AU - Meyer, Mathias

AU - Nance, John W.

AU - Schoepf, Uwe J.

AU - Attenberger, Ulrike I.

AU - Schoenberg, Stefan O.

AU - Henzler, Thomas

PY - 2013/8

Y1 - 2013/8

N2 - Rationale and Objectives: To prospectively compare four contrast material injection protocols for dual-energy computed tomography (CT) pulmonary angiography (DE-CTPA) in patients with suspected pulmonary embolism (PE). Materials and Methods: One hundred twenty consecutive patients were randomized to contrast material injection protocols defined by different iodine concentrations and iodine delivery rates (IDRs): (A) 80mL iopromide 370/4mL/sec=IDR 1.4 gI/sec; (B) 80mL iopromide 370 at 3mL/sec=IDR 1.1 gI/sec; (C) 98mL iopromide 300 at 4.9mL/sec=IDR 1.4 gI/sec; and (D) 98mL iopromide 300 at 3.7mL/sec=IDR 1.1 gI/sec. Attenuation values were measured in the inflow tract (subclavian vein-superior vena cava-right atrium), target tract (rightventricle-pulmonary trunk-pulmonary arteries), and outflow tract (left atrium-left ventricle-ascending aorta). Two readers assessed subjective image quality of CTPA images and iodine perfusion maps. The number of artifacts due to hyperdense contrast material on iodine perfusion maps was recorded. Results: Target tract attenuation was highest for protocol A with 374 ± 98 Hounsfield units (HU) (highly concentrated contrast material/high IDR). This was significant compared to protocols B and D (P = .0118, P = .0427) but not compared to protocol C (P = .3395). Nosignificant difference in target tract attenuation was found between protocols B (309 ± 80 HU), protocol C (352 ± 119 HU), and D (325 ± 74 HU). CTPA and iodine perfusion map image quality for protocol A was rated significantly higher compared to all other protocols (median score=5/4; P < .0001 for both) with moderate interreader agreement (κ=0.58/0.47). Protocols A and B displayed increased artifacts on iodine perfusion maps compared to protocols C and D (3 versus 2). Conclusion: Despite increased artifacts on iodine perfusion maps, highly concentrated iodinated contrast material combined with high flow rates provides improved diagnostic image quality and has the highest target-tract attenuation for DE-CTPA protocols.

AB - Rationale and Objectives: To prospectively compare four contrast material injection protocols for dual-energy computed tomography (CT) pulmonary angiography (DE-CTPA) in patients with suspected pulmonary embolism (PE). Materials and Methods: One hundred twenty consecutive patients were randomized to contrast material injection protocols defined by different iodine concentrations and iodine delivery rates (IDRs): (A) 80mL iopromide 370/4mL/sec=IDR 1.4 gI/sec; (B) 80mL iopromide 370 at 3mL/sec=IDR 1.1 gI/sec; (C) 98mL iopromide 300 at 4.9mL/sec=IDR 1.4 gI/sec; and (D) 98mL iopromide 300 at 3.7mL/sec=IDR 1.1 gI/sec. Attenuation values were measured in the inflow tract (subclavian vein-superior vena cava-right atrium), target tract (rightventricle-pulmonary trunk-pulmonary arteries), and outflow tract (left atrium-left ventricle-ascending aorta). Two readers assessed subjective image quality of CTPA images and iodine perfusion maps. The number of artifacts due to hyperdense contrast material on iodine perfusion maps was recorded. Results: Target tract attenuation was highest for protocol A with 374 ± 98 Hounsfield units (HU) (highly concentrated contrast material/high IDR). This was significant compared to protocols B and D (P = .0118, P = .0427) but not compared to protocol C (P = .3395). Nosignificant difference in target tract attenuation was found between protocols B (309 ± 80 HU), protocol C (352 ± 119 HU), and D (325 ± 74 HU). CTPA and iodine perfusion map image quality for protocol A was rated significantly higher compared to all other protocols (median score=5/4; P < .0001 for both) with moderate interreader agreement (κ=0.58/0.47). Protocols A and B displayed increased artifacts on iodine perfusion maps compared to protocols C and D (3 versus 2). Conclusion: Despite increased artifacts on iodine perfusion maps, highly concentrated iodinated contrast material combined with high flow rates provides improved diagnostic image quality and has the highest target-tract attenuation for DE-CTPA protocols.

KW - Dual-energy CT

KW - Iodine delivery rate

KW - Pulmonary embolism

KW - Pulmonary perfusion

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Impact of iodine delivery rate with varying flow rates on image quality in dual-energy CT of patients with suspected pulmonary embolism

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