Investigative Radiology

Skip Navigation LinksHome > April 2014 - Volume 49 - Issue 4 > Diagnostic Accuracy of Computed Tomography Pulmonary Angiogr...
Investigative Radiology:
doi: 10.1097/RLI.0000000000000016
Original Articles

Diagnostic Accuracy of Computed Tomography Pulmonary Angiography With Reduced Radiation and Contrast Material Dose: A Prospective Randomized Clinical Trial

Szucs-Farkas, Zsolt MD*†; Christe, Andreas MD*; Megyeri, Boglarka MD; Rohacek, Martin MD§∥; Vock, Peter MD*; Nagy, Endre V. MD; Heverhagen, Johannes T. MD*; Schindera, Sebastian T. MD*#

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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.

© 2014 by Lippincott Williams & Wilkins

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