Prospective Study of Low-Radiation and Low-Iodine Dose Aortic CT Angiography in Obese and Non-Obese Patients: Image Quality and Impact of Patient Characteristics.

The purpose of this study was to prospectively analyse image quality and radiation dose of body mass index (BMI)-adapted low-radiation and low-iodine dose CTA of the thoracoabdominal aorta in obese and non-obese patients. This prospective, single-centre study included patients scheduled for aortic CTA between November 2017 and August 2020 without symptoms of high-grade heart failure. A BMI-adapted protocol was used: Group A/Group B, BMI < 30/≥ 30 kg/m2, tube potential 80/100 kVp, total iodine dose 14.5/17.4 g. Intraindividual comparison with the institutional clinical routine aortic CTA protocol was performed. The final study cohort comprised 161 patients (mean 71.1 ± 9.4 years, 32 women), thereof 126 patients in Group A (mean BMI 25.4 ± 2.8 kg/m2) and 35 patients in Group B (34.0 ± 3.4 kg/m2). Mean attenuation over five aortoiliac measurement positions for Group A/B was 354.9 ± 78.2/262.1 ± 73.0 HU. Mean effective dose for Group A/B was 3.05 ± 0.46/6.02 ± 1.14 mSv. Intraindividual comparison in 50 patients demonstrated effective dose savings for Group A/B of 34.4 ± 14.5/25.4 ± 14.1% (both p < 0.001), and iodine dose savings for Group A/B of 54/44.8%. Regression analysis showed that female sex and increasing age were independently associated with higher vascular attenuation. In conclusion, BMI-adapted, low-radiation and low-iodine dose CTA of the thoracoabdominal aorta delivers diagnostic image quality in non-obese and obese patients without symptoms of high-grade heart failure, with superior image quality in females and the elderly.