Dual Energy CT Pulmonary Angiography with 6g Iodine-A Propensity Score-Matched Study

To evaluate the performance of low contrast media (CM) dose dual-energy computed tomography pulmonary angiography (CTPA) with advanced monoenergetic reconstructions in patients with suspected pulmonary embolism (PE). The study had institutional review board approval; all patients gave written inform...

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Bibliographic Details
Published in:PloS one 2016-12, Vol.11 (12), p.e0167214-e0167214
Main Authors: Meier, Andreas, Higashigaito, Kai, Martini, Katharina, Wurnig, Moritz, Seifert, Burkhardt, Keller, Dagmar I, Frauenfelder, Thomas, Alkadhi, Hatem
Format: Article
Language:English
Subjects:
Algorithms
Angiography
Biology and Life Sciences
Care and treatment
Computed tomography
Contrast agents
Contrast media
CT imaging
Diagnosis
Embolism
Embolisms
Energy
Engineering and Technology
Image contrast
Image quality
Informed consent
Iodine
Medical imaging
Medical screening
Medicine and Health Sciences
Mortality
Noise
Patients
Physical Sciences
Pulmonary arteries
Pulmonary embolism
Quality
Quality assessment
Regression analysis
Research and Analysis Methods
Tomography
Veins & arteries
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Summary:To evaluate the performance of low contrast media (CM) dose dual-energy computed tomography pulmonary angiography (CTPA) with advanced monoenergetic reconstructions in patients with suspected pulmonary embolism (PE). The study had institutional review board approval; all patients gave written informed consent. Forty-one patients (25 men, 16 women, mean age 62.9±14.7 years) undergoing low CM dose (15ml, 6g iodine) dual-energy CTPA with advanced monoenergetic reconstructions were matched via propensity-scoring based on logistic regression analysis with a comparison group of 41 patients (24 men, 17 women, mean age 62.7±13.9 years) undergoing standard CM dose single-energy CTPA (80ml, 24g iodine). Subjective (noise, artifacts) and objective (attenuation, noise, contrast-to-noise ratio (CNR)) image quality was assessed by two blinded, independent readers. All patients underwent clinical follow-up after three months for evaluation of adverse events. Interrater agreement for subjective image quality in both groups ranged from fair to excellent (ICC: 0.46-0.84); agreement for objective image quality was excellent (ICC: 0.83-0.93). There was no significant difference regarding subjective noise (p = 0.15-0.72) and artifacts (p = 0.16-1) between the low and the standard CM dose group. There was no significant difference regarding CNR between the CM dose groups (p = 0.11-0.87). Seven of the 41 (17%) patients in the low and 5/41 (12%) in the standard CM dose group were diagnosed with PE (p = 0.32). No patient suffered from subsequent PE or PE-associated death during the follow-up period. Dual-energy CTPA with advanced monoenergetic reconstruction is feasible with 6g iodine and allows for the diagnosis and safe exclusion of central, lobar, and segmental PE.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0167214