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Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial

Stephan Achenbach, Jean-François Paul, François Laurent, Hans-Christoph Becker, Marco Rengo, Jerome Caudron, Sebastian Leschka, Olivier Vignaux, Gesine Knobloch, Giorgio Benea, Thomas Schlosser, Jordi Andreu, Beatriz Cabeza, Alexis Jacquier, Miguel Souto, Didier Revel, Salah Dine Qanadli, Filippo Cademartiri &

Kurzfassung

OBJECTIVES
To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses.

METHODS
In this multicentre trial, 452 patients were randomized to receive iobitridol 350, iopromide 370 or iomeprol 400 and underwent coronary CTA using CT systems with 64-detector rows or more. Two core lab readers assessed 18 coronary segments per patient regarding image quality (score 0 = non diagnostic to 4 = excellent quality), vascular attenuation, signal and contrast to noise ratio (SNR, CNR). Patients were considered evaluable if no segment had a score of 0.

RESULTS
Per-patient, the rate of fully evaluable CT scans was 92.1, 95.4 and 94.6 % for iobitridol, iopromide and iomeprol, respectively. Non-inferiority of iobitridol over the best comparator was demonstrated with a 95 % CI of the difference of [-8.8 to 2.1], with a pre-specified non-inferiority margin of -10 %. Although average attenuation increased with higher iodine concentrations, average SNR and CNR did not differ between groups.

CONCLUSIONS
With current CT technology, iobitridol 350 mg iodine/ml is not inferior to contrast media with higher iodine concentrations in terms of image quality for coronary stenosis assessment.

KEY POINTS
• Iodine concentration is an important parameter for image quality in coronary CTA. • Contrast enhancement must be balanced against the amount of iodine injected. • Iobitridol 350 is non-inferior compared to CM with higher iodine concentrations. • Higher attenuation with higher iodine concentrations, but no SNR or CNR differences.
   
Zitation Achenbach S, Paul J F, Laurent F, Becker H C, Rengo M, Caudron J, Leschka S, Vignaux O, Knobloch G, Benea G, Schlosser T, Andreu J, Cabeza B, Jacquier A, Souto M, Revel D, Qanadli S D, Cademartiri F, . Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial. Eur Radiol 2016; 27:821-830.
   
Typ Wissenschaftlicher Artikel/Review (Englisch)
Veröffentlichungsdatum 07-06-2016
Titel der Zeitschrift Eur Radiol (27/2)
ISSN electronic 1432-1084
Seiten 821-830
PubMed 27271922
DOI 10.1007/s00330-016-4437-9