Circle of Willis at CT Angiography: Dose Reduction and Image Quality—Reducing Tube Voltage and Increasing Tube Current Settings

Purpose: To prospectively assess the effects of lower tube voltage and various effective tube currents on image quality for computed tomographic (CT) angiography of the circle of Willis.

Materials and Methods: Institutional review board approval was obtained. Patients or family provided written informed consent. Signal-to-noise ratios (SNRs) were determined in a head phantom for various effective tube currents with tube voltages of 90, 120, and 140 kVp. Patients were referred for CT angiography because of acute subarachnoid hemorrhage (n = 20) or family history of cerebral aneurysms (n = 20). In each group, 10 patients were scanned with 120 kVp and 200 mAseff and 10 were scanned with 90 kVp and 330 mAseff (CT dose index volumes, 27.2 mGy and 20.6 mGy, respectively). CT numbers were measured in the internal carotid artery at the T junction and compared with a t test. Two radiologists used a five-point scale to subjectively score arterial enhancement, depiction of small arterial detail, image noise, venous contamination, and interference of subarachnoid blood. Mann-Whitney U test was used for statistical analysis.

Results: In the phantom, SNR2 was proportional to effective tube current and CT dose index volume. With an identical effective tube current, SNR2 was lower at 90 kVp than at 120 or 140 kVp. With identical CT dose index volume, tube voltage of 90 kVp resulted in a 45%–52% increase of SNR2 compared with SNR2 at 120 kVp. In patients, mean attenuation in the internal carotid artery T junction was higher with 90 kVp (340 HU) than with 120 kVp (252 HU, P < .001). Although dose at 90 kVp was 30% lower than dose at 120 kVp, scores for arterial enhancement and depiction of small arterial detail were higher at 90 kVp than at 120 kVp (4.0 vs 3.2 and 3.6 vs 3.1, respectively; P < .005).

Conclusion: In head phantoms, lower tube voltage improved SNR at equal radiation doses. For CT angiography of the circle of Willis, this translated into superior image quality at 90 kVp.

© RSNA, 2007

References

  • 1 Kato Y, Katada K, Hayakawa M, et al. Can 3D-CTA surpass DSA in diagnosis of cerebral aneurysm? Acta Neurochir (Wien) 2001; 143: 245–250. Google Scholar
  • 2 Velthuis BK, Rinkel GJ, Ramos LM, et al. Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography. Radiology 1998;208:423–430. LinkGoogle Scholar
  • 3 Villablanca JP, Jahan R, Hooshi P, et al. Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography. AJNR Am J Neuroradiol 2002;23:1187–1198. MedlineGoogle Scholar
  • 4 Wintermark M, Uske A, Chalaron M, et al. Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography. J Neurosurg 2003;98:828–836. Crossref, MedlineGoogle Scholar
  • 5 Velthuis BK, van Leeuwen MS, Witkamp TD, Ramos LM, Berkelbach van der Sprenkel JW, Rinkel GJ. Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography. J Neurosurg 1999;91:761–767. Crossref, MedlineGoogle Scholar
  • 6 Verro P, Tanenbaum LN, Borden NM, Sen S, Eshkar N. CT angiography in acute ischemic stroke: preliminary results. Stroke 2002;33:276–278. Crossref, MedlineGoogle Scholar
  • 7 Ruigrok YM, Rinkel GJ, Buskens E, Velthuis BK, van Gijn J. Perimesencephalic hemorrhage and CT angiography: a decision analysis. Stroke 2000;31:2976–2983. Crossref, MedlineGoogle Scholar
  • 8 Brix G, Nagel HD, Stamm G, et al. Radiation exposure in multi-slice versus single-slice spiral CT: results of a nationwide survey. Eur Radiol 2003;13:1979–1991. Crossref, MedlineGoogle Scholar
  • 9 Wintermark M, Maeder P, Verdun FR, et al. Using 80 kVp versus 120 kVp in perfusion CT measurement of regional cerebral blood flow. AJNR Am J Neuroradiol 2000;21:1881–1884. MedlineGoogle Scholar
  • 10 Sigal-Cinqualbre AB, Hennequin R, Abada HT, Chen X, Paul JF. Low-kilovoltage multi–detector row chest CT in adults: feasibility and effect on image quality and iodine dose. Radiology 2004;231:169–174. LinkGoogle Scholar
  • 11 Cohnen M, Fischer H, Hamacher J, Lins E, Kotter R, Modder U. CT of the head by use of reduced current and kilovoltage: relationship between image quality and dose reduction. AJNR Am J Neuroradiol 2000;21:1654–1660. MedlineGoogle Scholar
  • 12 Mullins ME, Lev MH, Bove P, et al. Comparison of image quality between conventional and low-dose nonenhanced head CT. AJNR Am J Neuroradiol 2004;25:533–538. MedlineGoogle Scholar
  • 13 Farr RF, Allisy-Roberts PJ. Radiation physics. In: Physics for medical imaging. London, England: Elsevier Science, 2002; 19–22. Google Scholar
  • 14 Zonneveld FW. Principles of computed tomography. In: Computed tomography of the temporal bone and orbit. Munich, Germany: Urban & Schwarzenberg, 1987; 12–13. Google Scholar
  • 15 Zatz LM. The effect of the kVp level on EMI values: selective imaging of various materials with different kVp settings. Radiology 1976;119:683–688. LinkGoogle Scholar
  • 16 Keller MR, Kessler RM, Brooks RA, Kirkland LR. Optimum energy for performing CT iodinated constrast studies. Br J Radiol 1980;53:576–579. Crossref, MedlineGoogle Scholar
  • 17 Ertl-Wagner BB, Hoffmann RT, Bruning R, et al. Multi–detector row CT angiography of the brain at various kilovoltage settings. Radiology 2004;231:528–535. LinkGoogle Scholar
  • 18 Bahner ML, Bengel A, Brix G, Zuna I, Kauczor HU, Delorme S. Improved vascular opacification in cerebral computed tomography angiography with 80 kVp. Invest Radiol 2005;40:229–234. Crossref, MedlineGoogle Scholar
  • 19 DeMarco JJ, Cagnon CH, Cody DD, et al. A Monte Carlo based method to estimate radiation dose from multidetector CT (MDCT): cylindrical and anthropomorphic phantoms. Phys Med Biol 2005;50:3989–4004. Crossref, MedlineGoogle Scholar
  • 20 Prokop M. Image analysis. In: Prokop M, Galanski M. Computed tomography of the body. Stuttgart, Germany: Georg Thieme Verlag, 2003; 143. Google Scholar
  • 21 Husstedt H, Prokop M, Becker H. Window width as a dosage-relevant factor in high-contrast structures in CT [in German]. Rofo 1998;168:139–143. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2007