Impact of Contrast Media Concentration and kVp settings on Image Quality in CT Angiography of the Intracranial Vessels Birgitta Ramgren MD Roger Siemund.

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Presentation transcript:

Impact of Contrast Media Concentration and kVp settings on Image Quality in CT Angiography of the Intracranial Vessels Birgitta Ramgren MD Roger Siemund MD, PhD Isabella Björkman-Burtscher MD, PhD Department of Neuroradiology Center for Medical Imaging and Physiology Skåne University Hospital, Lund Sweden

Disclosure The study has been supported by grants from Bracco Imaging S.p.A.

Purpose Contrast media concentration and kVp setting are two important parameters with impact on the intensity of vessel enhancement in CTA.

Purpose Quantify the effect on intracranial vessel enhancement: Increase of the contrast media concentration from 300 mgI/ml to 400 mgI/ml Decrease of the tube voltage from 120 kVp to 90 kVp .

Method Consecutive inclusion, retrospective analyse including 63 patients referred for clinical examination 16 slice scanner (Philips MX 8000 IDT 16) Iomeprol (Iomeron®, Bracco Imaging, Italy) 300 mgI/ml or 400 mgI/ml. Contrast volume 80 ml, injection rate 5 ml/s and test bolus based scan delay All examinations were performed on a

Scan parameters and patients Group 1 Group 2 Group 3 Contrast media 300 mgI/ml 400 mgI/ml Tube voltage 120 kVp 90 kVp Tube current 229 mAs 564 mAs CTDIvol 32,7 mGy 36,8 mGy Patients (female) 15 (6) 15 (7) 33 (17) Age mean (years) 54 (21-78) 51 (25-74) 59 (17-87)

Scan parameters and patients Group 1 Group 2 Group 3 Contrast media 300 mgI/ml 400 mgI/ml Tube voltage 120 kVp 90 kVp Tube current 229 mAs 564 mAs CTDIvol 32.7 mGy 36.8 mGy Patients (female) 15 (6) 15 (7) 33 (17) Age mean (years) 54 (21-78) 51 (25-74) 59 (17-87)

Scan parameters and patients Group 1 Group 2 Group 3 Contrast media 300 mgI/ml 400 mgI/ml Tube voltage 120 kVp 90 kVp Tube current 229 mAs 564 mAs CTDIvol 32.7 mGy 36.8 mGy Patients (female) 15 (6) 15 (7) 33 (17) Age mean (years) 54 (21-78) 51 (25-74) 59 (17-87)

Measurements Below the top of the ICA M1 and M2 segments

Image quality grading Grading 1-4 (poor-excellent) 360 HU (Grade 2 M1, Grade 3 M2) 300 mgI/ml, 120 kV 690 HU (grad 4 M1&M2) 400 mgI/ml, 90 kV Grading 1-4 (poor-excellent) 257 HU (Grade 2) 300 mgI/ml, 120 kV 683 HU (Grade 4) 400 mgI/ml, 90 kV

Measurements HU Mean HU ± SD Group difference, p value (Welch two sample t-test) mgI/ml/kV Group 1 300/120 Group 2 400/120 Group 3 400/90 Group 1 versus Group 2 versus versus Group 3 ICA 360 ± 75 424 ± 82 579 ± 157 0.03* < 0.01* M1 333 ± 68 382 ± 84a 525 ± 133 0.10 M2 306 ± 66 354 ± 82a 465 ± 127 0.09 a One patient excluded because of coilartefacts * significans at p ≤ 0.05

Image quality grading Image quality grading Mean values Group difference, p value (Wilcoxon rank sum test) mgI/ml/kV Group 1 300/120 Group 2 400/120 Group 3 400/90 Group 1 versus Group 2 Group 2 versus Group 3 Group 1 versus Group 3 M1 3.00 3.43a 3.45 0.12 0.86 0.05* M2 3.36a 3.55 0.21 0.43 0.02* Volume rendering 3.14a 3.52 0.57 0.07 0.01* General impression 2.80 2.86a 3.21 0.83 0.11 0.06 a One patient excluded because of coilartefacts * significans at p ≤ 0.05

Results Contrast media with 400 mgI/ml instead 300 mgI/ml increases intracranial vessel enhancement with 18%. The decrease of tube voltage from 120 kVp to 90 kVp increases intracranial vessel enhancement with 37%. The combined effect of both parameters yields an increase of the enhancement with 61%. When measuring in the ICA….

Conclusion The use of highly concentrated contrast media in combination with low tube voltage are easily performed measures to improve the image quality on slice images and 3D reconstructions. Both measures can be recommended for optimization of intracranial CTA.