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Fischer AM, Decker JA, Schoepf J, Varga-Szemes A, Flohr T, Schmidt B, Gutjahr R, Sahbaee P, Giovagnoli DA, Emrich T, Martinez JD, Lari KB, Bayer RR, Martin SS. Optimization of contrast material administration for coronary CT angiography using a software-based test-bolus evaluation algorithm. Br J Radiol 2022; 95:20201456. [PMID: 35084228 PMCID: PMC10993975 DOI: 10.1259/bjr.20201456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the benefit of a prototype circulation time-based test bolus evaluation algorithm for the individualized optimal timing of contrast media (CM) delivery in patients undergoing coronary CT angiography (CCTA). METHODS Thirty-two patients (62 ± 16 years) underwent CCTA using a prototype bolus evaluation tool to determine the optimal time-delay for CM administration. Contrast attenuation, signal-to-noise ratio (SNR), objective, and subjective image quality were evaluated by two independent radiologists. Results were compared to a control cohort (matched for age, sex, body mass index, and tube voltage) of patients who underwent CCTA using the generic test bolus peak attenuation +4 s protocol as scan delay. RESULTS In the study group, the mean time delay to CCTA acquisition was significantly longer (26.0 ± 2.9 s) compared to the control group (23.1 ± 3.5 s; p < 0.01). In the study group, SNR improvement was seen in the right coronary artery (17.5 vs 13; p = 0.028), the left main (15.3 vs 12.3; p = 0.027), and the left anterior descending artery (18.5 vs 14.1; p = 0.048). Subjective image quality was rated higher in the study group (4.75 ± 0.7 vs 3.64 ± 0.5; p < 0.001). CONCLUSIONS The prototype test bolus evaluation algorithm provided a reliable patient-specific scan delay for CCTA that ensured homogenous vascular attenuation, improvement in objective and subjective image quality, and avoidance of beam hardening artifacts. ADVANCES IN KNOWLEDGE The prototype contrast bolus evaluation and optimization tool estimated circulation time-based time-delay improves the overall quality of CCTA.
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Affiliation(s)
- Andreas M Fischer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- University Department of Geriatric Medicine FELIX PLATTER and
University of Basel, Basel,
Switzerland
| | - Josua A. Decker
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Augsburg,
Augsburg, Germany
| | - Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | | | | | | | | | - Dante A Giovagnoli
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Medical Center, Mainz,
Germany
- German Center for Cardiovascular Research (DZHK), Partner Site
Rhine Main, Mainz,
Germany
| | - John D Martinez
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
| | - Kia B Lari
- University of South Carolina School of Medicine
Greenville, Greenville, South
Carolina, USA
| | - Robert R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Division of Cardiology, Department of Medicine, Medical
University of South Carolina, Charleston, South
Carolina, USA
| | - Simon S Martin
- Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, South Carolina,
USA
- Department of Diagnostic and Interventional Radiology,
University Hospital Frankfurt,
Frankfurt, Germany
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Ogata S, Nagatomo D, Mizoguchi K, Teshima T, Hotta A. [Can Echocardiography Adjust Corrected Contrast Injection Condition in Coronary CT Angiography?]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:484-491. [PMID: 35321993 DOI: 10.6009/jjrt.2022-1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purposes were to search which factor of cardiac function in echocardiography correlates with the CT value, to correct contrast injection conditions with cardiac function in addition to suppress error in the contrast effect between patients, and to achieve the target CT value (350 HU) in coronary computed tomography angiography (CCTA). METHODS In 112 patients (conventional group), the contrast material was administered at a fractional dose (FD) of 21 mgI/kg/s. We measured the aortic CT value in the coronary origin part. In 112 patients (correction group), the contrast material was administered at corrected injection conditions with the most correlated functional factor and CT value. RESULTS The CT value of the conventional group was an average of 400.8±51.5 HU. The most correlated factor with the CT value was stroke volume [SV (r=-0.555)]. The CT value of the conventional group was an average of 360±46 HU. The case of the aim CT level was improved from 46% to 74%. In the correction group, the average value of FD was 18.5 mgI/kg/s. This enabled the reduction of the contrast material in 95% of patients. CONCLUSION The best correlation was obtained between the CT value of coronary arteries and SV. The contrast medium injection conditions were corrected for cardiac function in addition to body weight. As a result, we were able to control the CCTA target CT value of 300 to 400 HU at our hospital.
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Affiliation(s)
- Sho Ogata
- Department of Radiology, Saiseikai Fukuoka General Hospital
| | | | | | | | - Atsushi Hotta
- Department of Radiology, Saiseikai Fukuoka General Hospital
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Nguyen TC, Ohyama Y, Taketomi-Takahashi A, Nguyen HT, Sugimoto A, Sato M, Sumiyoshi H, Nakamura T, Kurabayashi M, Tsushima Y. Impact of left atrial enlargement on image quality in coronary computed tomography angiography. Clin Imaging 2022; 84:87-92. [DOI: 10.1016/j.clinimag.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
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Chandrasekharan R, Kulkarni CB, Pullara SK, Moorthy S. Does Contrast Dose Based in Lean body Weight Allow Lesser Volumes on High BMI Patients for CT Angiography? J Clin Imaging Sci 2021; 11:38. [PMID: 34345528 PMCID: PMC8326097 DOI: 10.25259/jcis_97_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: The objective was to evaluate whether contrast dose based on lean body weight (LBW) protocol has the potential to reduce contrast volume in patients with high basal metabolic index (BMI) compared to total body weight (TBW)-based protocols. Material and Methods: The Institutional Review Board approval was obtained for this prospective study. Initially, a pilot study with a sample size of 150 patients was conducted to estimate the average fat fraction in our population. Then, CT angiography (CTA) for the thoracic and abdominal aorta was performed using a 256-multidetector computed tomography scanner in 117 patients who were undergoing screening for aortic aneurysm and vascular assessment of prospective transplant donors. The patients were divided into two groups: A TBW group (n = 60) and LBW group (n = 57). Lean body weight (LBW) was estimated from the patient weight, height, and gender using Hume’s equation. The TBW group received 1.2 ml/kg contrast dose and the LBW group received 1.6 ml/kg contrast dose to achieve approximately equal iodine dose in both groups. Differences in the degree of aortic enhancement between the estimated LBW and TBW group were evaluated. In higher BMI patients (>25), the mean aortic enhancement (MAEnh) and the contrast volume delivered between the LBW and TBW group were compared. Results: Mean aortic enhancement (MAEnh) 422.45 (±74.5) Hounsfield unit (HU) in the TBW group and 432.67 (±69.4) HU in the LBW group showed no statistical difference (P = 0.439). In population with BMI >25, the contrast delivered in LBW protocol patients was significantly less (P = 0.00) compared to TBW protocol patients, with no significant difference in the MAEnh between the groups (P = 0.479). Conclusion: CTA using a LBW protocol helps to significantly reduce the volume of contrast delivered, especially in patients with BMI >25 compared to TBW protocol, without compromising the aortic enhancement.
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Affiliation(s)
- Rajsekar Chandrasekharan
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | | | - Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Jin L, Jie B, Gao Y, Jiang A, Weng T, Li M. Low dose contrast media in step-and-shoot coronary angiography with third-generation dual-source computed tomography: feasibility of using 30 mL of contrast media in patients with body surface area <1.7 m 2. Quant Imaging Med Surg 2021; 11:2598-2609. [PMID: 34079726 DOI: 10.21037/qims-20-500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Reducing contrast media volume in coronary computed tomography angiography minimizes the risk of adverse events but may compromise diagnostic image quality. We aimed to evaluate coronary computed tomography angiography's diagnostic image quality while using 30 mL of contrast media in patients with a body surface area <1.7 m2. Methods This prospective study included patients who underwent coronary computed tomography angiography from May 2018 to June 2019. The patients were divided into a low-dose group, who received 30 mL of contrast media, and a routine-dose group, who received contrast media based on body weight. Patient characteristics, coronary computed tomography angiography results, and quantitative and qualitative image results were assessed and compared. Results In total, 103 patients with a body surface area <1.7 m2 were 53 in the low-dose group and 50 in the routine-dose group. Sex, age, body surface area, body weight, and heart rate were similar between the groups (P>0.05). A contrast media volume of 30±0 mL was used for the low-dose group, and 41.62±4.59 mL was used for the routine-dose group. The low-dose group's computed tomography values were significantly different from those of the routine-dose group (P<0.05). The radiologists demonstrated agreement regarding diagnostic image quality and accuracy (kappa =0.91 and 0.85, respectively). Conclusions Using 30 mL of contrast media for coronary computed tomography angiography in patients with a body surface area <1.7 m2 provided a suitable diagnostic image quality for coronary artery disease diagnosis. Although radiation doses were similar between the groups, the decreased contrast media volume was likely beneficial for the patients.
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Affiliation(s)
- Liang Jin
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - Bing Jie
- Radiology Department, Shanghai Pulmonary Hospital, Affiliated with Tongji University, Shanghai, China
| | - Yiyi Gao
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - An'qi Jiang
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China
| | - Tingwen Weng
- Cardiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
| | - Ming Li
- Radiology Department, Huadong Hospital, affiliated with Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
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Contrast medium administration with a body surface area protocol in step-and-shoot coronary computed tomography angiography with dual-source scanners. Sci Rep 2020; 10:16690. [PMID: 33028924 PMCID: PMC7541528 DOI: 10.1038/s41598-020-73915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/21/2020] [Indexed: 11/08/2022] Open
Abstract
We evaluated the feasibility and image quality of prospective electrocardiography (ECG)-triggered coronary computed tomography angiography (CCTA) using a body surface area (BSA) protocol for contrast-medium (CM) administration on both second- and third-generation scanners (Flash and Force CT), without using heart rate control. One-hundred-and-eighty patients with suspected coronary heart disease undergoing CCTA were divided into groups A (BSA protocol for CM on Flash CT), B (body mass index (BMI)-matched patients; BMI protocol for CM on Flash CT), and C (BMI-matched patients; BSA protocol for CM on Force CT). Patient characteristics, quantitative and qualitative measures, and radiation dose were compared between groups A and B, and A and C. Of the 180 patients, 99 were male (median age, 62 years). Average BSA in groups A, B, and C was 1.80 ± 0.17 m2, 1.74 ± 0.16 m2, and 1.64 ± 0.17 m2, respectively, with groups A and C differing significantly (P < 0.001). Contrast volume (50.50 ± 8.57 mL vs. 45.00 ± 6.18 mL) and injection rate (3.90 ± 0.44 mL/s vs. 3.63 ± 0.22 mL/s) differed significantly between groups A and C (P < 0.001). Groups A and C (both: all CT values > 250 HU, average scores > 4) achieved slightly lower diagnostic image quality than group B. The BSA protocol for CM administration was feasible in both Flash and Force CT, and therefore may be valuable in clinical practice.
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Monica MP, Merkely B, Szilveszter B, Drobni ZD, Maurovich-Horvat P. Computed Tomographic Angiography for Risk Stratification in Patients with Acute Chest Pain - The Triple Rule-out Concept in the Emergency Department. Curr Med Imaging 2020; 16:98-110. [PMID: 32003310 DOI: 10.2174/1573405614666180604095120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/20/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acute chest pain is one of the most common reasons for Emergency Department (ED) visits and hospital admissions. As this could represent the first symptom of a lifethreatening condition, urgent identification of the etiology of chest pain is of utmost importance in emergency settings. Such high-risk conditions that can present with acute chest pain in the ED include Acute Coronary Syndromes (ACS), Pulmonary Embolisms (PE) and Acute Aortic Syndromes (AAS). DISCUSSION The concept of Triple Rule-out Computed Tomographic Angiography (TRO-CTA) for patients presenting with acute chest pain in the ED is based on the use of coronary computed tomographic angiography as a single imaging technique, able to diagnose or exclude three lifethreatening conditions in one single step: ACS, AAS and PE. TRO-CTA protocols have been proved to be efficient in the ED for diagnosis or exclusion of life-threatening conditions and for differentiation between various etiologies of chest pain, and application of the TRO-CTA protocol in the ED for acute chest pain of uncertain etiology has been shown to improve the further clinical evaluation and outcomes of these patients. CONCLUSION This review aims to summarize the main indications and techniques used in TRO protocols in EDs, and the role of TRO-CTA protocols in risk stratification of patients with acute chest pain.
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Affiliation(s)
- Marton-Popovici Monica
- Department of Internal Medicine and Critical Care, Swedish Medical Center, Edmonds, Washington, United States
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Dora Drobni
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Yu Y, Yin W, Liao K, Liu T, Wang X, Sun K, Lu B. Individualized contrast agents injection protocol tailored to body surface area in coronary computed tomography angiography. Acta Radiol 2019; 60:1430-1437. [PMID: 31081338 DOI: 10.1177/0284185119840769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yitong Yu
- Department of Radiologic Imaging, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- State Key Laboratory and National Center for Cardiovascular Diseases, Beijing, People’s Republic of China
| | - Weihua Yin
- Department of Radiologic Imaging, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- State Key Laboratory and National Center for Cardiovascular Diseases, Beijing, People’s Republic of China
| | - Kai Liao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Ting Liu
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Ximing Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, People’s Republic of China
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Inner Mongolia, People’s Republic of China
| | - Bin Lu
- Department of Radiologic Imaging, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- State Key Laboratory and National Center for Cardiovascular Diseases, Beijing, People’s Republic of China
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9
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Rengo M, Dharampal A, Lubbers M, Kock M, Wildberger JE, Das M, Niezen A, van Tilborg F, Kofflard M, Laghi A, Krestin G, Nieman K. Impact of iodine concentration and iodine delivery rate on contrast enhancement in coronary CT angiography: a randomized multicenter trial (CT-CON). Eur Radiol 2019; 29:6109-6118. [PMID: 31016447 DOI: 10.1007/s00330-019-06196-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/27/2019] [Accepted: 03/22/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the effect of contrast medium iodine concentration on contrast enhancement, heart rate, and injection pressure when injected at a constant iodine delivery rate in coronary CT angiography (CTA). METHODS One thousand twenty-four patients scheduled for coronary CTA were prospectively randomized to receive one of four contrast media: iopromide 300 mg I/ml, iohexol 350 mg I/ml, iopromide 370 mg I/ml, or iomeprol 400 mg I/ml. Contrast media were delivered at an equivalent iodine delivery rate of 2.0 g I/s. Intracoronary attenuation was measured and compared (per vessel and per segment). Heart rate before and after contrast media injection was documented. Injection pressure was recorded (n = 403) during contrast medium injection and compared between groups. RESULTS Intracoronary attenuation values were similar for the different contrast groups. The mean attenuation over all segments ranged between 384 HU for 350 mg I/ml and 395 HU for 400 mg I/ml (p = 0.079). Dose-length product (p = 0.8424), signal-to-noise ratio (all p > 0.05), time to peak (p = 0.324), and changes in heart rate (p = 0.974) were comparable between groups. The peak pressures differed: 197.4 psi for 300 mg I/ml (viscosity 4.6 mPa s), 229.8 psi for 350 mg I/ml (10.4 mPa s), 216.1 psi for 370 mg I/ml (9.5 mPa s), and 243.7 psi for 400 mg I/ml (12.6 mPa s) (p < 0.0001). CONCLUSION Intravascular attenuation and changes in heart rate are independent of iodine concentration when contrast media are injected at the same iodine delivery rate. Differences in injection pressures are associated with the viscosity of the contrast media. KEY POINTS • The contrast enhancement in coronary CT angiography is independent of the iodine concentration when contrast media are injected at body temperature (37 °C) with the same iodine delivery rate. • Iodine concentration does not influence the change in heart rate when contrast media are injected at identical iodine delivery rates. • For a fixed iodine delivery rate and contrast temperature, the viscosity of the contrast medium affects the injection pressure.
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Affiliation(s)
- Marco Rengo
- Faculty of Pharmacy and Medicine, University of Rome Sapienza, Latina, Italy
| | - Anoeshka Dharampal
- Departments of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marisa Lubbers
- Departments of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc Kock
- Department of Radiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Marco Das
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - André Niezen
- Department of Radiology and Nuclear medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Fiek van Tilborg
- Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Marcel Kofflard
- Department of Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, University of Rome Sapienza, Rome, Italy
| | - Gabriel Krestin
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Koen Nieman
- Departments of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands. .,Stanford University School of Medicine and Cardiovascular Institute, 300 Pasteur Dr, Room H2157, Stanford, CA, 94305, USA.
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Nguyen TC, Ohyama Y, Taketomi-Takahashi A, Nguyen HT, Sugimoto A, Sato M, Sumiyoshi H, Nakamura T, Kurabayashi M, Tsushima Y. Influence of cardiac function on image quality in coronary computed tomography angiography. Clin Imaging 2018; 53:58-64. [PMID: 30312856 DOI: 10.1016/j.clinimag.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the correlation between cardiac functional parameters and image quality in coronary computed tomography angiography (CCTA). MATERIAL AND METHODS Sixty-six patients who underwent both CCTA and echocardiography were included. The coronary artery attenuation values and contrast-to-noise ratios (CNR) were measured in the proximal right coronary arteries (RCA) and left main (LM) trunk. Then, the averages of the mean values derived from RCA and LM were calculated. The cardiac output (CO), left atrial (LA) volume, and early mitral inflow velocity to mitral annular early diastolic velocity ratio (E/e') were measured by echocardiography. The relationship of cardiac parameters with arterial attenuation and CNR were assessed by Pearson's correlation, Spearman's rank correlation and multivariable linear regression analysis adjusted for age, gender, body surface area and heart rate. RESULTS The coronary artery attenuation value was negatively correlated with CO (r = -0.30, p = 0.01) and LA volume (r = -0.37, p = 0.002). CNR was negatively correlated with LA volume (r = -0.4, p = 0.001) and E/e' (r = -0.27, p = 0.03). These associations remained significant in the multivariable analysis. CONCLUSION CO and diastolic function had an impact on image quality of CCTA. Adjusting CCTA protocol may improve image quality in patients with known diastolic dysfunction or reduced cardiac output.
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Affiliation(s)
- Tien C Nguyen
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Japan; Department of Diagnostic Radiology, Bach Mai Hospital, Viet Nam
| | - Yoshiaki Ohyama
- Clinical Investigation and Research Unit, Gunma University Hospital, Japan.
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Japan
| | - Huong T Nguyen
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Japan; Department of Diagnostic Radiology, Bach Mai Hospital, Viet Nam
| | | | - Makito Sato
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
| | - Hisako Sumiyoshi
- Clinical Investigation and Research Unit, Gunma University Hospital, Japan
| | - Tetsuya Nakamura
- Clinical Investigation and Research Unit, Gunma University Hospital, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Japan; Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Gunma, Japan
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11
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Higaki T, Nakaura T, Kidoh M, Yuki H, Yamashita Y, Nakamura Y, Tatsugami F, Baba Y, Iida M, Awai K. Effect of contrast material injection duration on arterial enhancement at CT in patients with various cardiac indices: Analysis using computer simulation. PLoS One 2018; 13:e0191347. [PMID: 29474457 PMCID: PMC5825030 DOI: 10.1371/journal.pone.0191347] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 01/03/2018] [Indexed: 11/24/2022] Open
Abstract
Arterial peak enhancement on contrast-enhanced CT (CECT) images is thought to be higher in patients with low cardiac function. Using computer simulations, we tested the hypothesis that the relationship between the cardiac index and the aortic peak CT number (PCTN) is affected by the contrast material (CM) injection duration. We created computer simulation software for the contrast enhancement of various organs and vessels based on the Bae pharmacokinetics model and implemented models for CM transmission within organs and CM diffusion in blood plasma based on the osmotic pressure. Aortic contrast enhancement at coronary- and abdominal CT angiographs (CTA) was simulated for a representative 60-year-old Japanese male 166 cm in height and 65.0 kg in weight. The injection protocol for coronary CTA was: CM dose 45.5 ml, iodine dose, 245 mg/kg body weight (BW); injection duration 8–20 sec in 2-sec increments. For abdominal CTA it was CM dose 74.3 ml; iodine dose 400 mg/kg BW; injection duration 10–40 sec in 5-sec increments. In both protocols the iodine concentration was 350 mgI/ml, osmotic pressure was 590 mOsm/kgH2O, and the cardiac index ranged from 0.1–6.0 l/min/m2. Under all protocols, the aortic PCTN increased as the injection duration decreased and as the cardiac index rose to the cardiac index value. It then decreased as it exceeded the cardiac index value. At coronary CTA, at an injection duration of 8 or 10 sec, the PCTN exceeded 350 Hounsfield units (HU) at a cardiac index from 0.9–5.6 l/min/m2. At an HU value greater than 350, the range of the cardiac index narrowed when the injection duration was 12 sec or longer. On abdominal CTA scans performed with an injection duration of 10-, 15-, or 20 sec, the PCTN exceeded 350 HU at a cardiac index ranging from 0.4–5.3 l/min/m2. When the injection duration ranged from 25–40 sec, there was narrowing of the range of the cardiac index at which the PCTN exceeded 350 HU. For coronary and abdominal CTA, contrast enhancement protocols with shorter injection durations yield a diagnostically adequate aortic PCTN at a wide range of cardiac indices.
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Affiliation(s)
- Toru Higaki
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Honjyo, Chuo-ku, Kumamoto, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Honjyo, Chuo-ku, Kumamoto, Japan
| | - Hideaki Yuki
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Honjyo, Chuo-ku, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Honjyo, Chuo-ku, Kumamoto, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Makoto Iida
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
- * E-mail:
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12
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Benz DC, Gräni C, Hirt Moch B, Mikulicic F, Vontobel J, Fuchs TA, Stehli J, Clerc OF, Possner M, Pazhenkottil AP, Gaemperli O, Buechel RR, Kaufmann PA. A low-dose and an ultra-low-dose contrast agent protocol for coronary CT angiography in a clinical setting: quantitative and qualitative comparison to a standard dose protocol. Br J Radiol 2017; 90:20160933. [PMID: 28406318 DOI: 10.1259/bjr.20160933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a low-dose (LD) and an ultra-LD (ULD) contrast protocol for coronary CT angiography on qualitative and quantitative image parameters in a clinical setting. METHODS We scanned 120 consecutive patients with a 256-slice CT scanner applying a LD (60 patients, 35-55 ml) or ULD (60 patients, 25-45 ml) contrast protocol adapted to the body mass index. Visually assessed image quality and attenuation measured in each coronary segment were retrospectively compared in 20 consecutive patients scanned with a normal-dose (ND, 40-105 ml) contrast protocol. RESULTS Visually assessed image quality did not differ significantly among protocols. By contrast, attenuation obtained from the ULD protocol (median contrast volume 35 ml) differed significantly from the LD (median 45 ml) and ND (median 70 ml) protocols in the coronary segments (316 ± 52 vs 363 ± 60 and 359 ± 52 HU, p < 0.001). Attenuation did not differ significantly between the LD and ND protocol. The proportion of patients with inadequate coronary vessel attenuation was significantly higher (p < 0.001) in the ULD protocol (37%) than in the ND (5%) and LD (10%) protocols but did not differ significantly between the ND and LD protocols. CONCLUSION In a clinical setting, a LD contrast protocol with a median volume of 45 ml is feasible for the latest generation 256-slice coronary CT angiography as it yields attenuation comparable to a ND protocol. By contrast, the implementation of an ULD protocol remains challenging. Advances in knowledge: Although not perceived by the naked eye, an ULD contrast protocol in a clinical setting yields attenuation below a threshold for diagnostic image quality.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Hirt Moch
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
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13
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Kidoh M, Nakaura T, Funama Y, Shimonobo T, Shirasaka T, Hatemura M, Utsunomiya D, Oda S, Yuki H, Namimoto T, Higaki T, Awai K, Yamashita Y. Paradoxical Effect of Cardiac Output on Arterial Enhancement at Computed Tomography: Does Cardiac Output Reduction Simply Result in an Increase in Aortic Peak Enhancement? J Comput Assist Tomogr 2017; 41:349-353. [PMID: 28471868 DOI: 10.1097/rct.0000000000000541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of cardiac output (CO) on aortic peak enhancement using protocols with different contrast material (CM) injection durations. METHODS We used a flow phantom that simulated the human circulatory system. Contrast material was injected at a rate of 4.0 mL/s for a period of 2.5, 5, 10, 15, or 20 seconds for a CO of 2.8, 4.2, and 5.6 L/min. Single-level serial computed tomography scans of the simulated aorta were acquired after the start of CM delivery, and aortic peak enhancement was recorded under the different injection protocols. RESULTS Under a long injection duration protocol (20 seconds), a decrease in CO increased aortic peak enhancement proportionally (CO of 2.8 L/min, 420 Hounsfield units [HU]; CO of 4.2 L/min, 365 HU; CO of 5.6 L/min, 291 HU). However, this effect was decreased under shorter injection duration protocols (5, 10, and 15 seconds); under the shortest (2.5-second) injection duration protocol, a decrease in CO resulted in a decrease in aortic peak enhancement (CO of 2.8 L/min, 36 HU; CO of 4.2 L/min, 51 HU; CO of 5.6 L/min, 55 HU). CONCLUSIONS The magnitude of the effect of CO on aortic peak enhancement depends on the CM injection duration.
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Affiliation(s)
- Masafumi Kidoh
- From the Departments of *Diagnostic Radiology and †Medical Physics, Kumamoto University, Kumamoto; and ‡Department of Diagnostic Radiology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Identification of Left Ventricle Failure on Pulmonary Artery CTA: Diagnostic Significance of Decreased Aortic & Left Ventricle Enhancement. Emerg Radiol 2017; 24:487-496. [PMID: 28357505 DOI: 10.1007/s10140-017-1494-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to identify findings on non-ECG-gated CT pulmonary angiography (CTPA) indicating decreased left ventricle (LV) systolic function, later confirmed by echocardiogram. METHODS After obtaining institutional review board approval, review was performed of emergency department (ED) patients who had CTPA and follow-up echocardiogram within 48 h, over 18 months. Patients with pulmonary embolus, suboptimal CTPA, arrhythmias or pericardial tamponade were excluded. One hundred thirty-seven patients were identified and divided into cases (LVEF <40%, n = 52) and controls (LVEF >50%, n = 85). Two reviewers performed these analyses: measurement of enhancement in main pulmonary artery (MPA), LV, and aorta; subjective enhancement of LV and aorta (Ao) relative to MPA using a four-point Likert scale; contrast transit time (TD) to trigger CTPA and LV short & long axis dimensions. When available, the most recent N-terminal pro-B-type natriuretic peptide (NT-proBNP) level was recorded. RESULTS Decreased aortic and LV subjective enhancement were the best predictors of LV systolic dysfunction. For Ao/MPA ratio, an optimal cutoff value of 0.20 resulted in a sensitivity of 0.54 and specificity of 0.93 (AUC = 0.83, 0.78-0.88 95% CI). A threshold of 86.7 HU for Ao enhancement resulted in a sensitivity of 0.68 and specificity of 0.90 (AUC = 0.82, 0.77-0.88 95% CI). A LV short axis diameter of more than 54.3 mm had a sensitivity of 0.62 and specificity of 0.98 (AUC = 0.88, 0.83-0.92 95% CI). For the LV long axis diameter, a cutoff of 87.5 mm resulted in a sensitivity of 0.66 and specificity of 0.84 (AUC = 0.78, 0.72-0.84 95% CI). With bolus timing, cases had a longer TD (13.4 vs. 10.4 s, p < 0.0001). CONCLUSION Unsuspected LV systolic dysfunction can be recognized on a CTPA by identification of decreased aortic enhancement, LV enlargement and increased TD. This has important diagnostic implications for the patient presenting with shortness of breath, chest pain, or dyspnea.
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15
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Moradi M, Hashemi P, Momeni M. The influence of cardiac function on coronary arterial enhancement at coronary computed tomography angiography: A cross-sectional study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:132. [PMID: 28331518 PMCID: PMC5348831 DOI: 10.4103/1735-1995.196614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/14/2016] [Accepted: 09/06/2016] [Indexed: 01/16/2023]
Abstract
Background: The purpose of this study was to evaluate the influence of ejection fraction (EF) on peak aortic time (PAT) and peak aortic enhancement (PAE) during coronary computed tomography angiography (CTA). Materials and Methods: One-hundred and twenty patients (64 men, 56 women) underwent measurement of coronary CTA with a measurement of EF within 3 months of coronary CTA. Pearson's correlation coefficient analysis was used to investigate the relationships between EF, PAT and PAE, and peak attenuation of all coronary arteries. Results: The range of EF was (25%–70%) (mean: 55 ± 7.7). The range of PAT and PAE of ascending aorta on bolus test was 13–31 s (mean: 19.3 ± 2) and 153–435 HU (mean: 235 ± 40.6), respectively. Mean peak attenuation of ascending aorta, right coronary artery, left coronary artery, left circumflex artery, and left anterior descending were (561 ± 119), (476 ± 109), (505 ± 108), (467 ± 113), and (473 ± 104), respectively. There was a negative correlation between EF and PAT (r = −0.266, P = 0.003); however, there was no significant correlation between EF and PAE (r = −0.027, P = 0.767). In addition, there was no significant correlation between EF and the peak attenuation of coronary arteries. Conclusion: PAT was related to EF, but there was no relationship between PAE and EF. One of the explanation is that the left ventricular EF used for our study was assessed with echocardiography which is used roughly estimation of EF with interval of 5%–10% and may cause confounding results.
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Affiliation(s)
- Maryam Moradi
- Department of Radiology and Imaging, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peiman Hashemi
- Department of Radiology and Imaging, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Momeni
- Department of Radiology and Imaging, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Cao P, He M, Qiao C, Xu N, Huang D, Dai G, Wang Y, Pan H, Zhang L. Patient-related factors that influence coronary artery density in CCTA: a retrospective clinical study. Int J Clin Pract 2016; 70 Suppl 9B:B72-8. [PMID: 27577518 DOI: 10.1111/ijcp.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/15/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between various patient-related factors (physical and cardiac hemodynamic parameters) and the coronary artery density on coronary CT angiography (CCTA). METHODS A total of 64 patients (female: male ratio, 24:40; age, 58.2 years±9.3, age range, 31-81 years; mean body weight, 65.3 kg±11.6, range 40-88 kg) were effectively enrolled in this approved retrospective study. Patient-related physical factors including height, body weight (BW), body mass index (BMI), systolic blood pressure (BPsys), diastolic blood pressure (BPdis) and blood pulse pressure (Bp) were recorded, measured and calculated prior to the administration of contrast media during the CCTA. Patient-related cardiac hemodynamic parameters, including heart rate (HR), myocardial mass (MM), cardiac output (CO), ejection fraction (EF), end-diastolic dimension (EDV), end-systolic volume (ESV) and stroke volume (SV), were analysed and recorded on the multimodality workplace (MMWP). The mean attenuation values of the left main artery (LMA) were measured and calculated. The correlation of the mean attenuation in the coronary arteries with the physical and hemodynamic parameters was evaluated. The correlations between the physical factors and hemodynamic parameters were also calculated. RESULTS A significant negative linear correlation was found between the attenuation of the left main artery (LMA) and BW (P=.001), BMI (P=.006), CO (P=.008), EDV (P=.001) and MM (P<.001). Significant linear correlations were obtained between CO and HR (P<.001), EDV and BW (P=.001) and MM and BW (P<.001). CONCLUSION Coronary artery attenuation depends on the patient's specific physical and cardiac function status.
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Affiliation(s)
- Peng Cao
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Miao He
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chen Qiao
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Nan Xu
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Daoyi Huang
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gonghua Dai
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yibin Wang
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haihong Pan
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Zhang
- Department of Radiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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17
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Kao YT, Wang ST, Shih CM, Lin FY, Tsao NW, Chiang KH, Chan CS, Lin YC, Hung MY, Hsieh MH, Shyu KG, Chen JW, Chang NC, Yeh JS, Huang CY. Arterial Stiffness Index and Coronary Artery Plaques in Patients with Subclinical Coronary Atherosclerosis. ACTA CARDIOLOGICA SINICA 2016; 31:59-65. [PMID: 27122847 DOI: 10.6515/acs20140630b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Arterial stiffness is a physiologic quantitative value used to measure arterial compliance. It is predictive of coronary atherosclerosis in patients with intermediate to high cardiovascular risk. However, a correlation between arterial stiffness and subclinical coronary atherosclerosis has yet to be established. Therefore, the purpose of this study was to evaluate arterial stiffness using an arterial stiffness index (ASI) and investigate its association with coronary artery plaque in patients with subclinical coronary atherosclerosis. METHODS Our study enrolled 156 consecutive subjects who underwent health screening using a 64-slice cardiac computed tomography angiography (CCTA). Their arterial stiffness index was assessed noninvasively by CardioVision(®) MS-2000. The atheroma on the coronary vessel walls was analyzed. RESULTS Of the 156 patients, 53 displayed at least one > 50% stenotic lesion over the coronary arteries in CCTA images. The patients with at least one > 50% coronary stenotic plaque were older and had higher systolic blood pressure and ASI values than patients without > 50% coronary stenotic plaque. After dividing the study population into 2 groups by those patients over and under 50 years of age, the ASI positively correlated with the presentation of at least one > 50% coronary stenotic plaque in patients aged ≥ 50 years (odds ratio = 1.02, 95% confidence interval: 1.00-1.04, p = 0.03). CONCLUSIONS The ASI could play a role in risk stratification systems for coronary artery disease in patients with subclinical coronary atherosclerosis, and is a useful clinical marker for the correlation of early coronary plaque. KEY WORDS Arterial stiffness; Arterial stiffness index; Atherosclerosis; Coronary artery plaque.
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Affiliation(s)
- Yung-Ta Kao
- Division of Cardiology, Department of Internal Medicine
| | - Sen-Te Wang
- Health Management Center, Taipei Medical University Hospital
| | - Chun-Ming Shih
- Division of Cardiology, Department of Internal Medicine; ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Feng-Yen Lin
- Division of Cardiology, Department of Internal Medicine; ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Nai-Wen Tsao
- Division of Cardiovascular Surgery, Department of Surgery
| | | | | | - Yen-Chung Lin
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University
| | - Ming-Hsiung Hsieh
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University; ; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University
| | - Kuo-Gi Shyu
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital; ; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nen-Chung Chang
- Division of Cardiology, Department of Internal Medicine; ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Jong-Shiuan Yeh
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University; ; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University; ; Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, NY, USA
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine; ; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
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18
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Zhu X, Shi Z, Zhu Y, Liu W, Yang G, Yu T, Tang L, Xu Y. Individually adapted tube current selection and contrast medium injection protocol of coronary CT angiography based on test bolus parameters: a feasibility study. Acta Radiol 2015; 56:666-72. [PMID: 24938658 DOI: 10.1177/0284185114536156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/28/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Test bolus is mostly used to determine the starting point of a full cardiac scanning with respect to injection of a larger bolus of contrast material. So far there are limited data demonstrating the feasibility of using information obtained from a test bolus to adjust contrast delivery protocols and tube current individually during coronary computed tomography angiography (CCTA). PURPOSE To evaluate the feasibility of individually adapted tube current selection and contrast injection protocols of CCTA based on test bolus parameters. MATERIAL AND METHODS Test bolus followed by CCTA was performed in 93 patients at 100 kV and in 81 patients at 120 kV, respectively. Simulated attenuation of the descending aorta (SimDA) of CCTA was calculated at a fixed contrast injection rate of 4 mL/s. Univariate and multivariate comparisons were performed to identify associations of SimDA and image noise of CCTA (NoiseCCTA) with test bolus information and patient-related factors including body weight (BW), body mass index (BMI), and body surface area (BSA). RESULTS Compared with BW, BMI, and BSA, SimDA was more closely related to the peak time of left ventricle and peak enhancement of right ventricle obtained from test bolus (r = 0.495 and r = 0.642 for 100 and 120 kV protocol, respectively). Similarly, NoiseTB was much more closely related to NoiseCCTA (r = 0.740 and r = 0.630 for 100 and 120 kV protocol, respectively) when compared with BW, BMI, and BSA. CONCLUSION It is feasible to individually adapt tube current and contrast injection protocol of CCTA based on the information of test bolus.
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Affiliation(s)
- Xiaomei Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Zhaofei Shi
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Yinsu Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Wangyan Liu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Guanyu Yang
- Laboratory of Image Science & Technology, School of Computer Science and Engineering, Southeast University, Nanjing, Jiangsu, PR China
| | - Tongfu Yu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Lijun Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Yi Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
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Baumann S, Wang R, Schoepf UJ, Steinberg DH, Spearman JV, Bayer RR, Hamm CW, Renker M. Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements – initial experience with a novel physician-driven algorithm. Eur Radiol 2014; 25:1201-7. [DOI: 10.1007/s00330-014-3482-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 10/24/2014] [Accepted: 10/30/2014] [Indexed: 12/31/2022]
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20
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Morsbach F, Gordic S, Desbiolles L, Husarik D, Frauenfelder T, Schmidt B, Allmendinger T, Wildermuth S, Alkadhi H, Leschka S. Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience. Eur Radiol 2014; 24:1889-95. [PMID: 24838737 DOI: 10.1007/s00330-014-3209-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/15/2014] [Accepted: 04/28/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate image quality, maximal heart rate allowing for diagnostic imaging, and radiation dose of turbo high-pitch dual-source coronary computed tomographic angiography (CCTA). METHODS First, a cardiac motion phantom simulating heart rates (HRs) from 60-90 bpm in 5-bpm steps was examined on a third-generation dual-source 192-slice CT (prospective ECG-triggering, pitch 3.2; rotation time, 250 ms). Subjective image quality regarding the presence of motion artefacts was interpreted by two readers on a four-point scale (1, excellent; 4, non-diagnostic). Objective image quality was assessed by calculating distortion vectors. Thereafter, 20 consecutive patients (median, 50 years) undergoing clinically indicated CCTA were included. RESULTS In the phantom study, image quality was rated diagnostic up to the HR75 bpm, with object distortion being 1 mm or less. Distortion increased above 1 mm at HR of 80-90 bpm. Patients had a mean HR of 66 bpm (47-78 bpm). Coronary segments were of diagnostic image quality for all patients with HR up to 73 bpm. Average effective radiation dose in patients was 0.6 ± 0.3 mSv. CONCLUSIONS Our combined phantom and patient study indicates that CCTA with turbo high-pitch third-generation dual-source 192-slice CT can be performed at HR up to 75 bpm while maintaining diagnostic image quality, being associated with an average radiation dose of 0.6 mSv. KEY POINTS • CCTA is feasible with the turbo high-pitch mode. • Turbo high-pitch CCTA provides diagnostic image quality up to 73 bpm. • The radiation dose of high-pitch CCTA is 0.6 mSv on average.
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Affiliation(s)
- Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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21
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An individualized contrast material injection protocol with respect to patient-related factors for dual-source CT coronary angiography. Clin Radiol 2014; 69:e86-92. [DOI: 10.1016/j.crad.2013.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/11/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
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Kawaguchi N, Kurata A, Kido T, Nishiyama Y, Kido T, Miyagawa M, Ogimoto A, Mochizuki T. Optimization of Coronary Attenuation in Coronary Computed Tomography Angiography Using Diluted Contrast Material. Circ J 2014; 78:662-70. [DOI: 10.1253/circj.cj-13-1101] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Akira Kurata
- Department of Radiology, Erasmus University Medical Center
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Yoshiko Nishiyama
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine
| | - Akiyoshi Ogimoto
- Department of Cardiology, Ehime University Graduate School of Medicine
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Konno M, Hosokai Y, Usui A, Abe M, Tateishi T, Kawasumi Y, Tsuda M, Ota H, Takase K, Saito H. Cardiac output obtained from test bolus injections as a factor in contrast injection rate revision of following coronary CT angiography. Acta Radiol 2012; 53:1107-11. [PMID: 22993270 DOI: 10.1258/ar.2012.120276] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Optimal contrast enhancement is crucial for the detection of coronary artery stenoses and atherosclerotic changes in coronary CT angiography (CTA). PURPOSE To demonstrate the feasibility of using the cardiac output (CO) obtained from the test bolus injection data-set (COtest) as a factor in contrast injection rate revision of the following coronary CTA. MATERIAL AND METHODS The test bolus injection data-sets of 52 consecutive coronary CTAs were examined. COtest was calculated from the test bolus data-set. Aortic peak enhancement (APE) was measured on the following coronary CTA. We simulated the APE at a fixed contrast injection rate of 4 mL/s (simAPE) in each patient. RESULTS The ranges of COtest and simAPE were 2.82-7.56 L/min and 194-527 Hounsfield Units, respectively. There was a significant negative correlation (R = -0.802, P < 0.001) between simAPE and COtest. CONCLUSION COtest can be used for injection rate revision on coronary CTA.
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Affiliation(s)
- Masahiko Konno
- Division of Diagnostic Image Analysis, Graduate School of Medicine, Tohoku University, Miyagi
- Yamagata Prefecture Comprehensive Rehabilitation and Education Center, Yamagata
| | - Yoshiyuki Hosokai
- Division of Diagnostic Image Analysis, Graduate School of Medicine, Tohoku University, Miyagi
| | - Akihito Usui
- Division of Diagnostic Image Analysis, Graduate School of Medicine, Tohoku University, Miyagi
| | - Mitsuya Abe
- Division of Diagnostic Image Analysis, Graduate School of Medicine, Tohoku University, Miyagi
| | - Toshiki Tateishi
- Division of Diagnostic Image Analysis, Graduate School of Medicine, Tohoku University, Miyagi
| | - Yusuke Kawasumi
- Division of Diagnostic Image Analysis, Graduate School of Medicine, Tohoku University, Miyagi
| | - Masashi Tsuda
- Division of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Hideki Ota
- Division of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Kei Takase
- Division of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Haruo Saito
- Division of Diagnostic Image Analysis, Graduate School of Medicine, Tohoku University, Miyagi
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An initial randomised study assessing free-breathing CCTA using 320-detector CT. Eur Radiol 2012; 23:1199-209. [PMID: 23138388 DOI: 10.1007/s00330-012-2703-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/25/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the feasibility of free-breathing coronary computed tomography angiography (CCTA) in adults using with a 320-detector multidetector CT (MDCT). METHODS In 74 patients who underwent CCTA, 37 CCTA examinations were performed during free-breathing, and the remaining 37 CCTA examinations were produced with the standard breath-holding method. The quality scores for 16 segments of all coronary arteries were analysed and defined as: 1 (excellent), 2 (good), and 3 (poor). The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and effective radiation dose of each image were compared between the two methods. RESULTS No significant differences were observed in the quality scores between the breath-holding and free-breathing methods (1.10 ± 0.31 vs. 1.12 ± 0.33; P = 0.443). The SNR and CNR were not significantly different between the two methods. The overall mean effective radiation dose revealed no significant difference between the two methods (P = 0.585). CONCLUSIONS Free-breathing CCTA using 320-detector MDCT showed no significant difference in image quality compared with standard breath-holding CCTA. For patients with difficulties of breath-holding or non-negligible apnoea-related heart rate variability, free-breathing CCTA can be an alternative solution for coronary artery evaluation. KEY POINTS • Cardiac CT is becoming widely used and some patients are inevitably breathless. • Multidetector CT (e.g. 320) offers new opportunities for the breathless patient. • Free breathing images yielded similar image quality to those obtained using breath-holding. • However, a possibility of higher radiation dose precludes its routine application.
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Zhu X, Zhu Y, Xu H, Tang L, Xu Y. The influence of body mass index and gender on coronary arterial attenuation with fixed iodine load per body weight at dual-source CT coronary angiography. Acta Radiol 2012; 53:637-42. [PMID: 22798383 DOI: 10.1258/ar.2012.110657] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Most of current coronary CT angiography protocols are not adapted to body weight (BW) or cardiac output and no literature about influence of gender on coronary attenuation are reported with administration of a fixed iodine load per BW. PURPOSE To determine the influence of body mass index (BMI) and gender on coronary arterial attenuation if contrast material dose is linearly adjusted to a patient's BW at dual-source CT coronary angiography (DSCT-CA). MATERIAL AND METHODS A total of 207 consecutive patients (mean age 60.6 years) undergoing DSCT-CA were included. Contrast material (370 mg I/mL) dose calculation was randomly categorized into two groups (Group 1: 1.10 mL/kg for men and women; Group 2: men 1.10 mL/kg, women 0.99 mL/kg) and flow rate was calculated as dose was divided by scan time plus 8 s. Mean arterial attenuations between men and women were compared with respect to attenuations of ascending aorta (AA) above coronary ostia, left main coronary artery (LM), proximal segments of right coronary artery (RCA), left anterior descending (LAD), and left circumflex artery (LCX) in two groups, respectively. Attenuations of coronary arteries were correlated with BW and BMI with simple linear regression. RESULTS The mean attenuations of AA, LM, RCA, LAD, and LCX were 407.8 ± 53.6 HU, 412.6 ± 55.4 HU, 411.4 ± 64.3 HU, 399.1 ± 56.7 HU, and 399.1 ± 60.2 HU, respectively, and there were no significant differences between men and women in group 1 (AA, P = 0.571; LM, P = 0.670; RCA, P = 0.737; LAD, P = 0.439, and LCX, P = 0.888). In group 2, the mean attenuations of AA, LM, RCA, LAD, and LCX in men were significantly higher than those in women (AA, P = 0.008; LM, P = 0.025; RCA, P = 0.017; LAD, P = 0.015, and LCX, P = 0.002). Positive linear regression between BW and attenuations of AA (R(2) = 0.047, P = 0.02), LM (R(2) = 0.036, P = 0.04), RCA (R(2) = 0.080, P < 0.01), LAD (R(2) = 0.078, P < 0.01), and LCX (R(2) = 0.033, P = 0.05) was found in group 1, suggesting that attenuations of coronary arteries increased in heavier patients. Similarly, there was positive linear regression between BMI and attenuations of AA (R(2) = 0.117, P < 0.01), LM (R(2) = 0.090, P < 0.01), RCA (R(2) = 0.138, P < 0.01), LAD (R(2) = 0.111, P < 0.01), and LCX (R(2) = 0.078, P < 0.01). CONCLUSION Men and women have similar coronary attenuations with a fixed iodine load per BW. BMI has a positive linear influence on arterial attenuation at DSCT-CA involving injection protocol with dose linearly tailored to BW. Excessive contrast material may inadvertently be given in heavier patients when the dose is determined by BW only. Contrast material dose may need to be tailored individually by BW and BMI.
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Affiliation(s)
- Xiaomei Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yinsu Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hai Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lijun Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Kang EJ, Lee KN, Kim DW, Kim BS, Choi S, Park BH, Oh JY. Triple rule-out acute chest pain evaluation using a 320-row-detector volume CT: a comparison of the wide-volume and helical modes. Int J Cardiovasc Imaging 2012; 28 Suppl 1:7-13. [DOI: 10.1007/s10554-012-0072-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 05/10/2012] [Indexed: 11/27/2022]
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Shorter delay time reduces interpatient variability in coronary enhancement in coronary CT angiography using the bolus tracking method with 320-row CT. Int J Cardiovasc Imaging 2012; 29:185-90. [DOI: 10.1007/s10554-012-0045-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/26/2012] [Indexed: 02/05/2023]
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Coronary enhancement for prospective ECG-gated single R-R axial 320-MDCT angiography: comparison of 60- and 80-mL iopamidol 370 injection. AJR Am J Roentgenol 2011; 197:844-50. [PMID: 21940571 DOI: 10.2214/ajr.10.5980] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the difference in coronary enhancement provided by 60 versus 80 mL of contrast medium (370 mg I/mL) for prospectively ECG-gated single-heartbeat axial 320-MDCT. MATERIALS AND METHODS We retrospectively evaluated 108 consecutive 320-MDCT angiography studies. Group 1 (n = 36) received 60 mL of an iodinated contrast medium and group 2 (n = 72), 80 mL. All patients were imaged with a standardized protocol: iopamidol 370 followed by 40 mL of saline, both administered at a rate of 6 mL/s. Two imagers subjectively assessed image quality throughout the coronary arteries. Region-of-interest attenuation (HU) measurements were performed in the aorta plus the proximal and distal coronary arteries. RESULTS Subjective analysis of all coronary segments showed slightly better image quality for group 2. Patients in group 1 had significantly (p < 0.05) lower mean attenuation values for the individual coronary vessels. Nevertheless, 96.7% of all coronary segments in the group 1 patients had an attenuation of greater than 300 HU; when analysis was limited to group 1 patients with a body mass index of greater than 30, 92.8% of the segments were more than 300 HU, and all segments measured more than 250 HU. CONCLUSION An injection protocol based on 60 mL of iopamidol (370 mg I/mL) for prospectively ECG-gated wide-area detector single-heartbeat coronary CT angiography (CTA) has less coronary enhancement than a protocol based on 80 mL. However, using 60 mL, more than 96% of coronary segments had sufficient enhancement (i.e., > 300 HU), supporting the general use of 60-mL protocols for clinical wide-area detector coronary CTA.
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Zhu X, Chen W, Li M, Xu Y, Xu H, Zhu Y, Wang D, Tang L. Contrast material injection protocol with the flow rate adjusted to the heart rate for dual source CT coronary angiography. Int J Cardiovasc Imaging 2011; 28:1557-65. [DOI: 10.1007/s10554-011-9950-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 09/19/2011] [Indexed: 01/17/2023]
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Left ventricular ejection fraction impact on contrast opacification of coronary artery bypass grafts in 64-slice multidetector computed tomography angiography. J Comput Assist Tomogr 2011; 35:235-9. [PMID: 21412096 DOI: 10.1097/rct.0b013e3182067c05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was to find whether changes in left ventricular ejection fraction (LVEF) have an impact on contrast opacification of coronary artery bypass grafts (CABGs) in coronary computed tomography angiography (CTA). METHODS One hundred two CABG patients were assessed using 64-slice CTA. Concurrently, their LVEF was measured using computed tomography. Density of grafts were measured, and their correlation with parameters including LVEF determined. RESULTS A total of 253 grafts including 89 left internal mammary artery (LIMA) grafts, 41 saphenous vein grafts (SVGs) to diagonal artery, 66 SVGs to obtuse marginal (OM) artery, and 57 SVGs to posterior descending artery (PDA) were patent and assessed. Mean measured LVEF was 49% (SD, 7%). Mean attenuation value of the LIMA grafts was 302.39 (SD, 91.16) Hounsfield units (HU), and those of SVGs to diagonal artery, SVGs to OM artery, and SVGs to PDA were 348.73 (SD, 100.38) HU, 326.95 (SD, 101.41) HU, and 339.50 (SD, 111.67) HU, respectively. A significant negative correlation was found between LVEF and mean attenuation values of LIMA graft (P < 0.001; r = -0.80), SVG to diagonal artery (P < 0.001; r = -0.66), SVG to OM artery (P < 0.001; r = -0.75), and SVG to PDA (P < 0.001; r = -0.76). CONCLUSIONS A negative correlation was found between density of grafts and LVEF of CABG patients, which is usually echocardiographically assessed before CTA.
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Tang L, Zhu X, Xu Y, Yu T, Xu H, Tang J, Dogra V, Wang D. Factors influencing delay time and coronary arterial density during coronary angiography with DSCT. Acta Radiol 2011; 52:59-63. [PMID: 21498327 DOI: 10.1258/ar.2010.090465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. PURPOSE To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. MATERIAL AND METHODS One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight × height/3600](1/2)) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. RESULTS Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 × HR + 1.902 × gender + 0.394 × TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 × HR-3.293 × weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. CONCLUSION Delay time is influenced by HR, gender and TCD. Coronary arterial density also changes with HR and weight. So HR, gender, TCD and weight can be used to adjust flow rate and dosage of contrast media before administration of contrast media during coronary CT angiography.
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Affiliation(s)
- Lijun Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaomei Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yi Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tongfu Yu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hai Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinhua Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Vikram Dogra
- Department of Radiology, University of Rochester, NY, USA
| | - Dehang Wang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Tomizawa N, Komatsu S, Akahane M, Torigoe R, Kiryu S, Ohtomo K. Influence of hemodynamic parameters on coronary artery attenuation with 320-detector coronary CT angiography. Eur J Radiol 2011; 81:230-3. [PMID: 21237602 DOI: 10.1016/j.ejrad.2010.12.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 12/17/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the relationship between cardiac output, end diastolic volume and the contrast enhancement in coronary CT angiography using 320-detector CT. MATERIALS AND METHODS A total of 38 patients underwent coronary CT angiography by using a 320-detector CT scanner (detector configuration, 320 × 0.5mm). The attenuation value of the ascending aorta at the level of the orifice of the left main trunk was measured. The cardiac output (CO), end diastolic volume (EDV) and stroke volume (SV) were measured by echocardiography. The EDV was normalized to the body surface area (BSA). The total blood volume injected from the left ventricle from the beginning of the contrast agent injection to the time of image acquisition was determined to be the total injected blood volume (TIV), which is a product of SV and the number of heart beats from the initiation of contrast agent injection to the scan. RESULTS There was a negative correlation between the attenuation of the ascending aorta and CO (r = -0.44, P = 0.0053). However, the negative correlation between the attenuation of the ascending aorta and TIV was stronger (r = -0.52, P = 0.0007). There was a negative correlation between the attenuation of the ascending aorta and EDV/BSA (r = -0.45, P = 0.0039). CONCLUSION In 320-detector CT, contrast enhancement in CCTA with a lesser amount of contrast medium decreases when cardiac output is high. Patients with larger EDV/BSA may also show decreased attenuation.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Iodine contrast iso-attenuating with diagnostic gadolinium doses in CTA and angiography results in ultra-low iodine doses. A way to avoid both CIN and NSF in azotemic patients? Eur Radiol 2010; 21:326-36. [DOI: 10.1007/s00330-010-1924-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 07/15/2010] [Accepted: 07/16/2010] [Indexed: 11/30/2022]
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Lu JG, Lv B, Chen XB, Tang X, Jiang SL, Dai RP. What is the best contrast injection protocol for 64-row multi-detector cardiac computed tomography? Eur J Radiol 2010; 75:159-65. [PMID: 19467812 DOI: 10.1016/j.ejrad.2009.04.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 04/13/2009] [Accepted: 04/15/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Jin-guo Lu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, China
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Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 2010; 256:32-61. [PMID: 20574084 DOI: 10.1148/radiol.10090908] [Citation(s) in RCA: 658] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The continuing advances in computed tomographic (CT) technology in the past decades have provided ongoing opportunities to improve CT image quality and clinical practice and discover new clinical CT imaging applications. New CT technology, however, has introduced new challenges in clinical radiology practice. One of the challenges is with intravenous contrast medium administration and scan timing. In this article, contrast medium pharmacokinetics and patient, contrast medium, and CT scanning factors associated with contrast enhancement and scan timing are presented and discussed. Published data from clinical studies of contrast medium and physiology are reviewed and interpreted. Computer simulation data are analyzed to provide an in-depth analysis of various factors associated with contrast enhancement and scan timing. On the basis of basic principles and analysis of the factors, clinical considerations and modifications to protocol design that are necessary to optimize contrast enhancement for common clinical CT applications are proposed.
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Affiliation(s)
- Kyongtae T Bae
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Contrast material injection protocol with the dose adjusted to the body surface area for MDCT aortography. AJR Am J Roentgenol 2010; 194:903-8. [PMID: 20308489 DOI: 10.2214/ajr.09.3460] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to investigate the effect on aortic enhancement of contrast material volumes adjusted for a patient's body surface area (BSA) at CT angiography (CTA). SUBJECTS AND METHODS A 64-MDCT scanner was used to perform CTA of the whole aorta in 89 patients (mean age, 68.7 years) with confirmed or suspected aortoiliac disease. The patients were divided into groups: a body weight (BW) group (n = 45) and a BSA (n = 44) group. The contrast dose was 360 mg I/kg BW in the BW group and 12,753 mg I/m(2) BSA in the BSA group. Because the average BW of Japanese adults is approximately 60 kg, the contrast dose in the two protocols was identical in patients weighing 60 kg. We compared aortic enhancement achieved with the two protocols using the two-tailed Student's t test, and we used the generalized linear model to analyze the effect of patient age, sex, and BW on aortic enhancement in each protocol group. RESULTS The mean aortic enhancement in the BW and BSA groups was 324.2 and 311.7 HU, respectively; the difference was not significant (p = 0.26). In the BW group, BW had a statistically significant effect on aortic enhancement (p < 0.01), whereas neither patient age nor sex did (p = 0.08 and 0.07, respectively). In the BSA group, the age, sex, BW, and BW by sex had no statistically significant effect on aortic enhancement (p = 0.33, 023, 0.10, and 0.16, respectively). CONCLUSION Under the BSA protocol, aortic enhancement tended to be consistent and adequate regardless of patient BW.
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Rutten A, Meijs MFL, de Vos AM, Seidensticker PR, Prokop M. Biphasic contrast medium injection in cardiac CT: moderate versus high concentration contrast material at identical iodine flux and iodine dose. Eur Radiol 2010; 20:1917-25. [PMID: 20306079 PMCID: PMC2899014 DOI: 10.1007/s00330-010-1752-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 01/04/2010] [Accepted: 02/07/2010] [Indexed: 02/06/2023]
Abstract
Objective To prospectively investigate the influence of contrast material concentration on enhancement in cardiac CT by using a biphasic single-injection protocol. Methods Sixty-four-row multidetector cardiac CT angiography was performed in 159 patients randomised to a moderate or high contrast medium concentration. Contrast material injection included a first phase for enhancement of the coronary arteries and a second phase, at half the iodine flux, targeted at enhancement of the right ventricle. Contrast medium injection was followed by a saline flush. For both concentrations, injection duration (and thus total iodine dose) was adapted to the duration of the CT data acquisition and iodine flux was adjusted to patient weight. Attenuation was measured at various levels in the heart and vessels and the two concentrations compared, overall and per weight group. Results Enhancement of the aorta and left ventricle was significantly greater with the moderate than with the high concentration contrast medium. This remained true for the two higher weight groups. No difference was found in the lowest weight group or in the right ventricle and pulmonary outflow tract. Conclusion With a biphasic injection protocol, enhancement of the aorta and left ventricle was weaker with the higher concentration of contrast material.
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Affiliation(s)
- Annemarieke Rutten
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Pazhenkottil AP, Husmann L, Buechel RR, Herzog BA, Nkoulou R, Burger IA, Vetterli A, Valenta I, Ghadri JR, von Schulthess P, Kaufmann PA. Validation of a new contrast material protocol adapted to body surface area for optimized low-dose CT coronary angiography with prospective ECG-triggering. Int J Cardiovasc Imaging 2010; 26:591-7. [PMID: 20131006 DOI: 10.1007/s10554-010-9594-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 01/18/2010] [Indexed: 01/24/2023]
Abstract
In patients with large total blood volume contrast material (CM) dilution decreases coronary attenuation in CT coronary angiography (CTCA). As increased blood volume is well paralleled by body surface area (BSA) we assessed a BSA-adapted CM protocol to compensate for dilution effects. Low-dose CTCA with prospective ECG-triggering was performed in 80 patients with a BSA-adapted CM bolus ranging 40-105 ml and injection rate ranging 3.5-5.0 ml/s for a BSA of <1.70 to >or=2.5 m(2). Eighty control patients matched for BSA who had previously undergone routine CTCA with a fixed CM protocol of 80 ml at 5 ml/s served as reference group. The average vessel attenuation from the proximal right (RCA) and the left main coronary artery (LMA) was assessed. Correlation of BSA with vessel attenuation was assessed in both groups. BSA-matching of all patients was successful (BSA-adapted group 1.98 +/- 0.15 m(2), range 1.66-2.39 m(2) versus reference group 1.98 +/- 0.17 m(2), range 1.59-2.38 m(2); P = 0.74). Mean CM bolus was significantly smaller in the BSA-adapted versus the reference group (70.9 +/- 14.1 vs. 80.0 +/- 0 ml, P < 0.001). There was no correlation in the BSA-adapted group (r = -0.07, P = 0.53, SEE = 0.15), while coronary attenuation was inversely related to BSA in the reference group (r = -0.59, P < 0.001, SEE = 0.14). We have successfully validated a BSA-adapted contrast material protocol which results in a comparable coronary contrast enhancement independent of individual BSA. This was achieved despite a significant reduction in the overall contrast material amount.
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Affiliation(s)
- Aju P Pazhenkottil
- Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Dual source CT coronary angiography in severely obese patients: trading off temporal resolution and image noise. Invest Radiol 2010; 44:720-7. [PMID: 19809341 DOI: 10.1097/rli.0b013e3181b46f1a] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess in severely obese patients the subjective and objective image quality parameters and to estimate the radiation dose of dual-source computed tomography coronary angiography (CTCA), using 3 different protocols. MATERIALS AND METHODS Dual-source CTCA was performed in 60 patients (30 women; mean age 58 +/- 7 years) suffering from obesity class II or higher (body mass index [BMI] >35 kg/sq m). Twenty patients were examined with a standard CTCA protocol at 120 kV/350 mAs (protocol A), 20 patients with a CTCA protocol at 140 kV/350 mAs (protocol B), and 20 patients at 140 kV/350 mAs with a dedicated obesity protocol (protocol C), that allows the additional data sampling by expanding the data acquisition for each tube from a quarter to a half rotation, permitting to trade off temporal resolution and image noise. Two blinded observers independently assessed the image quality of each coronary segment, using a 4-point scale (1: excellent-4: nondiagnostic) and measured the different image parameters (image noise, signal-to-noise ratio [SNR], and contrast-to-noise ratio [CNR]). Radiation dose estimates were calculated. RESULTS The average BMI was 46.3 +/- 8.3 kg/sq m (range, 36.8-69.6 kg/sq m). Subjective image quality (1.55 +/- 0.73) was significantly better in protocol C when compared with protocol A (2.46 +/- 0.76; P < 0.01) and protocol B (2.12 +/- 0.87; P < 0.017). There was a significantly lower rate of coronary artery segments with nondiagnostic image quality when using the obesity protocol C (1.5%; 4/262) compared with that obtained when using protocol A (7.8%; 22/280; P < 0.01) and protocol B (4.4%; 12/275; P < 0.017). Image noise was significantly lower in protocol C (31.8 +/- 5.0 HU) when compared with group A (43.5 +/- 4.7 HU; P < 0.001) and B (36.8 +/- 5.5 HU; P < 0.01). SNR and CNR were significantly higher in group C (13.8 +/- 2.4 and 23.1 +/- 2.8) compared with group A (10.6 +/- 1.7 and 15.1 +/- 3.2; each P < 0.001) and group B (12.0 +/- 2.0 and 18.8 +/- 3.1; each P < 0.01). The estimated effective radiation dose of the obesity protocol C (15.6 +/- 0.9 mSv) was significantly higher when compared with that in protocol A (10.1 +/- 0.8 mSv; P < 0.01), but not significantly different from that in protocol B (13.3 +/- 0.8 mSv; P = 0.022). CONCLUSIONS Use of an obesity protocol in dual-source CTCA in severely obese patients significantly improves image quality, but goes along with a higher radiation dose.
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Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study. Eur Radiol 2009; 20:1321-30. [DOI: 10.1007/s00330-009-1691-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/21/2009] [Accepted: 10/22/2009] [Indexed: 12/21/2022]
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Contrast Material Administration Protocols for 64-MDCT Angiography: Altering Volume and Rate and Use of a Saline Chaser to Better Match the Imaging Window—Physiologic Phantom Study. AJR Am J Roentgenol 2009; 193:1568-75. [DOI: 10.2214/ajr.09.2670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Low-dose coronary CT angiography with prospective ECG triggering: validation of a contrast material protocol adapted to body mass index. AJR Am J Roentgenol 2009; 193:802-6. [PMID: 19696295 DOI: 10.2214/ajr.08.2052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of the study was to validate a body mass index (BMI)-adapted contrast material protocol to compensate for the effect of BMI on coronary attenuation during low-dose coronary CT angiography with prospective ECG triggering. MATERIALS AND METHODS One hundred forty patients underwent prospectively ECG-triggered coronary CT angiography for clinical indications. The following BMI-adapted contrast material protocol was used for imaging of 70 consecutively registered patients: BMI < 17.5, 50 mL contrast material at 4.0 mL/s; 17.5-22.4, 55 mL at 4.0 mL/s; 22.5-24.9, 65 mL at 4.0 mL/s; 25.0-27.4, 80 mL at 4.5 mL/s; 27.5-29.9, 80 mL at 5.0 mL/s; 30.0-34.9, 85 mL at 5.0 mL/s; 35.0-40.0, 95 mL at 5.0 mL/s; > 40, 105 mL at 5.0 mL/s. Seventy patients matched for BMI who had previously undergone routine coronary CT angiography with a fixed contrast material dosage of 80 mL at 5 mL/s served as the reference group. Vessel attenuation in the left main and proximal right coronary arteries was measured and correlated with BMI, and the results in the two protocol groups were compared. RESULTS The groups were well matched for BMI. The mean BMI in the nonadapted protocol group was 26.5 +/- 4.0 (standard deviation) (range, 18.9-36.5), and that in the BMI-adapted protocol group was 26.7 +/- 4.2 (range, 18.2-37.2) (p not significant). The mean amount of contrast material used was smaller in the BMI-adapted group (73.9 +/- 11.2 vs 80.0 +/- 0 mL; p < 0.01). Mean coronary artery attenuation did not differ significantly between the two groups (386 +/- 102 HU vs 385 +/- 64 HU; p not significant). Without BMI adaptation, coronary attenuation correlated strongly with BMI (r = -0.63; p < 0.001). With the BMI-adapted protocol, however, there was no correlation between BMI and coronary attenuation (r = -0.24; p not significant). CONCLUSION We validated a BMI-adapted contrast material protocol that results in adequate coronary vessel attenuation independent of individual BMI despite a significant reduction in overall amount of contrast material used.
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HUSMANN L, GAEMPERLI O, VALENTA I, SCHEPIS T, SCHEFFEL H, STOLZMANN P, LESCHKA S, DESBIOLLES L, MARINCEK B, ALKADHI H, KAUFMANN PA. Impact of vessel attenuation on quantitative coronary angiography with 64-slice CT. Br J Radiol 2009; 82:649-53. [DOI: 10.1259/bjr/40319502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography. Eur Radiol 2009; 19:2373-82. [DOI: 10.1007/s00330-009-1421-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 02/23/2009] [Accepted: 03/07/2009] [Indexed: 10/20/2022]
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Herzog BA, Husmann L, Valenta I, Tay FM, Burkhard N, Gaemperli O, Wyss CA, Landmesser U, Kaufmann PA. Determinants of vessel contrast in BMI-adapted low dose CT coronary angiography with prospective ECG-triggering. Int J Cardiovasc Imaging 2009; 25:625-30. [PMID: 19381867 DOI: 10.1007/s10554-009-9460-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
Abstract
We evaluated the determinants of vessel contrast in prospectively ECG-triggered CT coronary angiography (CTCA). Seventy patients underwent low-dose CTCA using body mass index (BMI)-adapted tube parameters and a fixed contrast material bolus. Contrast to noise ratio (CNR) was calculated from contrast (between coronaries and perivascular tissue) and image noise (standard deviation of aortic attenuation). Cardiac output (CO) was calculated from gated (99m)Tc-tetrofosmin-SPECT. Mean radiation dose was 2.13 +/- 0.69 mSv. Image noise was not affected by BMI (r = 0.1, P = 0.36), while CNR was inversely related to body surface area (BSA) (r = -0.5, P < 0.001) and CO (r = -0.45, P < 0.001). After successfully overcoming the impact of BMI on image noise by adapting tube parameters, CNR mainly depends on coronary vessel contrast. The latter reflects the dilution of the contrast material by blood volume and CO, which are both correlated to BSA. Therefore, BSA adapted contrast administration may help to compensate for this effect.
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Evaluation of a Body Mass Index–Adapted Protocol for Low-Dose 64-MDCT Coronary Angiography with Prospective ECG Triggering. AJR Am J Roentgenol 2009; 192:635-8. [PMID: 19234258 DOI: 10.2214/ajr.08.1390] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nakamura K, Funabashi N, Uehara M, Suzuki K, Terao M, Okubo K, Mita Y, Maeda F, Komuro I. Impairment factors for evaluating the patency of drug-eluting stents and bare metal stents in coronary arteries by 64-slice computed tomography versus conventional coronary angiography. Int J Cardiol 2008; 130:349-56. [DOI: 10.1016/j.ijcard.2007.08.104] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 08/10/2007] [Indexed: 11/29/2022]
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Imaging of the coronary venous system in patients with congestive heart failure: comparison of 16 slice MSCT and retrograde coronary sinus venography. Int J Cardiovasc Imaging 2008; 24:783-91. [DOI: 10.1007/s10554-008-9333-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 06/16/2008] [Indexed: 11/25/2022]
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Leschka S, Stolzmann P, Schmid FT, Scheffel H, Stinn B, Marincek B, Alkadhi H, Wildermuth S. Low kilovoltage cardiac dual-source CT: attenuation, noise, and radiation dose. Eur Radiol 2008; 18:1809-17. [PMID: 18392829 DOI: 10.1007/s00330-008-0966-1] [Citation(s) in RCA: 218] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 02/04/2008] [Accepted: 03/05/2008] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to investigate the effect of low kilovoltage dual-source computed tomography coronary angiography (CTCA) on qualitative and quantitative image quality parameters and radiation dose. Dual-source CTCA with retrospective ECG gating was performed in 80 consecutive patients of normal weight. Forty were examined with a standard protocol (120 kV/330mAs), 20 were examined at 100 kV/330mAs, and 20 at 100 kV/220mAs. Two blinded observers independently assessed image quality of each coronary segment and measured the image parameters noise, attenuation, and contrast-to-noise ratio (CNR). The effective radiation dose was calculated using CT dose volume index and the dose-length product. Diagnostic image quality was obtained in 99% of all coronary segments (1,127/1,140) without significant differences among the protocols. Image noise, attenuation, and CNR were significantly higher for 100 kV/330mAs (26 +/- 3 HU, 549 +/- 62 HU, 25.5 +/- 3.2; each P < 0.01) and 100 kV/220mAs (27 +/- 2 HU, 560 +/- 43 HU, 25.0 +/- 2.2; each P < 0.01) when compared to the 120-kV protocol (21 +/- 2 HU, 317 +/- 28 HU, 20.6 +/- 1.7). There was no significant difference between the two 100-kV protocols. Estimated effective radiation dose of the 120-kV protocol (8.9 +/- 1.2 mSv) was significantly higher than the 100 kV/330mAs (6.7 +/- 0.8 mSv, P < 0.01) or 100 kV/220mAs (4.4 +/- 0.6 mSv, P < 0.001) protocols. Dual-source CTCA with 100 kV is feasible in patients of normal weight, results in a diagnostic image quality with a higher CNR, and at the same time significantly reduces the radiation dose.
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Affiliation(s)
- Sebastian Leschka
- Institute of Radiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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