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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Optimized dual-energy CT protocol for inferior vena cava CT angiography using 60 keV virtual monoenergetic imaging and 60% ASIR-V

  • Jiantao Deng1
  • Xiaoping Fan1
  • Qingwei Zhang1
  • Jing Yan1
  • Yong Li1
  • Gaowu Yan1
  • Linwei Zhao1
  • Xiaocheng Shen1
  • Qijia Peng1
  • Ting Ma1
  • Siyi Wu1
  • Xiaohan Wang1,2
3 more authors
  • Xisi HE1,3
  • Morgan A. McClure4
  • Anup Bhetuwal5
5 affiliations
  1. 1Department of Radiology, Suining Central Hospital
  2. 2Department of Radiology, Affiliated Hospital of North Sichuan Medical College
  3. 3Department of Radiology, Affiliated Hospital of Southwest Medical University
  4. 4Department of Radiology and Imaging, Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital
  5. 5Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College
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Abstract

Objective: To investigate the effects of a dual-energy CT (DECT) protocol combining virtual monoenergetic imaging (VMI) with adaptive statistical iterative reconstruction-V (ASIR-V) on image quality and radiation dose for inferior vena cava (IVC) CT angiography (CTA), and to compare the optimized protocol with a conventional 120 kVp protocol.

Methods: 120 consecutive patients undergoing IVC-CTA were enrolled and allocated sequentially to two groups ( n = 60 each). Group A underwent conventional 120 kVp scanning with 400 mgI/mL contrast medium at 1.5 mL/kg and 50% ASIR-V reconstruction. Group B underwent DECT (rapid 80/140 kVp switching) with 320 mgI/mL contrast medium at 1.2 mL/kg. In Group B, seven VMI datasets from 40 to 70 keV in 5 keV increments were first reconstructed with 50% ASIR-V. At 60 keV, images were reconstructed with filtered back projection (FBP; 0% ASIR-V) and ASIR-V levels from 20% to 100% in 20% increments. Objective image quality was assessed using CT attenuation, standard deviation (SD), background noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) at five venous levels. Two radiologists independently rated subjective image quality and diagnostic confidence on 5-point Likert scales. Dose-length product (DLP), effective dose (ED), contrast medium volume, and iodine intake were also recorded and compared between protocols.

Results: In Group B, with ASIR-V fixed at 50%, CT attenuation, SD, background noise, SNR, and CNR decreased progressively as VMI energy increased. Among the seven VMI levels, 60 keV achieved the highest subjective image-quality score (all P < 0.05). At 60 keV, increasing ASIR-V reduced vascular SD and background noise and increased SNR and CNR. The 60 keV VMI plus 60% ASIR-V combination (Group B1) achieved the highest subjective score. Compared with Group A, Group B1 had significantly higher IVC CT attenuation and background noise (both P < 0.001), but SNR, CNR, and subjective image-quality scores did not differ significantly (all P > 0.05). Diagnostic-confidence scores for thrombosis, luminal stenosis, post-filter placement, and normal IVC findings were similar between Groups A and B1 (all P > 0.05). Relative to Group A, Group B1 reduced contrast medium volume, iodine intake, and ED by approximately 20.0%, 36.0%, and 12.51%, respectively (all P < 0.001).

Conclusion: The DECT protocol combining 60 keV VMI with 60% ASIR-V provided a favorable balance of image quality for IVC-CTA. The optimized protocol achieved SNR, CNR, subjective image quality, and diagnostic confidence similar to those of the conventional 120 kVp protocol while reducing contrast medium volume, iodine intake, and effective radiation dose.

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Cite

BibTeXRIS
BibTeX
@article{deng2026optimized,
  title = {{Optimized dual-energy CT protocol for inferior vena cava CT angiography using 60 keV virtual monoenergetic imaging and 60% ASIR-V}},
  author = {Jiantao Deng and Xiaoping Fan and Qingwei Zhang and Jing Yan and Yong Li and Gaowu Yan and Linwei Zhao and Xiaocheng Shen and Qijia Peng and Ting Ma and Siyi Wu and Xiaohan Wang and Xisi HE and Morgan A. McClure and Anup Bhetuwal},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1969018},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969018/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Optimized dual-energy CT protocol for inferior vena cava CT angiography using 60 keV virtual monoenergetic imaging and 60% ASIR-V
AU  - Jiantao Deng
AU  - Xiaoping Fan
AU  - Qingwei Zhang
AU  - Jing Yan
AU  - Yong Li
AU  - Gaowu Yan
AU  - Linwei Zhao
AU  - Xiaocheng Shen
AU  - Qijia Peng
AU  - Ting Ma
AU  - Siyi Wu
AU  - Xiaohan Wang
AU  - Xisi HE
AU  - Morgan A. McClure
AU  - Anup Bhetuwal
PY  - 2026
DA  - 2026/10/29
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1969018
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969018/full
AB  - Objective: To investigate the effects of a dual-energy CT (DECT) protocol combining virtual monoenergetic imaging (VMI) with adaptive statistical iterative reconstruction-V (ASIR-V) on image quality and radiation dose for inferior vena cava (IVC) CT angiography (CTA), and to compare the optimized protocol with a conventional 120 kVp protocol.  Methods: 120 consecutive patients undergoing IVC-CTA were enrolled and allocated sequentially to two groups ( n = 60 each). Group A underwent conventional 120 kVp scanning with 400 mgI/mL contrast medium at 1.5 mL/kg and 50% ASIR-V reconstruction. Group B underwent DECT (rapid 80/140 kVp switching) with 320 mgI/mL contrast medium at 1.2 mL/kg. In Group B, seven VMI datasets from 40 to 70 keV in 5 keV increments were first reconstructed with 50% ASIR-V. At 60 keV, images were reconstructed with filtered back projection (FBP; 0% ASIR-V) and ASIR-V levels from 20% to 100% in 20% increments. Objective image quality was assessed using CT attenuation, standard deviation (SD), background noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) at five venous levels. Two radiologists independently rated subjective image quality and diagnostic confidence on 5-point Likert scales. Dose-length product (DLP), effective dose (ED), contrast medium volume, and iodine intake were also recorded and compared between protocols.  Results: In Group B, with ASIR-V fixed at 50%, CT attenuation, SD, background noise, SNR, and CNR decreased progressively as VMI energy increased. Among the seven VMI levels, 60 keV achieved the highest subjective image-quality score (all P < 0.05). At 60 keV, increasing ASIR-V reduced vascular SD and background noise and increased SNR and CNR. The 60 keV VMI plus 60% ASIR-V combination (Group B1) achieved the highest subjective score. Compared with Group A, Group B1 had significantly higher IVC CT attenuation and background noise (both P < 0.001), but SNR, CNR, and subjective image-quality scores did not differ significantly (all P > 0.05). Diagnostic-confidence scores for thrombosis, luminal stenosis, post-filter placement, and normal IVC findings were similar between Groups A and B1 (all P > 0.05). Relative to Group A, Group B1 reduced contrast medium volume, iodine intake, and ED by approximately 20.0%, 36.0%, and 12.51%, respectively (all P < 0.001).  Conclusion: The DECT protocol combining 60 keV VMI with 60% ASIR-V provided a favorable balance of image quality for IVC-CTA. The optimized protocol achieved SNR, CNR, subjective image quality, and diagnostic confidence similar to those of the conventional 120 kVp protocol while reducing contrast medium volume, iodine intake, and effective radiation dose.
SN  - 2297-055X
ER  -