The initial experience of the upper abdominal CT angiography using low-concentration contrast medium on dual energy spectral CT

Objective To investigate the feasibility of using Spectral CT imaging with low contrast medium in abdominal CT angiography (CTA). Subjects and methods 70 consecutive patients (40 men, 42.6 ± 20.4 years; 30 women, 46.7 ± 18.8 years) with suspected abdominal focal lesions were referred to CTA exam. They were randomly assigned into two groups. Group A: 35 patients underwent conventional CT scan of Tube voltage 120 kVp, automatic current modulation with a Noise Index of 12, ASIR 30%, and injected with Iohexol (350 mgI/ml). Group B: 35 patients underwent Spectral CT Imaging, with Tube current of 600 mA, injected with Iodixanol (270 mgI/ml). The optimal mono-energy keV was achieved using the optimal contrast noise ratio in abdominal aorta at the renal artery level relative to the erector spine muscle. Both groups were injected with an injection rate of 3.5 ml/s, and a contrast volume of 1.5 ml/kg body weight. The Hounsfield units (HU) and noise of the bilateral renal arteries and muscle of both groups, as well as the optimal monochromatic image set of Group B were measured. Two radiologists assessed all images with a 5-points scale. CTDIvol and DLP were recorded. Data were analyzed using student t test. Results The total iodine intake of Group B was 28% lower than that of Group A. The CNR of abdomen artery, celiac trunk, superior mesenteric artery, and renal artery in spectral group (at the best mono-energy of 53.0 keV) were higher than those in conventional CTA group ( p < 0.001). The subjective image quality score of spectral CTA group was also rated higher than conventional CTA group ( p < 0.001). CTDIvol, DLP, and effective dose of spectral group were all lower than conventional group, but there were no significant differences ( p > 0.05). Conclusion With 28% contrast medium reduction and reduced radiation dose, CT angiography using spectral imaging and lower concentration contrast agent provided better image quality than conventional CTA.