Dual-Energy CT as a Well-Established CT Modality to Reduce Contrast Media Amount: A Systematic Review from the Computed Tomography Subspecialty Section of the Italian Society of Radiology

Susanna Guerrini; Matteo Zanoni; Cristian Sica; Giulio Bagnacci; Nicoletta Mancianti; Giuseppe Galzerano; Guido Garosi; Laura Maria Cacioppa; Michaela Cellina; Giulia A Zamboni; Giuseppe Minetti; Chiara Floridi; Maria Antonietta Mazzei

doi:10.3390/jcm13216345

Dual-Energy CT as a Well-Established CT Modality to Reduce Contrast Media Amount: A Systematic Review from the Computed Tomography Subspecialty Section of the Italian Society of Radiology

J Clin Med. 2024 Oct 23;13(21):6345. doi: 10.3390/jcm13216345.

Authors

Susanna Guerrini^{1

2}, Matteo Zanoni³, Cristian Sica³, Giulio Bagnacci^{2

3}, Nicoletta Mancianti⁴, Giuseppe Galzerano⁵, Guido Garosi⁴, Laura Maria Cacioppa^{2

6}, Michaela Cellina^{2

7}, Giulia A Zamboni^{2

8}, Giuseppe Minetti^{2

9}, Chiara Floridi^{2

6}, Maria Antonietta Mazzei^{2

3}

Affiliations

¹ Unit of Diagnostic Imaging, Department of Medical Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy.
² Italian Society of Medical and Interventional Radiology (SIRM), Italian College of Computed Tomography, Italian Society of Medical and Interventional Radiology, 20122 Milano, Italy.
³ Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy.
⁴ Unit of Nephrology, Dialysis and Transplantation, Department of Emergency and Transplantation, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy.
⁵ Unit of Vascular Surgery, Department of Heart, Thorax and Vessels, University of Siena, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy.
⁶ Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy.
⁷ Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Principessa Clotilde 3, 20121 Milan, Italy.
⁸ Institute of Radiology, Department of Diagnostics and Public Health, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy.
⁹ Radiology Unit, Ospedale Santo Spirito, ASL AL Casale Monferrato, 15121 Alessandria, Italy.

Abstract

Background: Our study aims to provide an overview of existing evidence regarding the image quality of dual-energy CT (DECT) employing reduced contrast media (CM) volumes, in comparison to single-energy CT (SECT) with standard CM loads. The advantages, indications, and possible applications of DECT were investigated from the perspective of providing better patient care, minimizing CM volume and managing CM shortage. Methods: In this systematic review (PRISMA methodology), PubMed and WOS were searched from January 2010 to January 2023 by two independent reviewers. The scan and CM characteristics, radiation dose, and results of quantitative (contrast to noise ratio, CNR, and signal to noise ratio, SNR) and qualitative assessment of image quality were collected. Sixty non-duplicated records eligible for full-text screening were examined. Results: Finally, 22 articles (1818 patients) were included. The average CM reduction with DECT ranged between 43.4 ± 11%. Despite the wide variability in CT scan protocols, no differences were found in radiation doses between DECT and SECT. Conclusions: DECT scanners allow the employment of lower CM volumes with equal or better image quality evaluated by quantitative and qualitative analyses and similar dose radiation compared to SECT. Using image reconstructions at low monochromatic energy levels, DECT increases iodine conspicuity and attenuation contributing to CM containment measures.

Keywords: contrast media; contrast volume; contrast-induced nephropathy prevention; dual-energy CT; iodinated contrast shortage; single-energy CT.

Publication types

Review

Grants and funding

This research received no external funding.