CT imaging using variable helical pitch scanning for lower extremity arterial disease: reduced contrast medium dose, improved image quality and diagnostic accuracy

Objectives This study aimed to explore the feasibility of reducing contrast medium (CM) volume, improving image quality and diagnostic accuracy using variable helical pitch (VHP) scanning for patients with lower extremity arterial disease (LEAD). Materials and Methods Eighty patients who underwent lower extremity CT angiography (CTA) were prospectively enrolled and randomly assigned to either the VHP group (n = 40) or the conventional group (n = 40). Quantitative parameters and qualitative scores were compared between the two groups. Additionally, out of these patients, 72 arteries from 18 patients had DSA as the reference standard, and the diagnostic accuracy for the degree of vessel stenosis was assessed and compared. Results In the VHP group, the contrast volume was significantly lower than in the conventional group (79.55 ± 11.87 mL vs. 89.63 ± 10.03 mL, p < 0.001), showing a reduction of 12.7%. For all image quality characteristics, scores in VHP group were significantly superior to those to those in the conventional groups (all p < 0.05). Quantitative analysis revealed that images from the VHP group exhibited superior CT enhancement, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the anterior tibial arteries (ATA) and dorsali pedis arteries (DPA) compared to the conventional group (all p < 0.001). Moreover, the VHP group demonstrated significantly higher positive predictive value (PPV) and accuracy than the conventional group (PPV: 100% vs. 76.19%, p = 0.01; accuracy: 100% vs. 84.38%, p = 0.01, respectively). Conclusions The implementation of the VHP protocol led to a 12.7% decrease in contrast medium dosage compared to the conventional lower extremity CTA scanning protocol. Furthermore, it improved image quality and diagnostic accuracy, particularly for arteries below the knee.