Cerebral computed tomographic angiography using third-generation reconstruction algorithm provides improved image quality with lower contrast and radiation dose

Background: Computed tomographic angiography (CTA) and echocardiography (echo) are used preoperatively in coarctation of the aorta to define arch hypoplasia and great vessel branching. We sought to determine differences in quantitative measurements, as well as surgical utility, between modalities. Methods: Infants (less than six months) with both CTA and echo prior to coarctation repair from 2004 to 2013 were included. Measurements were compared and correlated with surgical approach. Three surgeons reviewed de-identified images to predict approach and characterize utility. Computed tomographic angiography radiation dose was calculated. Results: Thirty-three patients were included. No differences existed in arch measurements between echo and CTA ( z-score: −2.59 vs −2.43; P = .47). No differences between modalities were seen for thoracotomy ( z-score: −2.48 [echo] vs −2.31 [CTA]; P = .48) or sternotomy ( z-score: −3.13 [echo] vs −3.08 [CTA]; P = .84). Computed tomographic angiography delineated great vessel branching pattern in two patients with equivocal echo findings ( P = .60). Surgeons rated CTA as far more useful than echo in understanding arch hypoplasia and great vessel branching in cases where CTA was done to resolve anatomical questions that remain after echo evaluation. Two of three surgeons were more likely to choose the surgical approach taken based on CTA (surgeon A, P = .02; surgeon B, P = .01). Radiation dose averaged 2.5 (1.6) mSv and trended down from 2.9 mSv (1.8 mSv; n = 20) to 1.6 mSv (0.5 mSv; n = 7) ( P = .06) with new technology. Conclusion: Although CTA and echo measurements of the aorta do not differ, CTA better delineates branching and surgeons strongly prefer it for three-dimensional arch anatomy. We recommend CTA for patients with anomalous arch branching patterns, diffuse or complex hypoplasia, or unusual arch morphology not fully elucidated by echo.

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Effective Radiation Dose in Computed Tomographic Angiography of the Chest and Diagnostic Cardiac Catheterization in Pediatric Patients

Pediatric Cardiology ◽

10.1007/s00246-012-0486-2 ◽

2012 ◽

Vol 34 (3) ◽

pp. 518-524 ◽

Cited By ~ 40

Author(s):

Timotheus G. Watson ◽

Eugene Mah ◽

U. Joseph Schoepf ◽

Lydia King ◽

Walter Huda ◽

...

Keyword(s):

Radiation Dose ◽

Cardiac Catheterization ◽

Pediatric Patients ◽

Computed Tomographic Angiography ◽

Effective Radiation Dose ◽

Computed Tomographic ◽

Diagnostic Cardiac Catheterization ◽

Tomographic Angiography ◽

Effective Radiation

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EFFECT OF A STANDARDIZED BODY MASS INDEX- AND HEART RATE-BASED PROTOCOL ON RADIATION DOSE AND DIAGNOSTIC ACCURACY OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY: A PROSPECTIVE MULTICENTER STUDY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)60631-6 ◽

2010 ◽

Vol 55 (10) ◽

pp. A67.E630

Author(s):

Troy LaBounty ◽

Jonathon Leipsic ◽

G.B. John Mancini ◽

Brett Heilbron ◽

Smita Patel ◽

...

Keyword(s):

Body Mass Index ◽

Heart Rate ◽

Radiation Dose ◽

Diagnostic Accuracy ◽

Multicenter Study ◽

Computed Tomographic Angiography ◽

Prospective Multicenter Study ◽

Coronary Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Abstract WP72: Low kV Computed Tomography Cerebral Angiogram Using Third-Generation Reconstruction Algorithm Provides Significantly Improved Image Quality With Lower Contrast and Radiation Exposure

Stroke ◽

10.1161/str.51.suppl_1.wp72 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Girish Bathla ◽

Sarv Priya ◽

Neetu Soni ◽

Colin Derdeyn

Keyword(s):

Image Quality ◽

Radiation Exposure ◽

Basilar Artery ◽

Reconstruction Algorithm ◽

Third Generation ◽

Cerebral Angiogram ◽

Subjective Image Quality ◽

Contrast Dose ◽

Significant Difference ◽

Lower Contrast

Introduction/Aim: We aimed to determine if CTA imaging using third generation reconstruction algorithm and lower contrast dose-low kVp technique (LD-CTA) was comparable to regular contrast dose CTA at 120 kVp using a sinogram affirmed iterative reconstruction algorithm (ND-CTA). Methods: Retrospective imaging review of 100 consecutive patients (50 each in LD- and ND-CTA groups). Two readers independently assessed the subjective image quality across multiple vascular segments on a Likert-like scale. Contrast- and signal-to-noise ratios (CNR/ SNR) were compared for the mid-M1-MCA vessels bilaterally and the mid-basilar artery. Fisher’s exact test was used to compare subjective image quality. Interclass correlation coefficient (ICC) was calculated for the SNR/CNR values. Finally differences in contrast dose, CT-dose index (CTDI) and dose length product (DLP) were compared using Mann-Whitney U test. Results: Both observers showed excellent correlation in subjective image quality (mean percentage agreement of 95.2% (84-100%) for group-1 versus 89.2% (82%-98%) for group-2). The subjective scores were not statistically different in the anterior circulation but showed significantly better image quality for the basilar artery. LD-CTA group showed significantly better SNR and CNR (p < 0.0001) for both MCA vessels and the basilar artery. ICC showed moderate correlation (0.51-0.63) between the observers. Student paired t-test did not show any significant difference between the observers. LD-CTA group also used lower contrast (49 cc versus 103 cc in ND-CTA) and had lower radiation exposure (DLP/ CTDI for both groups 268.3/12.42 vs 519.5/ 25.15, both < 0.0001). Conclusion: Next-generation reconstruction algorithm and low-Kv scanning significantly improved image quality on cerebral CTA images despite lower contrast dose, and in addition, have lower radiation exposure.

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