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80-kV(p) hepatic CT to reduce contrast medium dose in azotemic patients: a feasibility study

Journal article
Authors F. Holmquist
M. Soderberg
U. Nyrnan
T. Falt
R. Siemund
Mats Geijer
Published in Acta Radiologica
ISSN 0284-1851
Publication year 2019
Published at Institute of Clinical Sciences, Department of Radiology
Language en
Links dx.doi.org/10.1177/0284185119866807
Keywords Computed tomography, contrast media, acute kidney injury, liver, filtered back-projection, image noise, low tube voltage, low-tube-voltage, image quality, software, impact, kvp, age, Radiology, Nuclear Medicine & Medical Imaging
Subject categories Radiology, Nuclear Medicine and Medical Imaging

Abstract

Background Low peak kilovoltage (kV(p)) computed tomography (CT) may be used to reduce contrast medium doses in patients at risk of contrast medium-induced acute kidney injury if image noise can be controlled by increasing X-ray tube loading (mAs). Purpose To evaluate objective and subjective image quality in 80-kV(p) CT with reduced contrast medium dose and compensated mAs for unchanged image noise in patients with estimated glomerular filtration rate Material and Methods 80-kV(p) CT with 300 mg I/kg in 40 patients (body mass index 18-32 kg/m(2), glomerular filtration rate <45 mL/min) and 120-kV(p) CT with 500 mg I/kg in 40 patients (body mass index = 17-30 kg/m(2), glomerular filtration rate >= 45 mL/min) was compared on mean hepatic attenuation, image noise, contrast medium enhancement, signal-to-noise ratio, contrast-to-noise ratio, effective radiation dose, and subjective image quality. Results There were no significant differences regarding median hepatic post-contrast attenuation, image noise, contrast medium enhancement, signal-to-noise ratio, contrast-to-noise ratio, or effective dose between the 80-kV(p) and 120-kV(p) cohorts: 114/110 HU; 14/14 HU; 57/53 HU; 8.0/7.4; 3.8/3.5; and 5.3/5.9 mSv, respectively. However, subjective image visual grading showed statistically significantly inferior scores for 80 kV(p) for six of eight items. After exclusion of seven inferior examinations not caused by the chosen kV(p) technique, only three items showed inferior scores for 80 kV(p). Only 5% of gradings regarding overall image quality were Conclusion Despite lower subjective image quality, objective data indicate that 80-kV(p) CT with reduced contrast medium doses and compensated mAs may have the potential to provide satisfactory diagnostic quality in patients with body mass index <30 kg/m(2), which could benefit patients at risk of contrast medium-induced acute kidney injury.

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