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Renal protection CT protocol using low-dose and low-concentration iodine contrast medium in at-risk patients of HCC and with chronic kidney disease: a randomized controlled non-inferiority trial
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- Authors
- Issue Date
- 2023-10-19
- Publisher
- BMC
- Citation
- Cancer Imaging, Vol.23(1):100
- Abstract
- Background Although efforts have been made to reduce the dose of Contrast Medium (CM) to improve patient
safety, there are ongoing concerns regarding its potential effects on image quality and diagnostic performance.
Moreover, research is lacking to establish a lower limit for safe and effective CM dose reduction. To determine whether
the image quality of contrast-enhanced liver computed tomography (CT) using a reduced amount of iodinated CM
was similar to that of standard liver CT.
Methods We enrolled participants at risk for hepatocellular carcinoma with decreased estimated glomerular filtration
rates (<60 mL/min/1.73m2
). Participants were randomly assigned to the standard group or the renal protection
protocol (RPP) group. In the standard group, images were reconstructed using hybrid iterative reconstruction
(iDose), while in the RPP group, low monoenergetic (50-keV) images and deep learning (DL)-based iodine-boosting
reconstruction were used. Four radiologists independently assessed image quality and lesion conspicuity.
Results Fifty-two participants were assigned to the standard (n=25) or RPP (n=27) groups. The iodine load was
significantly lower in the RPP group than in the standard group (301.5±1.71 vs. 524±7.37 mgI/kg, P<0.001). The
50-keV and DL-based iodine-boosting images from the RPP group exhibited higher image contrast than those from
the standard group during arterial (3.60±0.65, 3.75±0.60, and 3.09±0.43, respectively) and portal venous phases
(4.01±0.49, 3.86±0.42, and 3.21±0.31, respectively) (P<0.05 for all). Overall image quality was superior in the RPP
group (P<0.05 for all). No significant difference in lesion conspicuity was observed (P>0.017).
Conclusions The reduction in image contrast and overall image quality caused by decreased CM can be restored
using either low monoenergetic imaging or DL-based iodine-boosting reconstruction.
- ISSN
- 1470-7330
- Language
- English
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