title: Single-source dual-energy CT angiography with reduced iodine load in patients referred for aortoiliofemoral evaluation before transcatheter aortic valve implantation: impact on image quality and radiation dose.
abstract: OBJECTIVE
  To compare image quality and radiation dose of pre-transcatheter aortic valve implantation (TAVI) aortoiliofemoral CT angiography (AICTA) provided by standard vs. dual-energy mode with reduced iodine load protocols.
  
  
  METHODS
  One hundred and sixty-one patients underwent a two-step CTA protocol before TAVI including cardiac CTA with injection of 65 mL of iodinated contrast agent (ICA), immediately followed by AICTA. From this second acquisition, the following three different patient groups were identified: Group 1: 52 patients with standard AICTA (60 mL ICA, 100 kVp, mA automodulation); Group 2: 48 patients with dual-energy AICTA with 50 % iodine load reduction (30 mL ICA, fast kVp switching, 600 mA); Group 3: 61 patients with an identical protocol to Group 2, but exposed to 375 mA. The qualitative/subjective image quality (13-point score) and quantitative/objective image quality (contrast attenuation and image noise) were evaluated. The radiation dose was recorded.
  
  
  RESULTS
  There was no significant difference in non-diagnostic images between the three protocols. Contrast attenuation, signal-to-noise ratio and contrast-to-noise ratio were significantly higher, whereas noise was significantly lower in the standard protocol (all P < 0.05). The radiation dose was lower in the dual-energy protocol at 375 mA (P < 0.05).
  
  
  CONCLUSIONS
  Dual-energy AICTA before TAVI results in a reduction of iodine load while maintaining sufficient diagnostic information despite increased noise.
  
  
  CONCLUSIONS
  • Dual-energy AICTA before TAVI results in a 50 % reduction of iodine load. •The reduction of iodine load maintains sufficient image quality despite increased noise. • Using 375 mA in dual-energy mode results in a reduction of radiation dose. • A high tube current setting (600 mA) should be used in overweight patients.
authors: Department of Radiology, Rouen University Hospital, Cardiac MR/CT Unit, 1 Rue de Germont, 76031, Rouen CEDEX, France.
authors: Benjamin
authors: B
authors: Dubourg
authors: Jérôme
authors: J
authors: Caudron
authors: Jean-Pierre
authors: JP
authors: Lestrat
authors: Michael
authors: M
authors: Bubenheim
authors: Valentin
authors: V
authors: Lefebvre
authors: Matthieu
authors: M
authors: Godin
authors: Christophe
authors: C
authors: Tron
authors: Hélène
authors: H
authors: Eltchaninoff
authors: Fabrice
authors: F
authors: Bauer
authors: Jean-Nicolas
authors: JN
authors: Dacher
mesh_terms: D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007089:Image Enhancement; D007269:Injections, Intra-Arterial; D007455:Iodine; D007472:Iohexol / Q000008:administration & dosage; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D057234:Preoperative Period; D012372:ROC Curve; D011829:Radiation Dosage; D015203:Reproducibility of Results; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D007472:Iohexol; D007455:Iodine