AIM To evaluate the feasibility of reducing the dose of iodinated contrast agent in computed tomography pulmonary angiography(CTPA). METHODS One hundred and twenty-seven patients clinically suspected of having pulmona...AIM To evaluate the feasibility of reducing the dose of iodinated contrast agent in computed tomography pulmonary angiography(CTPA). METHODS One hundred and twenty-seven patients clinically suspected of having pulmonary embolism underwent spiral CTPA, out of whom fifty-seven received 75 mL and the remaining seventy a lower dose of 60 mL of contrast agent. Both doses were administered in a multiphasic injection. A minimum opacification threshold of 250 Hounsfield units(HU) in the main pulmonary artery is used for assessing the technical adequacy of the scans. RESULTS Mean opacification was found to be positively correlated to patient age(Pearson's correlation 0.4255, P < 0.0001) and independent of gender(male:female, 425.6 vs 450.4,P = 0.34). When age is accounted for, the study and control groups did not differ significantly in their mean opacification in the main(436.8 vs 437.9, P = 0.48),left(416.6 vs 419.8, P = 0.45) or the right pulmonary arteries(417.3 vs 423.5, P = 0.40). The number of sub-optimally opacified scans(the mean opacification in the main pulmonary artery < 250 HU) did not differ significantly between the study and control groups(7 vs 10).CONCLUSION A lower dose of iodine contrast at 60 mL can be feasibly used in CTPA without resulting in a higher number of sub-optimally opacified scans.展开更多
Background：Contrast dose and radiation dose reduction in computerized tomography （CT） scan for adult has been explored successfully,but there have been few studies on the application of low-concentration contrast i...Background：Contrast dose and radiation dose reduction in computerized tomography （CT） scan for adult has been explored successfully,but there have been few studies on the application of low-concentration contrast in pediatric abdominal CT examinations.This was a feasibility study on the use of dual-energy spectral imaging and adaptive statistical iterative reconstruction （ASiR） for the reduction of radiation dose and iodine contrast dose in pediatric abdominal CT patients with solid tumors.Methods：Forty-five patients with solid tumors who had initial CT （Group B） and follow-up CT （Group A） after chemotherapy were enrolled.The initial diagnostic CT scan （Group B） was performed using the standard two-phase enhanced CT with 320 mgI/ml concentration contrast,and the follow-up scan （Group A） was performed using a single-phase enhanced CT at 45 s after the beginning of the 270 mgI/ml contrast injection using spectral mode.Forty percent ASiR was used for the images in Group B and monochromatic images with energy levels ≥60 keV in Group A.In addition,filtered back-projection （FBP） reconstruction was used for monochromatic images 〈60 keV in Group A.The total radiation dose,total iodine load,contrast injection speed,and maximum injection pressure were compared between the two groups.The 40 keV and 60 keV spectral CT images of Group A were compared with the images of Group B to evaluate overall image quality.Results：The total radiation dose,total iodine load,injection speed,and maximum injection pressure for Group A were decreased by 19%,15%,34.4%,and 18.3%,respectively.The optimal energy level in spectral CT for displaying the abdominal vessels was 40 keV.At this level,the CT values in the abdominal aorta and its three branches,the portal vein and its two branches,and the inferior vena cava were all greater than 340 hounsfield unit （HU）.The abdominal organs of Groups A and B had similar degrees of absolute and relative enhancement （t =0.36 and-1.716 for liver,0.153 and-1.546 for pancreas,and 2.427 and 0.866 for renal cortex,all P 〉 0.05）.Signal-to-noise ratio of the abdominal organs was significantly lower in Group A than in Group B （t =-8.11 for liver,-7.83 for pancreas,and-5.38 for renal cortex,all P 〈 0.05）.However,the subjective scores for the 40 keV （FBP） and 60 keV （40% ASiR） spectral CT images determined by two radiologists were all 〉3,indicating clinically acceptable image quality.Conclusions：Single-phase,dual-energy spectral CT used for children with solid abdominal tumors can reduce contrast dose and radiation dose and can also maintain clinically acceptable image quality.展开更多
AIM:To evaluate the feasibility of low contrast medium and radiation dose for hepatic computed tomography(CT) perfusion of rabbit VX2 tumor.METHODS:Eleven rabbits with hepatic VX2 tumor underwent perfusion CT scanning...AIM:To evaluate the feasibility of low contrast medium and radiation dose for hepatic computed tomography(CT) perfusion of rabbit VX2 tumor.METHODS:Eleven rabbits with hepatic VX2 tumor underwent perfusion CT scanning with a 24-h interval between a conventional tube potential(120 k Vp) protocol with 350 mg I/m L contrast medium and filtered back projection,and a low tube potential(80 k Vp) protocol with 270 mg I/m L contrast medium with iterative reconstruction.Correlation and agreement among perfusion parameters acquired by the conventional and low dose protocols were assessed for the viable tumor component as well as whole tumor.Image noise and tumor-to-liver contrast to noise ratio during arterial and portal venous phases were evaluated.RESULTS:A 38% reduction in contrast medium dose(360.1 ± 13.3 mg I/kg vs 583.5 ± 21.5 mg I/kg,P < 0.001) and a 73% decrease in radiation dose(1898.5 m Gy·cm vs 6951.8 m Gy·cm) were observed.Interestingly,there was a strong positive correlation in hepatic arterial perfusion(r = 0.907,P < 0.001;r = 0.879,P < 0.001),hepatic portal perfusion(r = 0.819,P = 0.002;r = 0.831,P = 0.002),and hepatic blood flow(r = 0.945,P < 0.001;r = 0.930,P < 0.001) as well as a moderate correlation in hepatic perfusion index(r = 0.736,P = 0.01;r = 0.636,P = 0.035) between the low dose protocol with iterative reconstruction and the conventional protocol for the viable tumor component and the whole tumor.These two imaging protocols provided a moderate but acceptable agreement for perfusion parameters and similar tumorto-liver CNR during arterial and portal venous phases(5.63 ± 2.38 vs 6.16 ± 2.60,P = 0.814;4.60 ± 1.27 vs 5.11 ± 1.74,P = 0.587).CONCLUSION:Compared with the conventional protocol,low contrast medium and radiation dose with iterative reconstruction has no significant influence on hepatic perfusion parameters for rabbits VX2 tumor.展开更多
Background: Chronic kidney disease patients are at a greater risk for nephropathy requiring dialysis after percutaneous coronary intervention. Such patients are usually deferred due to fear of “Renalism”.?Objectives...Background: Chronic kidney disease patients are at a greater risk for nephropathy requiring dialysis after percutaneous coronary intervention. Such patients are usually deferred due to fear of “Renalism”.?Objectives This study assesses the outcome of Low dose contrast protocol during PCI in CKD patients whose e-GFR 60 ml/min/1.72 m and investigates a safety margin for contrast use in these high-risk categories.?Methods: Patients were into three groups according to CV/e-GFR ratio: Group (A) low-dose: CV/e-GFR ratio 2.0 Group (B) medium-dose: CV/e-GFR ratio > 2.0 and × bodyweight\s.creatinine). Group (C) high-dose: CV/e-GFR ratio > MACD. Results: A total of 73 patients were enrolled. Average age was 54 ± 8 years,81.4% were male and 18.6% were females and 52% were diabetic. Mean baseline e-GFR was 40 ± 8.0 ml/min/1.73m2. Contrast Volume used in group A was (58.26 ± 15.05) (n = 24), in group B (109.42 ± 17.11) (n = 26) and in group C (304.5 ± 60.30) (n = 23), respectively. The incidences of CI-AKI in the 3 groups were 0%, 11.5% and 35%, respectively (p = 0.02). All-cause death 0%, 17% and introduction of maintenance hemo dialysis was 0%, 11.5% and 26%, respectively (p Conclusion: Low dose contrast protocol is safe, effective and easily applicable technique without CI-AKI or death.展开更多
Estimated LBW could be used to determine the contrast material dose and rate during MDCT. The aim of this study is to test the accuracy of a technique for estimation of lean body weight (LBW) from a single multi-detec...Estimated LBW could be used to determine the contrast material dose and rate during MDCT. The aim of this study is to test the accuracy of a technique for estimation of lean body weight (LBW) from a single multi-detector row computed tomographic (MDCT) abdominal image, using a bioelectrical body composition analyzer scale as the reference standard. CT images of 21 patients with previously measured LBW (mLBW) were processed using computer-assisted, vendor-specific software (Advantage Windows 4.2;GE Healthcare, Inc). For each transverse image, a fat-fraction was automatically measured as the number of fat pixels (-200 to -50 HU) divided by the total number of pixels having an attenuation value ≥-200 HU. Estimated LBW (eLBW) of five single contiguous sections was calculated in each of three abdominal regions (upper abdomen, mid abdomen and pelvis) by multiplying TBW by (1 – fat-fraction). Bland-Altman plot with limits of agreement was used to assess agreement between mLBW and eLBW. The mean mLBW for all patients was 56 kg (range, 39 - 75 kg). Mean differences and limits of agreement between mLBW and eLBW measurements for the upper abdomen, mid abdomen and pelvis reported were -8.9 kg (-25.6 kg, +7.5 kg), -10.6 kg (-27.7 kg, +6.4 kg), and +0.5 kg (-12.8 kg, +13.8 kg) respectively. eLBW deriving directly from a transverse CT image of the pelvis can accurately predict mLBW.展开更多
AIM To assess the effect of neutral(NC) and positive(PC) oral contrast use on patient dose in low-dose abdominal computed tomography(CT).METHODS Low-dose clinically indicated CTs were performed on 79 Crohn's patie...AIM To assess the effect of neutral(NC) and positive(PC) oral contrast use on patient dose in low-dose abdominal computed tomography(CT).METHODS Low-dose clinically indicated CTs were performed on 79 Crohn's patients(35 = PC, 1 L 2% gastrografin; 44 = NC, 1.5 L polyethylene glycol). Scanner settings for both acquisitions were identical apart from 25 s difference in intravenous contrast timing. Body mass index(BMI), scan-ranges, dose-length product and size-specific dose estimated were recorded. Data was reconstructed with pure model-based iterative reconstruction. Image quality was objectively and subjectively analysed. Data analysis was performed with Statistical Package for Social Scientists.RESULTS Higher doses were seen in neutral contrast CTs(107.60 ± 78.7 m Gy.cm, 2.47 ± 1.21 m Gy vs 85.65 ± 58.2 m Gy.cm, 2.18 ± 0.96 m Gy). The differencehad both NC and PC investigations. Image-quality assessment yielded 6952 datapoints. NC image quality was significantly superior(P < 0.001)(objective noise, objective signal to noise ratio, subjective spatial resolution, subjective contrast resolution, diagnostic acceptability) at all levels. NC bowel distension was significantly(P < 0.001) superior.CONCLUSION The use of polyethylene glycol as a neutral OC agent leads to higher radiation doses than standard positive contrast studies, in low dose abdominal CT imaging. This is possibly related to the osmotic effect of the agent resulting in larger intraluminal fluid volumes and resultant increased overall beam attenuation.展开更多
文摘AIM To evaluate the feasibility of reducing the dose of iodinated contrast agent in computed tomography pulmonary angiography(CTPA). METHODS One hundred and twenty-seven patients clinically suspected of having pulmonary embolism underwent spiral CTPA, out of whom fifty-seven received 75 mL and the remaining seventy a lower dose of 60 mL of contrast agent. Both doses were administered in a multiphasic injection. A minimum opacification threshold of 250 Hounsfield units(HU) in the main pulmonary artery is used for assessing the technical adequacy of the scans. RESULTS Mean opacification was found to be positively correlated to patient age(Pearson's correlation 0.4255, P < 0.0001) and independent of gender(male:female, 425.6 vs 450.4,P = 0.34). When age is accounted for, the study and control groups did not differ significantly in their mean opacification in the main(436.8 vs 437.9, P = 0.48),left(416.6 vs 419.8, P = 0.45) or the right pulmonary arteries(417.3 vs 423.5, P = 0.40). The number of sub-optimally opacified scans(the mean opacification in the main pulmonary artery < 250 HU) did not differ significantly between the study and control groups(7 vs 10).CONCLUSION A lower dose of iodine contrast at 60 mL can be feasibly used in CTPA without resulting in a higher number of sub-optimally opacified scans.
文摘Background：Contrast dose and radiation dose reduction in computerized tomography （CT） scan for adult has been explored successfully,but there have been few studies on the application of low-concentration contrast in pediatric abdominal CT examinations.This was a feasibility study on the use of dual-energy spectral imaging and adaptive statistical iterative reconstruction （ASiR） for the reduction of radiation dose and iodine contrast dose in pediatric abdominal CT patients with solid tumors.Methods：Forty-five patients with solid tumors who had initial CT （Group B） and follow-up CT （Group A） after chemotherapy were enrolled.The initial diagnostic CT scan （Group B） was performed using the standard two-phase enhanced CT with 320 mgI/ml concentration contrast,and the follow-up scan （Group A） was performed using a single-phase enhanced CT at 45 s after the beginning of the 270 mgI/ml contrast injection using spectral mode.Forty percent ASiR was used for the images in Group B and monochromatic images with energy levels ≥60 keV in Group A.In addition,filtered back-projection （FBP） reconstruction was used for monochromatic images 〈60 keV in Group A.The total radiation dose,total iodine load,contrast injection speed,and maximum injection pressure were compared between the two groups.The 40 keV and 60 keV spectral CT images of Group A were compared with the images of Group B to evaluate overall image quality.Results：The total radiation dose,total iodine load,injection speed,and maximum injection pressure for Group A were decreased by 19%,15%,34.4%,and 18.3%,respectively.The optimal energy level in spectral CT for displaying the abdominal vessels was 40 keV.At this level,the CT values in the abdominal aorta and its three branches,the portal vein and its two branches,and the inferior vena cava were all greater than 340 hounsfield unit （HU）.The abdominal organs of Groups A and B had similar degrees of absolute and relative enhancement （t =0.36 and-1.716 for liver,0.153 and-1.546 for pancreas,and 2.427 and 0.866 for renal cortex,all P 〉 0.05）.Signal-to-noise ratio of the abdominal organs was significantly lower in Group A than in Group B （t =-8.11 for liver,-7.83 for pancreas,and-5.38 for renal cortex,all P 〈 0.05）.However,the subjective scores for the 40 keV （FBP） and 60 keV （40% ASiR） spectral CT images determined by two radiologists were all 〉3,indicating clinically acceptable image quality.Conclusions：Single-phase,dual-energy spectral CT used for children with solid abdominal tumors can reduce contrast dose and radiation dose and can also maintain clinically acceptable image quality.
基金National Natural Science Foundation of China,No.NSFC 81171389Key Program of Basic Research from Shanghai Municipal Science and Technology Commission,No.12JC1406500the Program of Shanghai Municipal Health Outstanding Discipline Leader,No.XBR 2013110
文摘AIM:To evaluate the feasibility of low contrast medium and radiation dose for hepatic computed tomography(CT) perfusion of rabbit VX2 tumor.METHODS:Eleven rabbits with hepatic VX2 tumor underwent perfusion CT scanning with a 24-h interval between a conventional tube potential(120 k Vp) protocol with 350 mg I/m L contrast medium and filtered back projection,and a low tube potential(80 k Vp) protocol with 270 mg I/m L contrast medium with iterative reconstruction.Correlation and agreement among perfusion parameters acquired by the conventional and low dose protocols were assessed for the viable tumor component as well as whole tumor.Image noise and tumor-to-liver contrast to noise ratio during arterial and portal venous phases were evaluated.RESULTS:A 38% reduction in contrast medium dose(360.1 ± 13.3 mg I/kg vs 583.5 ± 21.5 mg I/kg,P < 0.001) and a 73% decrease in radiation dose(1898.5 m Gy·cm vs 6951.8 m Gy·cm) were observed.Interestingly,there was a strong positive correlation in hepatic arterial perfusion(r = 0.907,P < 0.001;r = 0.879,P < 0.001),hepatic portal perfusion(r = 0.819,P = 0.002;r = 0.831,P = 0.002),and hepatic blood flow(r = 0.945,P < 0.001;r = 0.930,P < 0.001) as well as a moderate correlation in hepatic perfusion index(r = 0.736,P = 0.01;r = 0.636,P = 0.035) between the low dose protocol with iterative reconstruction and the conventional protocol for the viable tumor component and the whole tumor.These two imaging protocols provided a moderate but acceptable agreement for perfusion parameters and similar tumorto-liver CNR during arterial and portal venous phases(5.63 ± 2.38 vs 6.16 ± 2.60,P = 0.814;4.60 ± 1.27 vs 5.11 ± 1.74,P = 0.587).CONCLUSION:Compared with the conventional protocol,low contrast medium and radiation dose with iterative reconstruction has no significant influence on hepatic perfusion parameters for rabbits VX2 tumor.
文摘Background: Chronic kidney disease patients are at a greater risk for nephropathy requiring dialysis after percutaneous coronary intervention. Such patients are usually deferred due to fear of “Renalism”.?Objectives This study assesses the outcome of Low dose contrast protocol during PCI in CKD patients whose e-GFR 60 ml/min/1.72 m and investigates a safety margin for contrast use in these high-risk categories.?Methods: Patients were into three groups according to CV/e-GFR ratio: Group (A) low-dose: CV/e-GFR ratio 2.0 Group (B) medium-dose: CV/e-GFR ratio > 2.0 and × bodyweight\s.creatinine). Group (C) high-dose: CV/e-GFR ratio > MACD. Results: A total of 73 patients were enrolled. Average age was 54 ± 8 years,81.4% were male and 18.6% were females and 52% were diabetic. Mean baseline e-GFR was 40 ± 8.0 ml/min/1.73m2. Contrast Volume used in group A was (58.26 ± 15.05) (n = 24), in group B (109.42 ± 17.11) (n = 26) and in group C (304.5 ± 60.30) (n = 23), respectively. The incidences of CI-AKI in the 3 groups were 0%, 11.5% and 35%, respectively (p = 0.02). All-cause death 0%, 17% and introduction of maintenance hemo dialysis was 0%, 11.5% and 26%, respectively (p Conclusion: Low dose contrast protocol is safe, effective and easily applicable technique without CI-AKI or death.
文摘Estimated LBW could be used to determine the contrast material dose and rate during MDCT. The aim of this study is to test the accuracy of a technique for estimation of lean body weight (LBW) from a single multi-detector row computed tomographic (MDCT) abdominal image, using a bioelectrical body composition analyzer scale as the reference standard. CT images of 21 patients with previously measured LBW (mLBW) were processed using computer-assisted, vendor-specific software (Advantage Windows 4.2;GE Healthcare, Inc). For each transverse image, a fat-fraction was automatically measured as the number of fat pixels (-200 to -50 HU) divided by the total number of pixels having an attenuation value ≥-200 HU. Estimated LBW (eLBW) of five single contiguous sections was calculated in each of three abdominal regions (upper abdomen, mid abdomen and pelvis) by multiplying TBW by (1 – fat-fraction). Bland-Altman plot with limits of agreement was used to assess agreement between mLBW and eLBW. The mean mLBW for all patients was 56 kg (range, 39 - 75 kg). Mean differences and limits of agreement between mLBW and eLBW measurements for the upper abdomen, mid abdomen and pelvis reported were -8.9 kg (-25.6 kg, +7.5 kg), -10.6 kg (-27.7 kg, +6.4 kg), and +0.5 kg (-12.8 kg, +13.8 kg) respectively. eLBW deriving directly from a transverse CT image of the pelvis can accurately predict mLBW.
文摘AIM To assess the effect of neutral(NC) and positive(PC) oral contrast use on patient dose in low-dose abdominal computed tomography(CT).METHODS Low-dose clinically indicated CTs were performed on 79 Crohn's patients(35 = PC, 1 L 2% gastrografin; 44 = NC, 1.5 L polyethylene glycol). Scanner settings for both acquisitions were identical apart from 25 s difference in intravenous contrast timing. Body mass index(BMI), scan-ranges, dose-length product and size-specific dose estimated were recorded. Data was reconstructed with pure model-based iterative reconstruction. Image quality was objectively and subjectively analysed. Data analysis was performed with Statistical Package for Social Scientists.RESULTS Higher doses were seen in neutral contrast CTs(107.60 ± 78.7 m Gy.cm, 2.47 ± 1.21 m Gy vs 85.65 ± 58.2 m Gy.cm, 2.18 ± 0.96 m Gy). The differencehad both NC and PC investigations. Image-quality assessment yielded 6952 datapoints. NC image quality was significantly superior(P < 0.001)(objective noise, objective signal to noise ratio, subjective spatial resolution, subjective contrast resolution, diagnostic acceptability) at all levels. NC bowel distension was significantly(P < 0.001) superior.CONCLUSION The use of polyethylene glycol as a neutral OC agent leads to higher radiation doses than standard positive contrast studies, in low dose abdominal CT imaging. This is possibly related to the osmotic effect of the agent resulting in larger intraluminal fluid volumes and resultant increased overall beam attenuation.
