Diagnostic accuracy of computed tomography pulmonary angiography with reduced radiation and contrast material dose: A prospective randomized clinical trial

Zsolt Szucs-Farkas, Andreas Christe, Boglarka Megyeri, Martin Rohacek, Peter Vock, E. Nagy, Johannes T. Heverhagen, Sebastian T. Schindera

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

OBJECTIVE: The objective of the study was to test the diagnostic performance of low-dose computed tomography pulmonary angiography (CTPA) at peak tube voltage of 80 kVp with both reduced radiation and reduced contrast material (CM) dose. MATERIALS AND METHODS: In this single-center, single-blinded prospective randomized trial, 501 patients with body weights of less than 100 kg with suspected acute pulmonary embolism (PE) were assigned to normal-dose CTPA (100-kVp tube energy and 100-mL CM, 255 patients) and low-dose CTPA (80-kVp tube energy and 75-mL CM, 246 patients). Primary end points were evidence of PE in CTPA and accuracy of CTPA on a composite reference standard. Results were compared by calculating the odds ratio with the 95% confidence interval. RESULTS: The reference diagnosis was equivocal in 20 of the 501 patients. Diagnosis of CTPA was correct in 240 patients and incorrect in 5 in the normal-dose group. Computed tomography pulmonary angiography was correct in 230 patients and incorrect in 6 in the low-dose group (odds ratio, 1.25; 95% confidence interval, 0.38-4.16; P = 0.77). Sensitivity was 96.9% and 100% and specificity was 98.1% and 97.1% in the normal-dose and low-dose groups, respectively. No PE or PE-related death occurred during the 90-day follow-up. The size-specific dose estimates were 30% lower at 80 kVp (4.8 ± 1.0 mGy) compared with that at 100 kVp (6.8 ± 1.2 mGy; P <0.001). CONCLUSIONS: The accuracy of low-dose CTPA at 80 kVp with a 30% reduced radiation dose and a 25% lower CM volume is not significantly different from that of normal-dose CTPA at 100 kVp in detecting acute PE in patients weighing less than 100 kg.

Original languageEnglish
Pages (from-to)201-208
Number of pages8
JournalInvestigative Radiology
Volume49
Issue number4
DOIs
Publication statusPublished - 2014

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Contrast Media
Randomized Controlled Trials
Radiation
Lung
Pulmonary Embolism
Odds Ratio
Confidence Intervals
Computed Tomography Angiography
Routine Diagnostic Tests
Body Weight

Keywords

  • CT pulmonary angiography
  • diagnostic accuracy
  • low-dose
  • prospective randomized trial
  • pulmonary embolism

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Diagnostic accuracy of computed tomography pulmonary angiography with reduced radiation and contrast material dose : A prospective randomized clinical trial. / Szucs-Farkas, Zsolt; Christe, Andreas; Megyeri, Boglarka; Rohacek, Martin; Vock, Peter; Nagy, E.; Heverhagen, Johannes T.; Schindera, Sebastian T.

In: Investigative Radiology, Vol. 49, No. 4, 2014, p. 201-208.

Research output: Contribution to journalArticle

Szucs-Farkas, Zsolt ; Christe, Andreas ; Megyeri, Boglarka ; Rohacek, Martin ; Vock, Peter ; Nagy, E. ; Heverhagen, Johannes T. ; Schindera, Sebastian T. / Diagnostic accuracy of computed tomography pulmonary angiography with reduced radiation and contrast material dose : A prospective randomized clinical trial. In: Investigative Radiology. 2014 ; Vol. 49, No. 4. pp. 201-208.
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abstract = "OBJECTIVE: The objective of the study was to test the diagnostic performance of low-dose computed tomography pulmonary angiography (CTPA) at peak tube voltage of 80 kVp with both reduced radiation and reduced contrast material (CM) dose. MATERIALS AND METHODS: In this single-center, single-blinded prospective randomized trial, 501 patients with body weights of less than 100 kg with suspected acute pulmonary embolism (PE) were assigned to normal-dose CTPA (100-kVp tube energy and 100-mL CM, 255 patients) and low-dose CTPA (80-kVp tube energy and 75-mL CM, 246 patients). Primary end points were evidence of PE in CTPA and accuracy of CTPA on a composite reference standard. Results were compared by calculating the odds ratio with the 95{\%} confidence interval. RESULTS: The reference diagnosis was equivocal in 20 of the 501 patients. Diagnosis of CTPA was correct in 240 patients and incorrect in 5 in the normal-dose group. Computed tomography pulmonary angiography was correct in 230 patients and incorrect in 6 in the low-dose group (odds ratio, 1.25; 95{\%} confidence interval, 0.38-4.16; P = 0.77). Sensitivity was 96.9{\%} and 100{\%} and specificity was 98.1{\%} and 97.1{\%} in the normal-dose and low-dose groups, respectively. No PE or PE-related death occurred during the 90-day follow-up. The size-specific dose estimates were 30{\%} lower at 80 kVp (4.8 ± 1.0 mGy) compared with that at 100 kVp (6.8 ± 1.2 mGy; P <0.001). CONCLUSIONS: The accuracy of low-dose CTPA at 80 kVp with a 30{\%} reduced radiation dose and a 25{\%} lower CM volume is not significantly different from that of normal-dose CTPA at 100 kVp in detecting acute PE in patients weighing less than 100 kg.",
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T1 - Diagnostic accuracy of computed tomography pulmonary angiography with reduced radiation and contrast material dose

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AU - Szucs-Farkas, Zsolt

AU - Christe, Andreas

AU - Megyeri, Boglarka

AU - Rohacek, Martin

AU - Vock, Peter

AU - Nagy, E.

AU - Heverhagen, Johannes T.

AU - Schindera, Sebastian T.

PY - 2014

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N2 - OBJECTIVE: The objective of the study was to test the diagnostic performance of low-dose computed tomography pulmonary angiography (CTPA) at peak tube voltage of 80 kVp with both reduced radiation and reduced contrast material (CM) dose. MATERIALS AND METHODS: In this single-center, single-blinded prospective randomized trial, 501 patients with body weights of less than 100 kg with suspected acute pulmonary embolism (PE) were assigned to normal-dose CTPA (100-kVp tube energy and 100-mL CM, 255 patients) and low-dose CTPA (80-kVp tube energy and 75-mL CM, 246 patients). Primary end points were evidence of PE in CTPA and accuracy of CTPA on a composite reference standard. Results were compared by calculating the odds ratio with the 95% confidence interval. RESULTS: The reference diagnosis was equivocal in 20 of the 501 patients. Diagnosis of CTPA was correct in 240 patients and incorrect in 5 in the normal-dose group. Computed tomography pulmonary angiography was correct in 230 patients and incorrect in 6 in the low-dose group (odds ratio, 1.25; 95% confidence interval, 0.38-4.16; P = 0.77). Sensitivity was 96.9% and 100% and specificity was 98.1% and 97.1% in the normal-dose and low-dose groups, respectively. No PE or PE-related death occurred during the 90-day follow-up. The size-specific dose estimates were 30% lower at 80 kVp (4.8 ± 1.0 mGy) compared with that at 100 kVp (6.8 ± 1.2 mGy; P <0.001). CONCLUSIONS: The accuracy of low-dose CTPA at 80 kVp with a 30% reduced radiation dose and a 25% lower CM volume is not significantly different from that of normal-dose CTPA at 100 kVp in detecting acute PE in patients weighing less than 100 kg.

AB - OBJECTIVE: The objective of the study was to test the diagnostic performance of low-dose computed tomography pulmonary angiography (CTPA) at peak tube voltage of 80 kVp with both reduced radiation and reduced contrast material (CM) dose. MATERIALS AND METHODS: In this single-center, single-blinded prospective randomized trial, 501 patients with body weights of less than 100 kg with suspected acute pulmonary embolism (PE) were assigned to normal-dose CTPA (100-kVp tube energy and 100-mL CM, 255 patients) and low-dose CTPA (80-kVp tube energy and 75-mL CM, 246 patients). Primary end points were evidence of PE in CTPA and accuracy of CTPA on a composite reference standard. Results were compared by calculating the odds ratio with the 95% confidence interval. RESULTS: The reference diagnosis was equivocal in 20 of the 501 patients. Diagnosis of CTPA was correct in 240 patients and incorrect in 5 in the normal-dose group. Computed tomography pulmonary angiography was correct in 230 patients and incorrect in 6 in the low-dose group (odds ratio, 1.25; 95% confidence interval, 0.38-4.16; P = 0.77). Sensitivity was 96.9% and 100% and specificity was 98.1% and 97.1% in the normal-dose and low-dose groups, respectively. No PE or PE-related death occurred during the 90-day follow-up. The size-specific dose estimates were 30% lower at 80 kVp (4.8 ± 1.0 mGy) compared with that at 100 kVp (6.8 ± 1.2 mGy; P <0.001). CONCLUSIONS: The accuracy of low-dose CTPA at 80 kVp with a 30% reduced radiation dose and a 25% lower CM volume is not significantly different from that of normal-dose CTPA at 100 kVp in detecting acute PE in patients weighing less than 100 kg.

KW - CT pulmonary angiography

KW - diagnostic accuracy

KW - low-dose

KW - prospective randomized trial

KW - pulmonary embolism

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