Image quality and radiation dose of lower extremity CT angiography at 70 kVp on an integrated circuit detector dual-source computed tomography

Background: Despite the well-established requirement for radiation dose reduction there are few studies examining the potential for lower extremity CT angiography (CTA) at 70 kVp. Purpose: To compare the image quality and radiation dose of lower extremity CTA at 70 kVp using a dual-source CT system with an integrated circuit detector to similar studies at 120 kVp. Material and Methods: A total of 62 patients underwent lower extremity CTA. Thirty-one patients were examined at 70 kVp using a second generation dual-source CT with an integrated circuit detector (70 kVp group) and 31 patients were evaluated at 120 kVp using a first generation dual-source CT (120 kVp group). The attenuation and image noise were measured and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists assessed image quality. Radiation dose was compared. Results: The mean attenuation of the 70 kVp group was higher than the 120 kVp group (575 +/- 149 Hounsfield units [HU] vs. 258 +/- 38 HU, respectively, P < 0.001) as was SNR (44.0 +/- 22.0 vs 32.7 +/- 13.3, respectively, P = 0.017), CNR (39.7 +/- 20.6 vs 26.6 +/- 11.7, respectively, P = 0.003) and the mean image quality score (3.7 +/- 0.1 vs. 3.2 +/- 0.3, respectively, P < 0.001). The inter-observer agreement was good for the 70 kVp group and moderate for the 120 kVp group. The dose-length product was lower in the 70 kVp group (264.5 +/- 63.1 mGy x cm vs. 412.4 +/- 81.5 mGy x cm, P < 0.001). Conclusion: Lower extremity CTA at 70 kVp allows for lower radiation dose with higher SNR, CNR, and image quality when compared with standard 120 kVp.