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Cerebral bone subtraction CT angiography using 80 kVp and sinogram-affirmed iterative reconstruction: contrast medium and radiation dose reduction with improvement of image quality

  • Diagnostic Neuroradiology
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Abstract

Introduction

The purpose of this study was to evaluate the feasibility of a contrast medium (CM), radiation dose reduction protocol for cerebral bone-subtraction CT angiography (BSCTA) using 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE).

Methods

Seventy-five patients who had undergone BSCTA under the 120- (n = 37) or the 80-kVp protocol (n = 38) were included. CM was 370 mgI/kg for the 120-kVp and 296 mgI/kg for the 80-kVp protocol; the 120- and the 80-kVp images were reconstructed with filtered back-projection (FBP) and SAFIRE, respectively. We compared effective dose (ED), CT attenuation, image noise, and contrast-to-noise ratio (CNR) of two protocols. We also scored arterial contrast, sharpness, depiction of small arteries, visibility near skull base/clip, and overall image quality on a four-point scale.

Results

ED was 62% lower at 80- than 120-kVp (0.59 ± 0.06 vs 1.56 ± 0.13 mSv, p < 0.01). CT attenuation of the internal carotid artery (ICA) and middle cerebral artery (MCA) was significantly higher on 80- than 120-kVp (ICA: 557.4 ± 105.7 vs 370.0 ± 59.3 Hounsfield units (HU), p < 0.01; MCA: 551.9 ± 107.9 vs 364.6 ± 62.2 HU, p < 0.01). The CNR was also significantly higher on 80- than 120-kVp (ICA: 46.2 ± 10.2 vs 36.9 ± 7.6, p < 0.01; MCA: 45.7 ± 10.0 vs 35.7 ± 9.0, p < 0.01). Visibility near skull base and clip was not significantly different (p = 0.45). The other subjective scores were higher with the 80- than the 120-kVp protocol (p < 0.05).

Conclusion

The 80-kVp acquisition with SAFIRE yields better image quality for BSCTA and substantial reduction in the radiation and CM dose compared to the 120-kVp with FBP protocol.

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References

  1. Lell MM, Anders K, Uder M et al (2006) New techniques in CT angiography. Radiographics 26(Suppl 1):S45–S62

    Article  PubMed  Google Scholar 

  2. van Rooij WJ, Sprengers ME, de Gast AN, Peluso JP, Sluzewski M (2008) 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 29:976–979

    Article  PubMed  Google Scholar 

  3. Dawkins AA, Evans AL, Wattam J et al (2007) Complications of cerebral angiography: a prospective analysis of 2,924 consecutive procedures. Neuroradiology 49:753–759

    Article  CAS  PubMed  Google Scholar 

  4. Fifi JT, Meyers PM, Lavine SD et al (2009) Complications of modern diagnostic cerebral angiography in an academic medical center. J Vasc Interv Radiol 20:442–447

    Article  PubMed  Google Scholar 

  5. Moran CJ (2011) Aneurysmal subarachnoid hemorrhage: DSA versus CT angiography—is the answer available? Radiology 258:15–17

    Article  PubMed  Google Scholar 

  6. Gonner F, Lovblad KO, Heid O et al (2002) Magnetic resonance angiography with ultrashort echo times reduces the artefact of aneurysm clips. Neuroradiology 44:755–758

    Article  CAS  PubMed  Google Scholar 

  7. Olsrud J, Latt J, Brockstedt S, Romner B, Bjorkman-Burtscher IM (2005) Magnetic resonance imaging artifacts caused by aneurysm clips and shunt valves: dependence on field strength (1.5 and 3 T) and imaging parameters. J Magn Reson Imaging 22:433–437

    Article  PubMed  Google Scholar 

  8. Chen W, Xing W, Peng Y, He Z, Wang C, Wang Q (2013) Cerebral aneurysms: accuracy of 320-detector row nonsubtracted and subtracted volumetric CT angiography for diagnosis. Radiology 269:841–849

    Article  PubMed  Google Scholar 

  9. Aulbach P, Mucha D, Engellandt K, Hadrich K, Kuhn M, von Kummer R (2016) Diagnostic impact of bone-subtraction CT angiography for patients with acute subarachnoid hemorrhage. AJNR Am J Neuroradiol 37:236–243

    Article  CAS  PubMed  Google Scholar 

  10. Hwang SB, Kwak HS, Han YM, Chung GH (2011) Detection of intracranial aneurysms using three-dimensional multidetector-row CT angiography: is bone subtraction necessary? Eur J Radiol 79:e18–e23

    Article  PubMed  Google Scholar 

  11. Tomura N, Sakuma I, Otani T et al (2011) Evaluation of postoperative status after clipping surgery in patients with cerebral aneurysm on 3-dimensional-CT angiography with elimination of clips. J Neuroimaging 21:10–15

    Article  PubMed  Google Scholar 

  12. Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mathews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 346:f2360

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yuan MK, Tsai DC, Chang SC et al (2013) The risk of cataract associated with repeated head and neck CT studies: a nationwide population-based study. AJR Am J Roentgenol 201:626–630

    Article  PubMed  Google Scholar 

  15. Villablanca JP, Duckwiler GR, Jahan R et al (2013) Natural history of asymptomatic unruptured cerebral aneurysms evaluated at CT angiography: growth and rupture incidence and correlation with epidemiologic risk factors. Radiology 269:258–265

    Article  PubMed  Google Scholar 

  16. Wong JM, Ho AL, Lin N et al (2013) Radiation exposure in patients with subarachnoid hemorrhage: a quality improvement target. J Neurosurg 119:215–220

    Article  PubMed  Google Scholar 

  17. Gelfand AA, Josephson SA (2011) Substantial radiation exposure for patients with subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 20:131–133

    Article  PubMed  Google Scholar 

  18. McCullough PA, Wolyn R, Rocher LL, Levin RN, O’Neill WW (1997) Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 103:368–375

    Article  CAS  PubMed  Google Scholar 

  19. Gruberg L, Mintz GS, Mehran R et al (2000) The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. J Am Coll Cardiol 36:1542–1548

    Article  CAS  PubMed  Google Scholar 

  20. Nakaura T, Kidoh M, Sakaino N et al (2013) Low contrast- and low radiation dose protocol for cardiac CT of thin adults at 256-row CT: usefulness of low tube voltage scans and the hybrid iterative reconstruction algorithm. Int J Cardiovasc Imaging 29:913–923

    Article  PubMed  Google Scholar 

  21. Oda S, Utsunomiya D, Yuki H et al (2015) Low contrast and radiation dose coronary CT angiography using a 320-row system and a refined contrast injection and timing method. J Cardiovasc Comput Tomogr 9:19–27

    Article  PubMed  Google Scholar 

  22. Waaijer A, Prokop M, Velthuis BK, Bakker CJ, de Kort GA, van Leeuwen MS (2007) Circle of Willis at CT angiography: dose reduction and image quality—reducing tube voltage and increasing tube current settings. Radiology 242:832–839

    Article  PubMed  Google Scholar 

  23. Cho ES, Chung TS, DK O et al (2012) Cerebral computed tomography angiography using a low tube voltage (80 kVp) and a moderate concentration of iodine contrast material: a quantitative and qualitative comparison with conventional computed tomography angiography. Investig Radiol 47:142–147

    Article  Google Scholar 

  24. Kidoh M, Nakaura T, Ogata T et al (2013) Subtracted 3D CT angiography for the evaluation of intracranial aneurysms in 256-slice multidetector CT: usefulness of the 80-kVp plus compact contrast medium bolus protocol. Eur Radiol 23:3012–3019

    Article  PubMed  Google Scholar 

  25. Cho ES, Chung TS, Ahn SJ, Chong K, Baek JH, Suh SH (2015) Cerebral computed tomography angiography using a 70 kVp protocol: improved vascular enhancement with a reduced volume of contrast medium and radiation dose. Eur Radiol 25:1421–1430

    Article  PubMed  Google Scholar 

  26. Luo S, Zhang LJ, Meinel FG et al (2014) Low tube voltage and low contrast material volume cerebral CT angiography. Eur Radiol 24:1677–1685

    Article  PubMed  Google Scholar 

  27. Chen GZ, Zhang LJ, Schoepf UJ et al (2015) Radiation dose and image quality of 70 kVp cerebral CT angiography with optimized sinogram-affirmed iterative reconstruction: comparison with 120 kVp cerebral CT angiography. Eur Radiol 25:1453–1463

    Article  PubMed  Google Scholar 

  28. Ni QQ, Chen GZ, Schoepf UJ et al (2016) Cerebral CTA with low tube voltage and low contrast material volume for detection of intracranial aneurysms. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A4803

    Google Scholar 

  29. Watanabe Y, Kashiwagi N, Yamada N et al (2008) Subtraction 3D CT angiography with the orbital synchronized helical scan technique for the evaluation of postoperative cerebral aneurysms treated with cobalt-alloy clips. AJNR Am J Neuroradiol 29:1071–1075

    Article  CAS  PubMed  Google Scholar 

  30. ICRP (2007) Managing patient dose in multi-detector computed tomography (MDCT). ICRP Publication 102 Ann ICRP 37:1–79

  31. van der Schaaf I, van Leeuwen M, Vlassenbroek A, Velthuis B (2006) Minimizing clip artifacts in multi CT angiography of clipped patients. AJNR Am J Neuroradiol 27:60–66

    PubMed  Google Scholar 

  32. Ebersberger U, Tricarico F, Schoepf UJ et al (2013) CT evaluation of coronary artery stents with iterative image reconstruction: improvements in image quality and potential for radiation dose reduction. Eur Radiol 23:125–132

    Article  PubMed  Google Scholar 

  33. Venema HW, Hulsmans FJ, den Heeten GJ (2001) CT angiography of the circle of Willis and intracranial internal carotid arteries: maximum intensity projection with matched mask bone elimination-feasibility study. Radiology 218:893–898

    Article  CAS  PubMed  Google Scholar 

  34. Tomandl BF, Hammen T, Klotz E, Ditt H, Stemper B, Lell M (2006) Bone-subtraction CT angiography for the evaluation of intracranial aneurysms. AJNR Am J Neuroradiol 27:55–59

    CAS  PubMed  Google Scholar 

Download references

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Correspondence to Yasunori Nagayama.

Ethics declarations

We declare that all human studies have been approved by the institutional review board of Kumamoto City Hospital and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Nagayama, Y., Nakaura, T., Tsuji, A. et al. Cerebral bone subtraction CT angiography using 80 kVp and sinogram-affirmed iterative reconstruction: contrast medium and radiation dose reduction with improvement of image quality. Neuroradiology 59, 127–134 (2017). https://doi.org/10.1007/s00234-016-1776-9

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  • DOI: https://doi.org/10.1007/s00234-016-1776-9

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