Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial.
OBJECTIVE
To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses.


METHODS
In this multicentre trial, 452 patients were randomized to receive iobitridol 350, iopromide 370 or iomeprol 400 and underwent coronary CTA using CT systems with 64-detector rows or more. Two core lab readers assessed 18 coronary segments per patient regarding image quality (score 0 = non diagnostic to 4 = excellent quality), vascular attenuation, signal and contrast to noise ratio (SNR, CNR). Patients were considered evaluable if no segment had a score of 0.


RESULTS
Per-patient, the rate of fully evaluable CT scans was 92.1, 95.4 and 94.6 % for iobitridol, iopromide and iomeprol, respectively. Non-inferiority of iobitridol over the best comparator was demonstrated with a 95 % CI of the difference of [-8.8 to 2.1], with a pre-specified non-inferiority margin of -10 %. Although average attenuation increased with higher iodine concentrations, average SNR and CNR did not differ between groups.


CONCLUSIONS
With current CT technology, iobitridol 350 mg iodine/ml is not inferior to contrast media with higher iodine concentrations in terms of image quality for coronary stenosis assessment.


CONCLUSIONS
• Iodine concentration is an important parameter for image quality in coronary CTA. • Contrast enhancement must be balanced against the amount of iodine injected. • Iobitridol 350 is non-inferior compared to CM with higher iodine concentrations. • Higher attenuation with higher iodine concentrations, but no SNR or CNR differences.
Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany. stephan.achenbach@uk-erlangen.de.
Stephan
S
Achenbach
Department of Radiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
Jean-François
JF
Paul
University of Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.|CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, F-33600, Pessac, France.
François
F
Laurent
Department of Clinical Radiology, University Hospital Grosshadern, Munich, Germany.
Hans-Christoph
HC
Becker
Department of Radiological Sciences, Oncology and Pathology, Sapienza - University of Rome, ICOT Hospital, Latina, Italy.
Marco
M
Rengo
Department of Radiology, University Hospital of Rouen, Rouen, France.
Jerome
J
Caudron
Department of Radiology, Saint Gallen Hospital, Saint Gallen, Switzerland.
Sebastian
S
Leschka
Department of Radiology, Cochin Hospital, Paris, France.
Olivier
O
Vignaux
Department of Radiology, La Charité, Berlin, Germany.
Gesine
G
Knobloch
Ospedale del Delta, Ferrara, Italy.
Giorgio
G
Benea
Elisabeth-Krankenhaus Hospital, Essen, Germany.
Thomas
T
Schlosser
Hospital Vall d'Hebron, Barcelona, Spain.
Jordi
J
Andreu
Hospital Clinico San Carlos, Madrid, Spain.
Beatriz
B
Cabeza
Department of Radiology, La Timone Adult Hospital, Marseille, France.
Alexis
A
Jacquier
Complejo Hospitalario Universitario, Santiago de Compostela, Spain.
Miguel
M
Souto
Department of Radiology, Louis Pradel Hospital, Lyon, France.
Didier
D
Revel
Department of Radiology, University of Lausanne, Lausanne, Switzerland.
Salah Dine
SD
Qanadli
Department of Radiology, Giovanni XXIII Hospital, Monastier di Treviso, Italy.
Filippo
F
Cademartiri
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007455:Iodine; D007472:Iohexol / Q000031:analogs & derivatives; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
D003287:Contrast Media; C057937:iomeprol; C093233:iobitridol; D007472:Iohexol; C038192:iopromide; D007455:Iodine; D007479:Iopamidol
Contrast media; Coronary computed tomography angiography; Image quality; Iodine concentration; Safety