Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Systematic Review Article

A Systematic Review of Double Low-dose CT Pulmonary Angiography in Pulmonary Embolism

Author(s): Sultan Aldosari and Zhonghua Sun*

Volume 15, Issue 5, 2019

Page: [453 - 460] Pages: 8

DOI: 10.2174/1573405614666180813120619

Price: $65

Abstract

Background: The aim of this study is to perform a systematic review of the feasibility and clinical application of double low-dose CT pulmonary angiography (CTPA) in the diagnosis of patients with suspected pulmonary embolism.

Discussion: A total of 13 studies were found to meet selection criteria reporting both low radiation dose (70 or 80 kVp versus 100 or 120 kVp) and low contrast medium dose CTPA protocols. Lowdose CTPA resulted in radiation dose reduction from 29.6% to 87.5% in 12 studies (range: 0.4 to 23.5 mSv), while in one study, radiation dose was increased in the dual-energy CT group when compared to the standard 120 kVp group. CTPA with use of low contrast medium volume (range: 20 to 75 ml) was compared to standard CTPA (range: 50 to 101 ml) in 12 studies with reduction between 25 and 67%, while in the remaining study, low iodine concentration was used with 23% dose reduction achieved. Quantitative assessment of image quality (in terms of signal-to-noise ratio and contrast-to-noise ratio) showed that low-dose CTPA was associated with higher, lower and no change in image quality in 3, 3 and 6 studies, respectively when compared to the standard CTPA protocol. The subjective assessment indicated similar image quality in 11 studies between low-dose and standard CTPA groups, and improved image quality in 1 study with low-dose CTPA.

Conclusion: This review shows that double low-dose CTPA is feasible in the diagnosis of pulmonary embolism with significant reductions in both radiation and contrast medium doses, without compromising diagnostic image quality.

Keywords: Diagnosis, patients, pulmonary embolism, radiation, reduction, CTPA.

Graphical Abstract
[1]
Mayo J, Thakur Y. Pulmonary CT angiography as first-line imaging for PE: Image quality and radiation dose considerations. AJR Am J Roentgenol 2013; 200(3): 522-8.
[2]
Wittram C. How I do it: CT pulmonary angiography. AJR Am J Roentgenol 2007; 188(5): 1255-61.
[3]
den Exter AL, van der Hulle T, Klok FA, Huisman MV. Advances in the diagnosis and management of acute pulmonary embolism. Thromb Res 2014; 133(Suppl. 2): S10-6.
[4]
Righini M, Le GG, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: A randomised non-inferiority trial. Lancet 2008; 371(9621): 1343-52.
[5]
Sun Z, Lei J. Diagnostic yield of CT pulmonary angiography in the diagnosis of pulmonary embolism: a single center experience. Interv Cardiol 2017; 9: 191-8.
[6]
Ong CW, Malipatil V, Lavercombe M, et al. Implementation of a clinical prediction tool for pulmonary embolism diagnosis in a tertiary teaching hospital reduces the number of computed tomography pulmonary angiograms performed. Intern Med J 2013; 43: 169-74.
[7]
Newman DH, Schriger DL. Rethinking testing for pulmonary embolism: Less is more. Ann Emerg Med 2011; 57: 622-7.e3.
[8]
Laqmani A, Kurfurst M, Butscheidt S, et al. CT pulmonary angiography at reduced radiation exposure and contrast material volume using iterative model reconstruction and iDose 4 technique in comparison to FBP. PLoS One 2016; 11e0162429
[9]
Szucs-Farkas Z, Schibler F, Cullmann J, et al. Diagnostic accuracy of pulmonary CT angiography at low tube voltage: Intraindividual comparison of a normal-dose protocol at 120 kVp and a low-dose protocol at 80 kVp using reduced amount of contrast medium in a simulation study. AJR Am J Roentgenol 2011; 197W852-9
[10]
Szucs-Farkas Z, Schaller C, Bensler S, Patak MA, Vock P, Schindera ST. Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort. Invest Radiol 2009; 44: 793-9.
[11]
Boos J, Kropil P, Lanzman RS, et al. CT pulmonary angiography: simultaneous low-pitch dual-source acquisition mode with 70 kVp and 40 ml of contrast medium and comparison with high-pitch spiral dual-source acquisition with automated tube potential selection. Br J Radiol 2016; 8920151059
[12]
Laqmani A, Regier M, Veldhoen S, et al. Improved image quality and low radiation dose with hybrid iterative reconstruction with 80 kV CT pulmonary angiography. Eur J Radiol 2014; 83: 1962-9.
[13]
Lu GM, Luo S, Meinel FG, et al. High-pitch computed tomography pulmonary angiography with iterative reconstruction at 80 kVp and 20 mL contrast agent volume. Eur Radiol 2014; 24: 3260-8.
[14]
Shen Y, Hu X, Zhou X, Zhu D, Li Z, Hu D. Did low tube voltage CT combined with low contrast media burden protocols accomplish the goal of “double low” for patients? An overview of applications in vessels and abdominal parenchymal organs over the past 5 years. Int J Clin Pract 2016; 70(Suppl. 9B): B5-B15.
[15]
Mohr D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 Statement. Syst Rev 2015; 4: 1.
[16]
Chen HL, Chen TW, Qiu LH, Diao XM, Zhang C, Chen L. Application of flash dual-source CT at low radiation dose and low contrast medium dose in triple rule-out (tro) examination. Int J Clin Exp Med 2015; 8: 21898-905.
[17]
Dong J, Wang X, Jiang X, et al. Low-contrast agent dose dual-energy CT monochromatic imaging in pulmonary angiography versus routine CT. J Comput Assist Tomogr 2013; 37: 618-25.
[18]
Hu X, Ma L, Zhang J, Li Z, Shen Y, Hu D. Use of pulmonary CT angiography with low tube voltage and low-iodine-concentration contrast agent to diagnose pulmonary embolism. Sci Rep 2017; 7: 12741.
[19]
Kidoh M, Nakaura T, Nakamura S, et al. Contrast material and radiation dose reduction strategy for triple-rule-out cardiac CT angiography: feasibility study of non-ECG-gated low kVp scan of the whole chest following coronary CT angiography. Acta Radiol 2014; 55: 1186-96.
[20]
Kilic K, Erbas G, Ucar M, et al. Determination of lowest possible contrast volume in computed tomography pulmonary angiography by using pulmonary transit time. Jpn J Radiol 2014; 32: 90-7.
[21]
Li X, Ni Q, Schoepf J, et al. 70-kVp high-pitch computed tomography pulmonary angiography with 40 ml contrast agent: Initial experience. Acad Radiol 2015; 22: 1562-70.
[22]
Moynihan WA, Kiely BL, O’Brien JM. A comparison of 100 kVp verusu 120 kVp CTPA acquisition with direct comparisons of test bolus and bolus tracking at same and different voltages in multidetector 64 slice CT scanner. Int J Radiol Radiat Ther 2017. 4(2): 363-8.
[23]
Sodickson A, Weiss M. Effects of patient size on radiation dose reduction and image quality in low-kVp CT pulmonary angiography performed with reduced IV contrast dose. Emerg Radiol 2012; 19: 437-45.
[24]
Suntharalingam S, Mikat C, Stenzel E, et al. Submillisievert standard-pitch CT pulmonary angiography with ultra-low dose contrast media administration: A comparison to standard CT imaging. PLoS One 2017; 12e0186694
[25]
Viteri-Ramirex G, Garca-Lallana A, Simon-Yarza I, et al. Low radiation and low-contrast dose pulmonary CT angiography: Comparison of 80 kVp/60 ml and 100 kVp/80 ml protocols. Clin Radiol 2012; 67: 833-9.
[26]
Mamlouk MD, vanSonnenberg E, Gosalia R, et al. Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology 2010; 256(2): 625-32.
[27]
Mitchell AM, Jones AE, Tumlin JA, Kline JA. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med 2012; 19(6): 618-25.
[28]
Shen Y, Sun Z, Xu L, et al. High-pitch, low-voltage and low-iodine-concentration CT angiography of aorta: assessment of image quality and radiation dose with iterative reconstruction. PLoS One 2015; 10e0117469
[29]
Sun Z, Al Moudi M, Cao Y. CT angiography in the diagnosis of cardiovascular disease: A transformation in cardiovascular CT practice. Quant Imaging Med Surg 2014; 4: 376-96.
[30]
Cakmakci E, Ozkurt H, Tokgoz S, et al. CT-angiography protocol with low dose radiation and low volume contrast medium for non-cardiac chest pain. Quant Imaging Med Surg 2014; 4: 307-12.
[31]
Gill MK, Vijayananthan A, Kumar G, Jayarani K, Ng KH, Sun Z. Use of 100 kV versus 120 kV in computed tomography pulmonary angiography in the detection of pulmonary embolism: effect on radiation dose and image quality. Quant Imaging Med Surg 2015; 5: 524-33.
[32]
Tan S, Yeong CH, Aman R, et al. Low tube voltage prospectively ECG-triggered coronary CT angiography: A systematic review of image quality and radiation dose. Br J Radiol 2018; (1088): 20170874
[33]
Aldosari S, Almoudi M, Sun Z. Double-low dose protocol of CT pulmonary angiography in the diagnosis of pulmonary embolism: A feasible approach for reduction of both contrast medium and radiation dose. Heart Res Open J 2017; 4: 33-8.
[34]
Tan SK, Yeong CH, Ng KH, Abdul Aziz Y, Sun Z. Recent update on radiation dose assessment for the state-of-art Coronary Computed Tomography Angiography (CCTA) protocols. PLoS One 2016; 11e0161543
[35]
Al Shammakhi A, Sun Z. A systematic review of image quality, diagnostic value and radiation dose of coronary CT angiography using iterative reconstruction compared to filtered back projection in the diagnosis of coronary artery disease. J Med Imaging Health Inform 2015; 5: 96-102.
[36]
Shen Y, Fan Z, Sun Z, et al. High pitch dual-source whole aorta CT angiography in the detection of coronary arteries: A feasibility study of using Iodixanol 270 and 100 kVp with iterative reconstruction. J Med Imaging Health Inform 2015; 5: 117-25.
[37]
Sabarudin A, Mustafa Z, Nassir KM, Hamid HA, Sun Z. Radiation dose reduction in thoracic and abdomen-pelvic CT using tube current modulation: A phantom study. J Appl Clin Med Phys 2015; 16: 319-28.
[38]
Sabarudin A, Khairuddin Md Yusof A, Tay MF, Ng KH, Sun Z. Dual-source CT coronary angiography: Effectiveness of radiation dose reduction with lower tube voltage. Radiat Prot Dosimetry 2013; 153: 441-7.
[39]
Sabarudin A, Sun Z, Khairuddin Md Yusof A. Coronary CT angiography with single- source and dual-source CT: Comparison of image quality and radiation dose between prospective ECG-triggered and retrospective ECG-gated protocols. Int J Cardiol 2013; 168: 746-53.
[40]
Sabarudin A, Sun Z, Ng KH. Radiation dose in coronary CT angiography associated with prospective ECG-triggered technique: comparisons with different CT generations. Radiat Prot Dosimetry 2013; 154: 301-7.
[41]
Kanematsu M, Goshima S, Miyoshi T, et al. Whole-body CT angiography with low tube voltage and low-concentration contrast material to reduce radiation dose and iodine load. AJR Am J Roentgenol 2014; 202W106-16
[42]
Rodrigues JCL, Mathias H, Negus IS, Manghat NE, Hamilton MCK. Intravenous contrast medium administration at 128 multidetector row CT pulmonary angiography: Bolus tracking versus test bolus and the implications for diagnostic quality and effective dose. Clin Radiol 2012; 67: 1053-60.
[43]
Mourits MM, Nijhof WH, van Leuken MH, Jager GJ, Rutten MJCM. Reducing contrast medium volume and tube voltage in CT angiography of the pulmonary artery. Clin Radiol 2016; 71: 615.e7-615.e13.
[http://dx.doi.org/10.1016/j.crad.2016.03.005]
[44]
Petritsch B, Kosmala A, Gassenmaier T, et al. Diagnosis of pulmonary artery embolism: Comparison of single-source CT and 3rd generation dual-source CT using a dual-energy protocol regarding image quality and radiation dose. RoFo 2017; 189: 527-36.
[45]
De Zordo T, von Lutterotti K, Dejaco C, et al. Comparison of image quality and radiation dose of different pulmonary CTA protocols on a 128-slice CT: High-pitch dual source CT, dual energy CT and conventional spiral CT. Eur Radiol 2012; 22: 279-86.
[46]
Leithner D, Wichmann JL, Vogl TJ, et al. Virtual monoenergentic imaging and iodine perfusion maps improve diagnostic accuracy of dual-energy computed tomography pulmonary angiography with suboptimal contrast attenuation. Invest Radiol 2017; 52: 659-65.
[47]
Leithner D, Gruber-Rouh T, Beeres M, et al. 90-kVp low-tube-voltage CT pulmonary angiography in combination with advanced modeled iterative reconstruction algorithm: Effects on radiation dose, image quality and diagnostic accuracy for the detection of pulmonary embolism. Br J Radiol 2018; 91(1088)20180269
[http://dx.doi.org/10.1259/bjr.20180269]
[48]
Leithner D, Wichmann JL, Mahmoudi S, et al. Diagnostic yield of 90-kVp low-tube-voltage carotid and intracerebral CT-angiography: effects on radiation dose, image quality and diagnostic performance for the detection of carotid stenosis. Br J Radiol 2018; 91(1086)20170927
[http://dx.doi.org/10.1259/bjr.20170927]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy