High-pitch CT pulmonary angiography (CTPA) with ultra-low contrast medium volume for the detection of pulmonary embolism: a comparison with standard CTPA.

Autor: Schönfeld T; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.; Department of General and Geriatric Medicine, St. Elisabeth-Hospital Leipzig, Biedermannstr. 84, 04277, Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany., Seitz P; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany., Krieghoff C; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany., Ponorac S; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.; Institute of Radiology, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia., Wötzel A; Emergency Department, Helios Park-Clinic Leipzig, Strümpellstr. 41, 04289, Leipzig, Germany., Olthoff S; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany., Schaudt S; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany., Steglich J; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany., Gutberlet M; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany.; Leipzig Heart Institute, Russenstr. 69a, 04289, Leipzig, Germany., Gohmann RF; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. Robin.Gohmann@gmx.de.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103, Leipzig, Germany. Robin.Gohmann@gmx.de.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Mar; Vol. 34 (3), pp. 1921-1931. Date of Electronic Publication: 2023 Sep 01.
DOI: 10.1007/s00330-023-10101-8
Abstrakt: Objective: To investigate the feasibility and image quality of high-pitch CT pulmonary angiography (CTPA) with reduced iodine volume in normal weight patients.
Methods: In total, 81 normal weight patients undergoing CTPA for suspected pulmonary arterial embolism were retrospectively included: 41 in high-pitch mode with 20 mL of contrast medium (CM); and 40 with normal pitch and 50 mL of CM. Subjective image quality was assessed and rated on a 3-point scale. For objective image quality, attenuation and noise values were measured in all pulmonary arteries from the trunk to segmental level. Contrast-to-noise ratio (CNR) was calculated. Radiation dose estimations were recorded.
Results: There were no statistically significant differences in patient and scan demographics between high-pitch and standard CTPA. Subjective image quality was rated good to excellent in over 90% of all exams with no significant group differences (p = 0.32). Median contrast opacification was lower in high-pitch CTPA (283.18 [216.06-368.67] HU, 386.81 [320.57-526.12] HU; p = 0.0001). CNR reached a minimum of eight in all segmented arteries, but was lower in high-pitch CTPA (8.79 [5.82-12.42], 11.01 [9.19-17.90]; p = 0.005). Median effective dose of high-pitch CTPA was lower (1.04 [0.72-1.27] mSv/mGy·cm; 1.49 [1.07-2.05] mSv/mGy·cm; p < 0.0001).
Conclusion: High-pitch CTPA using ultra-low contrast volume (20 mL) rendered diagnostic images for the detection of pulmonary arterial embolism in most instances. Compared to standard CTPA, the high-pitch CTPA exams with drastically reduced contrast medium volume had also concomitantly reduced radiation exposure. However, objective image quality of high-pitch CTPA was worse, though likely still within acceptable limits for confident diagnosis.
Clinical Relevance: This study provides valuable insights on the performance of a high-pitch dual-source CTPA protocol, offering potential benefits in reducing contrast medium and radiation dose while maintaining sufficient image quality for accurate diagnosis in patients suspected of pulmonary embolism.
Key Points: • High-pitch CT pulmonary angiography (CTPA) with ultra-low volume of contrast medium and reduced radiation dose renders diagnostic examinations with comparable subjective image quality to standard CTPA in most patients. • Objective image quality of high-pitch CTPA is reduced compared to standard CTPA, but contrast opacification and contrast-to-noise ratio remain above diagnostic thresholds. • Challenges of high-pitch CTPA may potentially be encountered in patients with severe heart failure or when performing a Valsalva maneuver during the examination.
(© 2023. The Author(s).)
Databáze: MEDLINE
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