Low contrast volume dual-energy CT of the chest: Quantitative and qualitative assessment


      • Routine dual-energy CT with low contrast volume can achieve diagnostic quality opacification in pulmonary arteries and aorta.
      • Lower contrast volumes allow for lower injection rates and utilization of smaller peripheral veins for the exam.
      • This technology can be leveraged in cases of renal insufficiency to decrease the risk of contrast-induced nephropathy.



      To evaluate the image quality of chest CT performed on dual-energy scanners using low contrast volume for routine chest (DECT-R) and pulmonary angiography (DECTPA) protocols.

      Materials and methods

      This retrospective study included dual-energy CT scans of chest performed with low contrast volume in 84 adults (34M:50F; Age 69 ± 16 years: Weight 71 ± 16kg). There were 42 patients with DECT-R and 42 patients with DECT-PA protocols. Images were reviewed by two thoracic radiologists. Qualitative assessment was done on a four-point scale, for subjective assessment of contrast enhancement and artifacts (1 = Excellent, 2 = optimal, 3 = suboptimal, and 4 = Limited) in the pulmonary arteries and thoracic aorta, on virtual monoenergetic and material decomposition iodine (MDI) images. Quantitative assessment was performed by measuring the CT (Hounsfield) units in aorta and pulmonary arteries. The estimated glomerular filtration rate (eGFR) was calculated before and after CT scans. Two tailed student's t-test was performed to assess the significance of findings, and strength of correlation between readers was determined by Cohen's kappa test.


      DECT-PA and DECT-R demonstrated excellent/adequate contrast density within the pulmonary arteries (up to segmental branch), and aorta. There was no suboptimal or limited examination. There was strong interobserver agreement for arterial enhancement in pulmonary arteries (kappa = 0.62–0.89) and for thoracic aorta (kappa = 0.62–0.94). Pulmonary emboli were seen in 3/42(7%) in DECT-R and in 5/42(12%) in DECT-PA. There was no significant change in eGFR before and after IV contrast injection (p = 0.46–0.52).


      DECT-R and DECT-PA performed with low contrast volume provide diagnostic quality opacification of the pulmonary vessels and aorta vessels.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Otrakji A.
        • Digumarthy S.R.
        • Lo Gullo R.
        • Flores E.J.
        • Shepard J.A.
        • Kalra M.K.
        Dual-energy CT: spectrum of thoracic abnormalities.
        Radiographics. 2016; 36: 38-52
        • Sangwaiya M.J.
        • Kalra M.K.
        • Sharma A.
        • Halpern E.F.
        • Shepard J.A.
        • Digumarthy S.R.
        Dual-energy computed tomographic pulmonary angiography: a pilot study to assess the effect on image quality and diagnostic confidence.
        J Comput Assist Tomogr. 2010; 34: 46-51
        • McDermott S.
        • Otrakji A.
        • Flores E.J.
        • Kalra M.K.
        • Shepard J.O.
        • Digumarthy S.R.
        Should dual-energy computed tomography pulmonary angiography replace single-energy computed tomography pulmonary angiography in pregnant and postpartum patients?.
        J Comput Assist Tomogr. 2018; 42: 25-32
        • Heyman S.N.
        • Rosen S.
        • Khamaisi M.
        • Idée J.-M.
        • Rosenberger C.
        Reactive oxygen species and the pathogenesis of radiocontrast-induced nephropathy.
        Invest Radiol. 2010; 45
        • Canellas R.
        • Digumarthy S.R.
        • Otrakji A.
        • Kalra M.K.
        Applications of DECT in thoracic oncology: evidence so far.
        Clin Oncol. 2016; 1: 1148
        • Forghani R.
        • De Man B.
        • Gupta R.
        Dual-energy computed tomography: physical principles, approaches to scanning, usage, and implementation: part 2.
        Neuroimaging Clin N Am. 2017; 27: 385-400
        • Beeres M.
        • Trommer J.
        • Frellesen C.
        • et al.
        Evaluation of different keV-settings in dual-energy CT angiography of the aorta using advanced image-based virtual monoenergetic imaging.
        Int J Cardiovasc Imaging. 2016; 32: 137-144
        • Meyer M.
        • Haubenreisser H.
        • Schabel C.
        • et al.
        CT pulmonary angiography in patients with acute or chronic renal insufficiency: evaluation of a low dose contrast material protocol.
        Sci Rep. 2018; 8: 1995
        • Kalra M.K.
        • Becker H.C.
        • Enterline D.S.
        • et al.
        Contrast administration in CT: a patient-centric approach.
        J Am Coll Radiol. 2019; 16: 295-301
        • Parfrey P.S.
        • Griffiths S.M.
        • Barrett B.J.
        • et al.
        Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study.
        N Engl J Med. 1989; 320: 143-149
        • Heras Benito M.
        • Garrido Blazquez M.
        • Gomez Sanz Y.
        • et al.
        Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography.
        Radiologia. 2018; 60: 326-331
        • Toprak O.
        • Cirit M.
        • Yesil M.
        • et al.
        Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease.
        Nephrol Dial Transplant. 2007; 22: 819-826
        • Selistre LdS
        • Souza Vcd
        • Dubourg L.
        • Wagner M.B.
        • Hoefel Filho J.R.
        • Saitovitch D.
        Contrast-induced nephropathy after computed tomography.
        Brazilian Journal of Nephrology. 2015; 37: 27-31
        • Faucon A.L.
        • Bobrie G.
        • Clément O.
        Nephrotoxicity of iodinated contrast media: from pathophysiology to prevention strategies.
        Eur J Radiol. 2019; 116: 231-241
        • Han X.-f.
        • Zhang X.-x.
        • Liu K.-m.
        • Tan H.
        • Zhang Q.
        Contrast-induced nephropathy in patients with diabetes mellitus between iso- and low-osmolar contrast media: a meta-analysis of full-text prospective, randomized controlled trials.
        PLoS ONE. 2018; 13e0194330
        • Ludwig U.
        • Keller F.
        Prophylaxis of contrast-induced nephrotoxicity.
        Biomed Res Int. 2014; 2014308316
        • Davenport M.S.
        • Cohan R.H.
        • Khalatbari S.
        • Ellis J.H.
        The challenges in assessing contrast-induced nephropathy: where are we now?.
        AJR Am J Roentgenol. 2014; 202: 784-789
        • Abujudeh H.H.
        • Gee M.S.
        • Kaewlai R.
        In emergency situations, should serum creatinine be checked in all patients before performing second contrast CT examinations within 24 hours?.
        J Am Coll Radiol. 2009; 6: 268-273
      1. ([Accessed on June 2, 2018])
        • Christner J.A.
        • Kofler J.M.
        • McCollough C.H.
        Estimating effective dose for CT using dose-length product compared with using organ doses: consequences of adopting International Commission on Radiological Protection publication 103 or dual-energy scanning.
        AJR Am J Roentgenol. 2010; 194: 881-889
        • Yuan R.
        • Shuman W.P.
        • Earls J.P.
        • et al.
        Reduced iodine load at CT pulmonary angiography with dual-energy monochromatic imaging: comparison with standard CT pulmonary angiography—a prospective randomized trial.
        Radiology. 2012; 262: 290-297
        • Dong J.
        • Wang X.
        • Jiang X.
        • et al.
        Low-contrast agent dose dual-energy CT monochromatic imaging in pulmonary angiography versus routine CT.
        J Comput Assist Tomogr. 2013; 37: 618-625
        • Kristiansson M.
        • Holmquist F.
        • Nyman U.
        Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study.
        Eur Radiol. 2010; 20: 1321-1330
        • Nance Jr., J.W.
        • Henzler T.
        • Meyer M.
        • et al.
        Optimization of contrast material delivery for dual-energy computed tomography pulmonary angiography in patients with suspected pulmonary embolism.
        Invest Radiol. 2012; 47: 78-84
        • Godoy M.C.
        • Heller S.L.
        • Naidich D.P.
        • et al.
        Dual-energy MDCT: comparison of pulmonary artery enhancement on dedicated CT pulmonary angiography, routine and low contrast volume studies.
        Eur J Radiol. 2011; 79: e11-e17
        • Ding S.
        • Meystre N.R.
        • Campeanu C.
        • Gullo G.
        Contrast media extravasations in patients undergoing computerized tomography scanning: a systematic review and meta-analysis of risk factors and interventions.
        JBI Database System Rev Implement Rep. 2018; 16: 87-116
        • Sadigh G.
        • Kelly A.M.
        • Cronin P.
        Challenges, controversies, and hot topics in pulmonary embolism imaging.
        AJR Am J Roentgenol. 2011; 196: 497-515
        • Abujudeh H.H.
        • Kaewlai R.
        • Farsad K.
        • Orr E.
        • Gilman M.
        • Shepard J.A.
        Computed tomography pulmonary angiography: an assessment of the radiology report.
        Acad Radiol. 2009; 16: 1309-1315
        • Jones S.E.
        • Wittram C.
        The indeterminate CT pulmonary angiogram: imaging characteristics and patient clinical outcome.
        Radiology. 2005; 237: 329-337
        • Nazaroglu H.
        • Ozmen C.A.
        • Akay H.O.
        • Kilinc I.
        • Bilici A.
        64-MDCT pulmonary angiography and CT venography in the diagnosis of thromboembolic disease.
        AJR Am J Roentgenol. 2009; 192: 654-661
        • Ramadan S.U.
        • Kosar P.
        • Sonmez I.
        • Karahan S.
        • Kosar U.
        Optimisation of contrast medium volume and injection-related factors in CT pulmonary angiography: 64-slice CT study.
        Eur Radiol. 2010; 20: 2100-2107
        • Bach A.G.
        • Meyer H.J.
        • Taute B.M.
        • Surov A.
        The frequency of incidental pulmonary embolism in different CT examinations.
        Br J Radiol. 2016; 8920150737
        • Sheiman R.G.
        • Raptopoulos V.
        • Caruso P.
        • Vrachliotis T.
        • Pearlman J.
        Comparison of tailored and empiric scan delays for CT angiography of the abdomen.
        AJR Am J Roentgenol. 1996; 167: 725-729
        • Richman P.B.
        • Courtney D.M.
        • Friese J.
        • et al.
        Prevalence and significance of nonthromboembolic findings on chest computed tomography angiography performed to rule out pulmonary embolism: a multicenter study of 1,025 emergency department patients.
        Acad Emerg Med. 2004; 11: 642-647
        • Singh R.
        • Sharma A.
        • McDermott S.
        • et al.
        Comparison of image quality and radiation doses between rapid kV-switching and dual-source DECT techniques in the chest.
        Eur J Radiol. 2019; 119108639
        • Schenzle J.C.
        • Sommer W.H.
        • Neumaier K.
        • et al.
        Dual energy CT of the chest: how about the dose?.
        Invest Radiol. 2010; 45: 347-353