Objectives To assess the feasibility and image quality of a bolus tracking protocol with dual-flow mixture for contrast medium volume and radiation dose reduction in dual-energy CT pulmonary angiography (CTPA). Materials and methods Patients with suspected pulmonary embolism (PE) were prospectively included and randomly divided into the dual low-dose or routine CTPA groups. Virtual monoenergetic imaging results at 40 keV for the dual low-dose CTPA group were compared to 100-kV polyenergetic CT images from the routine CTPA group. Attenuation, noise, contrast-to-noise ratio, and figure of merit were determined in multiple pulmonary arteries. Qualitative image quality and PE detection were independently rated by two radiologists. Results The dual low-dose CTPA group showed a significantly higher attenuation in 40-keV virtual monoenergetic imaging (1027.0 ± 287.6 HU vs 391.8 ± 109.0 HU; p < 0.001) with a comparable median contrast-to-noise ratio (33.6 vs 41.0; p = 0.115) and superior figure of merit (711.4 vs 461.5; p = 0.006) in the pulmonary trunk in relation to that observed in the routine CTPA group. Superior vena cava artifacts were reduced (both p ≤ 0.002), while pulmonary branch visualization was preserved (p = 0.660 and 0.763). Effective radiation dose was lower in the dual low-dose CTPA group (1.61 mSv vs 3.62 mSv; p < 0.001), while PE diagnostic performance did not differ significantly between the two protocols. Conclusion The dual-flow mixture bolus-tracking protocol showed technical feasibility for dual-energy CTPA, achieving substantial reductions in radiation exposure and contrast medium volume while maintaining diagnostically acceptable image quality. Critical relevance statement The dual-flow mixture bolus-tracking protocol with dual-energy CT maintained feasible image quality for PE assessment, facilitating contrast medium volume and radiation exposure reduction. Trial registration NFEC, NFEC-2025-021, approved on January 10, 2025. Key Points <UnorderedList Mark="Bullet"> <ItemContent> Radiation exposure and substantial contrast medium doses during CTPA increased patient risks. </ItemContent> <ItemContent> Virtual monoenergetic imaging at 40 keV derived from dual-energy CT enhanced pulmonary vascular visualization. </ItemContent> <ItemContent> The dual-flow mixture technique with dual-energy CT reduced radiation dose and contrast medium volume. </ItemContent> </UnorderedList> Graphical Abstract

Dual-energy CT pulmonary angiography using dual-flow mixture bolus tracking: potential for contrast medium and radiation exposure reduction

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2026年6月20日

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Mingjue Jian,
Lisheng Huang,
Chenxi Zhang,
Xiang Qin,
Haixia Li,
Jiafang Wu,
Mingwang Chen,
Li Ding,
Xiaomei Li,
Yikai Xu,
Zhao Chen,
Chenggong Yan

摘要

Objectives

To assess the feasibility and image quality of a bolus tracking protocol with dual-flow mixture for contrast medium volume and radiation dose reduction in dual-energy CT pulmonary angiography (CTPA).

Materials and methods

Patients with suspected pulmonary embolism (PE) were prospectively included and randomly divided into the dual low-dose or routine CTPA groups. Virtual monoenergetic imaging results at 40 keV for the dual low-dose CTPA group were compared to 100-kV polyenergetic CT images from the routine CTPA group. Attenuation, noise, contrast-to-noise ratio, and figure of merit were determined in multiple pulmonary arteries. Qualitative image quality and PE detection were independently rated by two radiologists.

Results

The dual low-dose CTPA group showed a significantly higher attenuation in 40-keV virtual monoenergetic imaging (1027.0 ± 287.6 HU vs 391.8 ± 109.0 HU; p < 0.001) with a comparable median contrast-to-noise ratio (33.6 vs 41.0; p = 0.115) and superior figure of merit (711.4 vs 461.5; p = 0.006) in the pulmonary trunk in relation to that observed in the routine CTPA group. Superior vena cava artifacts were reduced (both p ≤ 0.002), while pulmonary branch visualization was preserved (p = 0.660 and 0.763). Effective radiation dose was lower in the dual low-dose CTPA group (1.61 mSv vs 3.62 mSv; p < 0.001), while PE diagnostic performance did not differ significantly between the two protocols.

Conclusion

The dual-flow mixture bolus-tracking protocol showed technical feasibility for dual-energy CTPA, achieving substantial reductions in radiation exposure and contrast medium volume while maintaining diagnostically acceptable image quality.

Critical relevance statement

The dual-flow mixture bolus-tracking protocol with dual-energy CT maintained feasible image quality for PE assessment, facilitating contrast medium volume and radiation exposure reduction.

Trial registration

NFEC, NFEC-2025-021, approved on January 10, 2025.

Key Points

Radiation exposure and substantial contrast medium doses during CTPA increased patient risks.

Virtual monoenergetic imaging at 40 keV derived from dual-energy CT enhanced pulmonary vascular visualization.

The dual-flow mixture technique with dual-energy CT reduced radiation dose and contrast medium volume.

Graphical Abstract