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/m(2), 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/m(2)) and 35 patients in Group B (34.0 +/- 3.4 kg/m(2)). 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.