Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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CT Venography for Deep Vein Thrombosis Using a Low Tube Voltage (100 kVp) Setting Could Increase Venous Enhancement and Reduce the Amount of Administered Iodine

  • Cho, Eun-Suk (Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital) ;
  • Chung, Jae-Joon (Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital) ;
  • Kim, Sungjun (Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital) ;
  • Kim, Joo Hee (Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital) ;
  • Yu, Jeong-Sik (Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital) ;
  • Yoon, Choon-Sik (Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital)
  • Published : 2013.04.01
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Abstract

Objective: To investigate the validity of the 100 kVp setting in CT venography (CTV) in the diagnosis of deep vein thrombosis (DVT), and to evaluate the feasibility of reducing the amount of administered iodine in this setting. Materials and Methods: After receiving the contrast medium (CM) of 2.0 mL/kg, 88 patients underwent CTV of the pelvis and lower extremities by using one of four protocols: Group A, 120 kVp setting and 370 mgI/mL CM; group B, 120 kVp and 300 mgI/mL; group C, 100 kVp and 370 mgI/mL; group D, 100 kVp and 300 mgI/mL. The groups were evaluated for venous attenuation, vein-to-muscle contrast-to-noise ratio ($CNR_{VEIN}$), DVT-to-vein contrast-to-noise ratio ($CNR_{DVT}$), and subjective degree of venous enhancement and image quality. Results: Venous attenuation and $CNR_{VEIN}$ were significantly higher in group C (144.3 Hounsfield unit [HU] and 11.9), but there was no significant difference between group A (118.0 HU and 8.2) and D (122.4 HU and 7.9). The attenuation value of DVT was not significantly different among the four groups, and group C had a higher absolute $CNR_{DVT}$ than the other groups. The overall diagnostic image quality and venous enhancement were significantly higher in group C, but there was no difference between groups A and D. Conclusion: The 100 kVp setting in CTV substantially help improve venous enhancement and $CNR_{VEIN}$. Furthermore, it enables to reduce the amount of administered iodine while maintaining venous attenuation, as compared with the 120 kVp setting.

Keywords

References

  1. Hirsh, J, Hoak, J,Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association, Circulation, 93, 1, 2212-2245(1996) https://doi.org/10.1161/01.CIR.93.12.2212
  2. Byun, SS, Kim, JH, Kim, YJ, Jeon, YS, Park, CH, Kim, WH,Evaluation of deep vein thrombosis with multidetector row CT after orthopedic arthroplasty: a prospective study for comparison with Doppler sonography, Korean J Radiol, 9, 2, 59-66(2008) https://doi.org/10.3348/kjr.2008.9.1.59
  3. Cham, MD, Yankelevitz, DF, Shaham, D, Shah, AA, Sherman, L, Lewis, A,Deep venous thrombosis: detection by using indirect CT venography, Radiology, 216, 3, 744-751(2000) https://doi.org/10.1148/radiology.216.3.r00se44744
  4. Loud, PA, Katz, DS, Bruce, DA, Klippenstein, DL, Grossman, ZD,Deep venous thrombosis with suspected pulmonary embolism: detection with combined CT venography and pulmonary angiography, Radiology, 219, 4, 498-502(2001) https://doi.org/10.1148/radiology.219.2.r01ma26498
  5. Duwe, KM, Shiau, M, Budorick, NE, Austin, JH, Berkmen, YM,Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: a retrospective comparison of helical CT venography and sonography. 2000 ARRS Executive Council Award I, AJR Am J Roentgenol, 175, 5, 1525-1531(2000) https://doi.org/10.2214/ajr.175.6.1751525
  6. Lim, KE, Hsu, WC, Hsu, YY, Chu, PH, Ng, CJ,Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients, Clin Imaging, 28, 6, 439-444(2004) https://doi.org/10.1016/S0899-7071(03)00319-X
  7. Yavas, US, Calisir, C, Ozkan, IR,The interobserver agreement between residents and experienced radiologists for detecting pulmonary embolism and DVT with using CT pulmonary angiography and indirect CT venography, Korean J Radiol, 9, 7, 498-502(2008) https://doi.org/10.3348/kjr.2008.9.6.498
  8. Arakawa, H, Kohno, T, Hiki, T, Kaji, Y,CT pulmonary angiography and CT venography: factors associated with vessel enhancement, AJR Am J Roentgenol, 189, 8, 156-161(2007) https://doi.org/10.2214/AJR.06.1240
  9. Lee, W, Chung, JW, Yin, YH, Jae, HJ, Kim, SJ, Ha, J,Three-Dimensional CT venography of varicose veins of the lower extremity: image quality and comparison with doppler sonography, AJR Am J Roentgenol, 191, 9, 1186-1191(2008) https://doi.org/10.2214/AJR.07.3471
  10. Taffoni, MJ, Ravenel, JG, Ackerman, SJ,Prospective comparison of indirect CT venography versus venous sonography in ICU patients, AJR Am J Roentgenol, 185, 10, 457-462(2005) https://doi.org/10.2214/ajr.185.2.01850457
  11. Begemann, PG, Bonacker, M, Kemper, J, Guthoff, AE, Hahn, KE, Steiner, P,Evaluation of the deep venous system in patients with suspected pulmonary embolism with multi-detector CT: a prospective study in comparison to Doppler sonography, J Comput Assist Tomogr, 27, 11, 399-409(2003) https://doi.org/10.1097/00004728-200305000-00017
  12. Stein, PD, Fowler, SE, Goodman, LR, Gottschalk, A, Hales, CA, Hull, RD,Multidetector computed tomography for acute pulmonary embolism, N Engl J Med, 354, 12, 2317-2327(2006) https://doi.org/10.1056/NEJMoa052367
  13. Kalva, SP, Jagannathan, JP, Hahn, PF, Wicky, ST,Venous thromboembolism: indirect CT venography during CT pulmonary angiography--should the pelvis be imaged?, Radiology, 246, 13, 605-611(2008) https://doi.org/10.1148/radiol.2462070319
  14. Goodman, LR, Stein, PD, Matta, F, Sostman, HD, Wakefield, TW, Woodard, PK,CT venography and compression sonography are diagnostically equivalent: data from PIOPED II, AJR Am J Roentgenol, 189, 14, 1071-1076(2007) https://doi.org/10.2214/AJR.07.2388
  15. Curry TS, Dowdey JE, Murry RC. Basic interactions between X-rays and matter. In: Curry TS, Dowdey JE, Murry RC, eds. Christensen's physics of diagnostic radiology, 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 1990:61-69
  16. Schindera, ST, Graca, P, Patak, MA, Abderhalden, S, von Allmen, G, Vock, P,Thoracoabdominal-aortoiliac multidetector-row CT angiography at 80 and 100 kVp: assessment of image quality and radiation dose, Invest Radiol, 44, 16, 650-655(2009) https://doi.org/10.1097/RLI.0b013e3181acaf8a
  17. Schueller-Weidekamm, C, Schaefer-Prokop, CM, Weber, M, Herold, CJ, Prokop, M,CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings, Radiology, 241, 17, 899-907(2006) https://doi.org/10.1148/radiol.2413040128
  18. Waaijer, A, Prokop, M, Velthuis, BK, Bakker, CJ, de Kort, GA, van Leeuwen, MS,Circle of Willis at CT angiography: dose reduction and image quality--reducing tube voltage and increasing tube current settings, Radiology, 242, 18, 832-839(2007) https://doi.org/10.1148/radiol.2423051191
  19. Fujikawa, A, Matsuoka, S, Kuramochi, K, Yoshikawa, T, Yagihashi, K, Kurihara, Y,Vascular enhancement and image quality of CT venography: comparison of standard and low kilovoltage settings, AJR Am J Roentgenol, 197, 19, 838-843(2011) https://doi.org/10.2214/AJR.10.5424
  20. Nakaura, T, Awai, K, Oda, S, Yanaga, Y, Namimoto, T, Harada, K,A low-kilovolt (peak) high-tube current technique improves venous enhancement and reduces the radiation dose at indirect multidetector-row CT venography: initial experience, J Comput Assist Tomogr, 35, 20, 141-147(2011) https://doi.org/10.1097/RCT.0b013e3181f5a62e
  21. Oda, S, Utsunomiya, D, Awai, K, Takaoka, H, Nakaura, T, Katahira, K,Indirect computed tomography venography with a low-tube-voltage technique: reduction in the radiation and contrast material dose--a prospective randomized study, J Comput Assist Tomogr, 35, 21, 631-636(2011) https://doi.org/10.1097/RCT.0b013e31822a563d
  22. Menke, J,Comparison of different body size parameters for individual dose adaptation in body CT of adults, Radiology, 236, 22, 565-571(2005) https://doi.org/10.1148/radiol.2362041327
  23. Szucs-Farkas, Z, Semadeni, M, Bensler, S, Patak, MA, von Allmen, G, Vock, P,Endoleak detection with CT angiography in an abdominal aortic aneurysm phantom: effect of tube energy, simulated patient size, and physical properties of endoleaks, Radiology, 251, 23, 590-598(2009) https://doi.org/10.1148/radiol.2512081687
  24. Yankelevitz, DF, Gamsu, G, Shah, A, Rademaker, J, Shaham, D, Buckshee, N,Optimization of combined CT pulmonary angiography with lower extremity CT venography, AJR Am J Roentgenol, 174, 24, 67-69(2000) https://doi.org/10.2214/ajr.174.1.1740067
  25. Wintersperger, B, Jakobs, T, Herzog, P, Schaller, S, Nikolaou, K, Suess, C,Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose, Eur Radiol, 15, 25, 334-341(2005) https://doi.org/10.1007/s00330-004-2575-y
  26. Goo, HW,CT radiation dose optimization and estimation: an update for radiologists, Korean J Radiol, 13, 26, 1-11(2012) https://doi.org/10.3348/kjr.2012.13.1.1
  27. Landis, JR, Koch, GG,The measurement of observer agreement for categorical data, Biometrics, 33, 27, 159-174(1977) https://doi.org/10.2307/2529310
  28. Huda, W, Scalzetti, EM, Levin, G,Technique factors and image quality as functions of patient weight at abdominal CT, Radiology, 217, 28, 430-435(2000) https://doi.org/10.1148/radiology.217.2.r00nv35430
  29. Goodman, LR, Gulsun, M, Nagy, P, Washington, L,CT of deep venous thrombosis and pulmonary embolus: does iso-osmolar contrast agent improve vascular opacification?, Radiology, 234, 29, 923-928(2005) https://doi.org/10.1148/radiol.2343031871
  30. Reichert, M, Henzler, T, Krissak, R, Apfaltrer, P, Huck, K, Buesing, K,Venous thromboembolism: additional diagnostic value and radiation dose of pelvic CT venography in patients with suspected pulmonary embolism, Eur J Radiol, 80, 30, 50-53(2011) https://doi.org/10.1016/j.ejrad.2010.12.101

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