Comparison of Coronary Computed Tomography Angiography Image Quality With High-concentration and Low-concentration Contrast Agents: The Randomized CONCENTRATE Trial

• Published in: Journal of thoracic imaging Vol. 38; no. 2; p. 120
• Main Authors: Im, Dong Jin, Kim, Yun-Hyeon, Choo, Ki Seok, Kang, Joon-Won, Jung, Jung Im, Won, Yoodong, Kim, Hyo Rim, Chung, Myung Hee, Han, Kyunghwa, Choi, Byoung Wook
• Format: Journal Article
• Language: English
• Published: United States 01.03.2023
• Subjects: Computed Tomography Angiography; Contrast Media; Coronary Angiography - methods; Humans; Prospective Studies; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted - methods; Tomography, X-Ray Computed - methods
• ISSN: 1536-0237
• DOI: 10.1097/RTI.0000000000000633

To confirm that the image quality of coronary computed tomography (CT) angiography with a low tube voltage (80 to 100 kVp), iterative reconstruction, and low-concentration contrast agents (iodixanol 270 to 320 mgI/mL) was not inferior to that with conventional high tube voltage (120 kVp) and high-concentration contrast agent (iopamidol 370 mgI/mL). This prospective, multicenter, noninferiority, randomized trial enrolled a total of 318 patients from 8 clinical sites. All patients were randomly assigned 1: 1: 1 for each contrast medium of 270, 320, and 370 mgI/mL. CT scans were taken with a standard protocol in the high-concentration group (370 mgI/mL) and with 20 kVp lower protocol in the low-concentration group (270 or 320 mgI/mL). Image quality and radiation dose were compared between the groups. Image quality was evaluated with a score of 1 to 4 as subject image quality. The mean HU, signal-to-noise ratio, and contrast-to-noise ratio of the 3 groups were significantly different (all P<0.0001). The signal-to-noise ratio and contrast-to-noise ratio of the low-concentration groups were significantly lower than those of the high-concentration group (P<0.05). However, the image quality scores were not significantly different among the 3 groups (P=0.745). The dose length product and effective dose of the high-concentration group were significantly higher than those of the low-concentration group (P<0.0001 and 0.003, respectively). The CT protocol with iterative reconstruction and lower tube voltage for low-concentration contrast agents significantly reduced the effective radiation dose (mean: 3.7±2.7 to 4.1±3.1 mSv) while keeping the subjective image quality as good as the standard protocol (mean: 5.7±3.4 mSv).