Potential increase in radiation-induced DNA double-strand breaks with higher doses of iodine contrast during coronary CT angiography

PURPOSE: To investigate the contrast media iodine dose dependency of radiation-induced DNA double-strand breaks (DSBs) during a coronary computed tomography angiography (CCTA) scan.

METHODS: This prospective patient study was approved by the ethical committee. Between November 2018 and July 2019, 50 patients (31 males and 19 females, mean age 64 years) were included in the study, 45 CCTA and five noncontrast-enhanced (NCE) cardiac computed tomography (CT) patients. A single-heartbeat scan protocol with a patient-tailored contrast media injection protocol was used, administering a patient-specific iodine dose. DNA double-strand breaks were quantified using a γH2AX foci assay on peripheral blood lymphocytes. The net amount of γH2AX/cell was normalized to the individual patient CT dose by the size-specific dose estimate (SSDE). Correlation between the administered and blood-iodine dose and the SSDE normalized amount of DNA DSBs was investigated using a Pearson correlation test.

RESULTS: CCTA patients were scanned with a mean CTDIvol of 10.6 ± 5.6 mGy, corresponding to a mean SSDE of 11.3 ± 5.3 mGy while the NCE cardiac CT patients were scanned with a mean CTDIvol of 6.00 ± 1.8 mGy, corresponding to a mean SSDE of 6.6 ± 2.7 mGy. The administered iodine dose ranged from 16.5 to 34.0 gI in the CCTA patients, resulting in a blood-iodine dose range from 5.1 to 15.0 gI in the exposed blood volume. A significant linear relationship (r = 0.79, p-value < 0.001) was observed between the blood iodine dose and SSDE normalized radiation-induced DNA DSBs. A similar significant linear relationship (r = 0.62, p-value < 0.001) was observed between the administered iodine dose and SSDE normalized radiation-induced DNA DSBs.

CONCLUSIONS: This study shows that contrast media iodine dose increases the level of radiation-induced DNA DSBs in peripheral blood lymphocytes in a linear dose-dependent manner with CCTA. Importantly, the level of DNA DSBs can be reduced by lowering the administered iodine dose.