Second-Generation Dual-Energy Computed Tomography of the Abdomen: Radiation Dose Comparison With 64-and 128-Row Single-Energy Acquisition

Purpose: This study was designed to compare the radiation dose in abdominal dual-energy (DE) and single-energy (SE) acquisitions obtained in clinical practice with a second-generation DE computed tomography (DECT) and to analyze the dose variation in comparison with an SE acquisition performed with a 64-row SECT (SECT). Methods: A total of 130 patients divided into 2 groups underwent precontrast and portal abdominal 128-row CT examination. In group A, DE portal acquisition was performed using a detector configuration of 2 x 40 x 0.6 mm, tube A at 80 kVp and a reference value of 559 mAs, tube B at 140 kVp and a reference value of 216 mAs, pitch 0.6, and online dose modulation; group B underwent SE portal acquisition using a detector configuration of 64 x 0.6 mm, 120 kVp and a reference value of 180 mAs, pitch 0.75, and online dose modulation. Group C consisted of 32 subjects from group A previously studied with 64-row SECT using the following parameters: detector configuration 64 x 0.6 mm, 120 kVp and a reference value of 180 mAs, pitch 0.75, and online dose modulation. In each group, the portal phase dose-length product and radiation dose (mSv) were calculated and normalized for a typical abdominal acquisition of 40 cm. Results: After normalization to standard 40-cm acquisition, a dose-length product of 599.0 +/- 133.5 mGy . cm (range, 367.5 +/- 1231.2 mGy . cm) in group A, 525.9 +/- 139.2 mGy . cm (range, 215.7-882.8 mGy . cm) in group B, and 515.9 +/- 111.3 mGy . cm (range, 305.5-687.2 mGy . cm) in group C was calculated for portal phase acquisition. A significant radiation dose increase (P < 0.05) was observed in group A (10.2 +/- 2.3 mSv) compared with group B (8.9 +/- 2.4) and group C (8.8 +/- 1.9 mSv). No significant difference (P > 0.05) was reported between SE 64- and 128-row acquisitions. A significant positive correlation between radiation dose and body mass index was observed in each group (group A, r(2) = 0.59, P < 0.0001; group B, r(2) = 0.35, P < 0.0001; group C, r(2) = 0.20, P = 0.0098). Conclusions: In clinical practice, abdominal DECT acquisition shows a significant but minimal radiation dose increase, on the order of 1 mSv, compared with 64- and 128-row SE acquisition. The slightly increased radiation dose can be justified if the additional information obtained using a spectral imaging approach directly impacts on patient management or reduce the overall radiation dose with the generation of virtual unenhanced images, which can replace the precontrast acquisition.