Contrast media injection protocol optimization for dual-energy coronary CT angiography. results from a circulation phantom

Objectives: To investigate the minimum iodine delivery rate (IDR) required to achieve diagnostic coronary attenuation (300 HU) with dual-energy coronary CTA. Methods: Acquisitions were performed on a circulation phantom with a third- generation dual-source CT scanner. Contrast media was injected for a fixed time whilst IDRs varied from 1.0 to 0.3 gI/s in 0.1-gI/s intervals. Noise-optimized virtual monoenergetic imaging (VMI+) reconstructions from 40 to 90 keV in 5 keV increments were generated. Contrast-to-noise ratio (CNR) and coronary HU were measured for each injection. Results: VMI+ from 40–70 keV reached diagnostic attenuation with at least one IDR. The minimum IDR achieving a diagnostic attenuation ranged from 0.4 gI/s at 40 keV (312.8 HU) to 1.0 gI/s at 70 keV (334.1 HU). Attenuation values reached with IDR of 1.0 gI/s were significantly higher at each keV level (p<0.001). CNR showed a near perfect correlation with the IDR (ρ≥0.962; p<0.001), the IDR of 1.0 gI/s provided the highest CNR at each keV level, achieving the highest overall value at 40 keV (54.0±3.1). Conclusions: IDRs from 0.4–1.0 gI/s associated with VMI+ from 40–70 keV provide diagnostic coronary attenuation with dual-energy coronary CTA. Key Points: • Iodine delivery rate (IDR) is a major determinant of contrast enhancement. • Low-keV noise-optimized monoenergetic images (VMI+) maximize iodine attenuation. • Low-keV VMI+ allows for lower IDRs while maintaining adequate coronary attenuation. • Lowest IDR to reach 300 HU was 0.4 gI/s, 40 keV VMI+.