Comparison of Coronary Computed Tomography Angiography Image Quality With High-concentration and Low-concentration Contrast Agents

The Randomized CONCENTRATE Trial

Abstract

Purpose: 

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).

Materials and Methods: 

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.

Results: 

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).

Conclusions: 

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).