Effect of different saline chaser volumes and flow rates on intravascular contrast enhancement in CT using a circulation phantom

Simultaneous Injection of Contrast and Saline Using Spiral Flow-Generating Tube for Hepatic Dynamic Computed Tomography: Effect on Enhancement of Liver Parenchyma and Metastases to the Liver

PURPOSE

Recently, there have been a few reports regarding the usefulness of a novel saline injection technique using a spiral flow-generating tube. The purpose of this study was to evaluate whether simultaneous saline injection using a spiral flow-generating tube was able to improve hepatic contrast enhancement and lesion conspicuity of metastatic liver tumors.

METHODS

We randomized a total of 411 patients with various liver diseases including metastases by total body weight (A, n = 204) and contrast dilution protocol (B, n = 207). Group A received 400 mgI/kg of contrast medium alone without a spiral flow-generating tube; group B received contrast medium 400 mgI/kg simultaneous with injection of a 0.57-ml/kg physiologic saline solution through a spiral flow-generating tube. Abdominal aorta computed tomography (CT) number, hepatic enhancement (ΔHU), percentage of tests demonstrating an enhancement effect of the liver parenchyma exceeding Δ50 HU in 3 measured segments (S2, S6, and S8), and the contrast-to-noise ratio of the metastatic liver tumors were measured.

RESULTS

The mean aortic CT number of group B (417.0 HU ± 61.7; P < 0.01) was approximately 10% higher than that of group A (384.6 ± 79.1 HU). The average ΔHU was 59.8 ± 11.4 HU for group A and 61.7 ± 11.7 for group B. The ΔHU for group B was significantly higher than that for group A ( P = 0.017). The percentage of tests demonstrating with the enhancement effect of group B was more than 80% in all subgroups; however, that of group A was less than 80% in all subgroups. The contrast-to-noise ratio of group B (7.8 ± 3.3 HU) was significantly higher compared to that of group A (6.5 ± 2.8 HU) ( P < 0.05).

CONCLUSIONS

Because of the volume effect, injecting a contrast medium diluted with normal saline improved the degree of hepatic and aortic contrast enhancement and achieved better visualization of liver metastases.

CLINICAL IMPACT

The use of spiral flow-generating tube may help diagnostic of hepatic and aortic contrast enhancement and liver metastases.

IMPORTANCE

The use of a spiral flow-generating tube improved the degree of hepatic and aortic contrast enhancement and achieve better visualization of liver metastases.

POINTS

The use of low-concentration syringe formulations is limited by body weight. However, the use of spiral flow-generating tube provides low-concentration contrast medium regardless of body weight.

Contrast media shortages - medical imaging considerations: A literature review

This literature review was conducted to analyze the current and future effects of intravenous contrast media shortages and how these shortages affect patient care within the field of computed tomography (CT). Substitutions and conservation methods were examined. One of the most important results of this review was to improve current and future patient care while actively making a conscious effort to help aid others in future shortages. Limitations can be found when looking at the research field concerning the substitutions for contrast media, such as nanoparticles and saline chasers following contrast boluses. CINAHL, CINAHL Complete, MEDLINE, MEDLINE Complete, Academic Search Complete, EBSCOhost, and Google Scholar were used to compile articles, which were then eliminated until only those pertaining to this review were left. Thirty-seven articles were included; of the 37 articles, two studied contrast enhancement in animals and were determined relevant to this review. The majority of sources were published within the past 20 years; older articles were included to identify gaps for future research; and all articles selected were peer-reviewed or scholarly. This review indicates the CT field can begin preparations now to help negate future contrast shortages as well as decrease patients' health risks. Future research should revolve around furthering the field's knowledge of nanoparticles being used as ICMs in human patients. Additionally, investigating which ordering providers should have ICM ordering privileges may identify conservation strategies.

Ladder-Like Low Iodine Delivery Rate Injection Protocols Based on BMI at 70 KV by Automated Tube Voltage Selection in Coronary CTA

Objective

To evaluate the feasibility of reducing the injection velocity and volume of contrast agent according to BMI, and the effect of body weight (BW), body surface area（BSA）, body mass index（BMI），and blood volume (BV) on aortic contrast enhancement when the voltage of third-generation dual-source CT is selected at 70 KV.

Methods

A total of 280 patients selected at 70 KV were randomly divided into an experimental group and a control group. Each group was divided into 7 subgroups according to BMI ≤20, 20–21, 21-22, 22-23, 23-24, 24-25, and 25–26. The experimental group uses 2.3/2.4/2.5/2.6/2.7/2.8/2.9 ml/s injection speed with 350 mgI/ml contrast agents according to the subgroups; injection time was fixed at 10 s. In the control group, the fixed injection flow rate was 3.5 ml/s, time was 12 s with a total of 42 ml. Subjects in both groups were inspected to adaptive prospective ECG-gating sequence scanning, and subjective and objective image quality of the two groups were compared using Student's t-test. BMI, BSA, and BV were calculated from the patient's body weight and height. We assess the relationship between aortic attenuation and BW, BMI, BV, and BSA using regression analysis or correlation analysis.

Results

Significant differences exist in vascular enhancement between the two groups; SNR and CNR of objective image quality in the experimental group were lower than those in the control group (P < 0.05). Both groups had the same subjective image scores (P > 0.05). The number of vessels in the optimal enhancement range counts more in the experimental group than in the control group (χ2 value = 334.25, P ＜ 0.05). In the control group, a weak to medium correlation was seen between vascular enhancement and BMI (r = −0.20), BW (r = −0.42), BSA (r = −0.46), and BV (r = −0.48) (P ＜ 0.05 for all).

Conclusions

Compared to BW, BSA, and BV, a weaker negative correlation exists between vascular enhancement and BMI when ATVS selects 70 KV. However, as a much easier way to operate, the stepped low flow and low-contrast agent injection based on BMI was feasible, and the image quality was more homogenized than that of the control group.

What the Baby Formula and Medical Contrast Material Shortages Have in Common: Insights and Recommendations for Managing the Iodinated Contrast Media Shortage

The impact of supply chain and supply chain logistics, including personnel directly and indirectly related to the movement of supplies, has come to light in a variety of industries since the global COVID-19 pandemic. Acutely, the experience with baby formula and iodinated contrast material exposes key vulnerabilities to supply chains. The rather sudden diminished availability of iodinated contrast material has forced health care systems to engage in more judicious use of product through catalyzing the adoption of behaviors that had been recommended and deemed reasonable prior to the shortage. The authors describe efforts at a large, academic safety net county health system to conserve iodinated contrast media by optimizing contrast media use in the CT department and changing ordering patterns of referring providers. Special attention is given to opportunities to conserve contrast material in cardiothoracic imaging, including low kV and dual-energy CT techniques. A values-based leadership philosophy and collaboration with key stakeholders facilitate effective response to the critical shortage and rapid deployment of iodinated contrast media conservation strategies. Last, while the single-supplier model is efficient and cost-effective, its application to critically necessary services such as health care must be questioned considering disruptions related to the COVID-19 pandemic. Keywords: CT, Intravenous Contrast Agents, CT-Spectral Imaging (Dual Energy) ©RSNA, 2022.

Closed versus conventional IV catheter in performing coronary CT Angiography

Background

The purpose of this study was to compare the performance of a closed IV catheter system (CICS) with conventional IV catheters for IV contrast infusion in terms of contrast enhancement and associated complications during coronary CT angiography.

It is a retrospective study of 54 patients for whom a follow-up CCTA was requested were included for this study. Those patients had previous experience with the insertion of a 18 g conventional IV catheter which allows a flow rate of ≥ 6 ml/s and the complications during injection were registered. Patients were informed that a new IV catheter (The BD Nexiva™ Diffusics™ Closed IV Catheter System 22 g while still meeting a high flow rate > 6 m/s) will be used for their examination. We analyzed mean vascular attenuations in the ascending aorta, left main coronary artery, left ventricular (LV) cavity, and descending aorta (DA). Their feedback was collected regarding pain and the number of trials for catheter insertion. In addition, the access site was evaluated for any complication e.g. perforation, contrast extravasation or contamination.

Result

All patients were very satisfied with the new cannula. The catheter was inserted from the first trials. No one has perforation or extravasation. Mean vascular attenuations of the left main coronary artery, LV cavity, and DA were significantly higher during the use 0f the BD Nexiva™ Diffusics™ Closed IV Catheter System (all P ≤ 0.001).

Conclusion

Although the CICS has a small lumen, it allows a high flow rate; therefore, IV access required for CCTA can be secured with higher vascular attenuation and fewer complications. It is encouraged to use the CIVC system for CT angiographic studies, in particular CCTA.

Optimization of Pediatric Body CT Angiography: What Radiologists Need to Know

OBJECTIVE. Pediatric CT angiography (CTA) presents unique challenges compared with adult CTA. Because of the ionizing radiation exposure, CTA should be used judiciously in children. The pearls offered here are observations gleaned from the authors' experience in the use of pediatric CTA. We also present some potential follies to be avoided. CONCLUSION. Understanding the underlying principles and paying meticulous attention to detail can substantially optimize dose and improve the diagnostic quality of pediatric CTA.

More holes, more contrast? Comparing an 18-gauge non-fenestrated catheter with a 22-gauge fenestrated catheter for cardiac CT

Objective

To compare the performance of an 18-gauge nonfenestrated catheter (18-NFC) with a 22-gauge fenestrated catheter (22-FC) for cardiac CT angiography (CCTA) in patients with suspected coronary heart disease.

Subjects and methods

74 consecutive patients imaged on a 2^nd generation dual-source CT with arterial phase CCTA were included in this retrospective investigation to either an 18-NFC or 22-FC. In comparison to the 18-NFC, the 22-FC has three additional perforations for contrast agent dispersal proximal to the tip. We examined the two groups for differences in their average attenuation in the right and left ventricles (RV, LV) and in the atrium (RA, LA) as well as in the proximal right coronary artery (RCA) and the left main coronary artery (LM). The averages were calculated for both the 18-NFC and 22-FC.

Results

Catheters were successfully placed on the first attempt 97% (36/37) for 18-NFC and 95% (35/37) for the 22-FC. The following enhancement levels were measured: 22-FC (in Hounsfield-Units (HU)): RV = 203±29, LV = 523±36, RA = 198±29, LA = 519±38, RCA = 547±26, LM = 562±25; 18-NFC: RV = 146±26, LV = 464±32, RA = 141±24, LA = 438±35, RCA = 501±23, LM = 523±23; RV (p = 0,03), LV (p = 0.12), RA (p = 0.02), LA (p = 0.04), RCA (p = 0.3), LM (p = 0.33).

Conclusion

No significant differences in attenuation levels as well as in image quality of the coronary arteries were found between NFC and FC. Nevertheless, the 22-gauge FC examinations showed significantly higher attenuation in the left and right atrium as well as the right ventricle. Patients with poor venous access may benefit from a smaller gauge catheter that can deliver sufficiently high flow rates for CCTA.

Impact of CT Injector Technology and Contrast Media Viscosity on Vascular Enhancement: Evaluation in a Circulation Phantom

Objective:

To assess the impact of piston-based vs peristaltic injection system technology and contrast media viscosity on achievable iodine delivery rates (IDRs) and vascular enhancement in a pre-clinical study.

Methods:

Four injectors were tested: MEDRAD^® Centargo, MEDRAD^® Stellant, CT Exprès^®, and CT motion^™ using five contrast media [iopromide (300 and 370 mgI ml⁻¹), iodixanol 320 mgI ml⁻¹, iohexol 350 mgI ml⁻¹, iomeprol 400 mgI ml⁻¹]. Three experiments were performed evaluating achievable IDR and corresponding enhancement in a circulation phantom.

Results:

Experiment I: Centargo provided the highest achievable IDRs with all tested contrast media (p < 0.05). Iopromide 370 yielded the highest IDR with an 18G catheter (3.15 gI/s); iopromide 300 yielded the highest IDR with 20G (2.70 gI/s) and 22G (1.65 gI/s) catheters (p < 0.05).

Experiment II: with higher achievable IDRs, piston-based injectors provided significantly higher peak vascular enhancement (up to 48% increase) than the peristaltic injectors with programmed IDRs from 1.8 to 2.4 gI/s (p < 0.05).

Experiment III: with programmed IDRs (e.g. 1.5 gI/s) achievable by all injection systems, Centargo, with sharper measured bolus shape, provided significant increases in enhancement of 34–73 HU in the pulmonary artery with iopromide 370 (p < 0.05).

Conclusion:

The tested piston-based injection systems combined with low viscosity contrast media provide higher achievable IDRs and higher peak vascular enhancement than the tested peristaltic-based injectors. With equivalent IDRs, Centargo provides higher peak vascular enhancement due to improved bolus shape.

Advances in knowledge:

This paper introduces a new parameter to compare expected performance among contrast media: the concentration/viscosity ratio. Additionally, it demonstrates previously unexplored impacts of bolus shape on vascular enhancement.

Effect of a saline flush technique for head and neck imaging in dual-energy CT: improvement of image quality and perivenous artefact reduction using virtual monochromatic imaging

AIM

To evaluate the effect of the saline flush (SF) technique on the depiction of lesions and the reduction of perivenous artefacts in the head and neck region using dual-energy computed tomography (CT) with virtual monochromatic imaging (VMI).

MATERIALS AND METHODS

Fifty patients with head and neck cancer were divided into two groups: group A, without a SF and group B, with a 30-ml SF. All images were acquired using fast kilovolt-switching CT (Revolution HD, GE Healthcare, Milwaukee, WI, USA). Contrast-to-noise ratios (CNRs) of the lesions were calculated at VMI energy levels ranging from 40 to 80 keV. Subjective analysis of overall image quality, delineation of lesions, and perivenous artefacts was conducted by two reviewers at both VMI energy level 40 keV and the optimal energy level (which showed optimal CNR by objective analysis).

RESULTS

Optimal energy level was 63 keV for group A and 61 keV for group B. At VMI energy levels ranging from 40 to 80 keV, the CNR was higher for group B. The highest subjective overall image quality was shown for group B at the optimal energy level (subjective image quality mean value, 3.40). Subjective delineation of lesions was comparable. The perivenous artefact score was significantly higher for group B (2.44 versus 2.74 [p<0.05] at 40 keV, 3.20 versus 3.46 [p<0.05] at the optimal energy level).

CONCLUSION

The SF technique results in an improvement of lesion CNR and a reduction of perivenous artefacts in VMI using duel-energy CT, especially at 40 keV.

The Usefulness of Fenestrated Intravenous Catheters Compared With Nonfenestrated Catheter for Cardiac Multidetector Computed Tomography

PURPOSE

To compare the fenestrated intravenous (IV) catheter and nonfenestrated conventional IV catheter in terms of contrast enhancement and injection pressure for coronary computed tomography angiography.

METHODS

Three hundred patients were prospectively and consecutively enrolled to either the 20-gauge nonfenestrated conventional (group 1) IV catheter group or the 20-gauge fenestrated (group 2) or 22-gauge fenestrated (group 3) IV catheter groups. We analyzed mean vascular attenuations in the ascending aorta, left main coronary artery, left ventricular (LV) cavity, and descending aorta. Injection pressure using pound-force per square inch (PSI) and extravasation of contrast media were recorded.

RESULTS

Mean attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 2 than in group 1 (P ≤ 0.001, P ≤ 0.001, P ≤ 0.001, respectively). Moreover, injection pressure was significantly lower in group 2 than in group 1 (208.3 vs 216.9 PSI, P = 0.006). Mean vascular attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 3 than in group 1 (P = 0.016, P = 0.029, P = 0.001, respectively). However, injection pressure was not statistically significant between group 3 and group 1 (213.6 vs 216.9 PSI, P = 0.355). No extravasation occurred in any patient groups during the study.

CONCLUSIONS

We suggest that fenestrated IV catheter is useful in terms of higher vascular attenuation and lower injection pressure for coronary computed tomography angiography. It has a potential merit in patients with fragile and small veins.

Basic Concepts of Contrast Injection Protocols for Coronary Computed Tomography Angiography

BACKGROUND

Coronary Computed Tomography Angiography (CTA) has become one of the most important diagnostic imaging modalities for the evaluation of coronary artery diseases. During coronary computed CTA, sufficient vascular enhancement is essential for the accurate detection and evaluation of lesions in the coronary arteries. To obtain optimal contrast enhancement and perform appropriate clinical coronary CTA, physicians, radiologists, and radiology technologists should acquire a basic knowledge of contrast injection protocols.

CONCLUSION

This review article summarizes the basic concepts of contrast injection protocols for coronary CTA.

Spiral flow-generating tube for saline chaser improves aortic enhancement in Gd-EOB-DTPA-enhanced hepatic MRI

OBJECTIVES

To evaluate the effect of a spiral tube on contrast enhancement in the hepatic arterial phase (HAP) of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).

METHODS

In this retrospective study, we observed 104 patients who underwent dynamic MRI of the liver between October 2017 and December 2017. Three Gd-EOB-DTPA injection protocols were compared: (A) conventional method (undiluted Gd-EOB-DTPA, injection rate 1 ml/s, n = 36); (B) spiral dilution method (1:1 diluted Gd-EOB-DTPA with saline [off-label], injection rate 2 ml/s via spiral tube, n = 38); (C) spiral-flushed method (undiluted Gd-EOB-DTPA, injection rate 1 ml/s via spiral tube, n = 30). We regarded protocol-A as a control. The signal-to-noise ratio (SNR) of the abdominal aorta was calculated using arterial phase images. Image contrast and artefacts were evaluated by two board-certified radiologists, using a four-point scale. Statistical analyses included Dunnett's test, the Kruskal-Wallis test and the Steel test.

RESULTS

The SNR of the aorta was significantly higher with protocol-C (25.4 ± 8.8) than protocol-A (20.8 ± 5.4, p = 0.01). There was no significant difference in SNR between protocols A and B (p = 0.47). The contrast score of protocol-C was significantly higher than that of protocol-A (p = 0.0019). There was no significant difference in contrast score between protocols A and B (p = 0.50). There was no significant difference in artefacts among the three protocols (p = 0.96).

CONCLUSIONS

Use of a spiral tube with a slow injection protocol contributed to improved aortic contrast enhancement in the HAP of GD-EOB-DTPA-enhanced hepatic MRI.

KEY POINTS

• Gadoxetic acid shows weaker arterial enhancement at recommended doses, compared with nonspecific gadolinium agents; selection of an appropriate injection protocol is important. • A spiral flow-generating tube improves the transport efficiency of the contrast media, and increases the signal-to-noise ratio of the aorta in hepatic arterial phase. • A spiral flow-generating tube does not contribute to artefact reduction in hepatic arterial phase.

[Effects of Mathematical Analysis of Test Injection on the CT Value Estimation of the Aorta]

The circulation time and the mechanical acceleration time (MA time) of an automatic injector were simulated using pharmacokinetic analysis. The addition method and transfer-function method, which are mathematical techniques used for analyzing the test bolus method in multi-detector computed tomography, were used to verify the accuracy of estimation of the time-enhancement curve (TEC) of the main bolus. The TEC estimated using the addition method, and the TEC of the main bolus matched completely only if the MA time of the automatic injector was set to 0 seconds. Moreover, the estimation accuracy of the TEC deteriorated when the MA time was set according to the TEC estimated by the addition method. In contrast, the TEC estimated using the transfer-function method, except when the MA time of the automatic injector was 0 seconds, had higher accuracy than the TEC estimated using the addition method. In this study, the addition method, a number of additions of TEC, and MA time of the automatic injector were found to have a negative effect on the estimation accuracy of the main bolus. The use of the transfer-function method for determining the TEC and the MA time has a positive effect on the estimation accuracy of the main bolus.

Getting the Most From Your Dual-Energy Scanner: Recognizing, Reducing, and Eliminating Artifacts

OBJECTIVE

Dual-energy CT (DECT) is an innovative imaging modality that allows superior detection of pulmonary embolism, enhanced detection of urate in gout, and improved assessment of metal prostheses when compared with conventional CT.

CONCLUSION

The primary aim of this review is to describe these DECT protocols and compare each to its respective diagnostic reference standards. Moreover, this review will describe how to recognize, reduce, and eliminate DECT artifacts, thereby maximizing its diagnostic capabilities.

Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know

Over the last decade, exponential advances in computed tomography (CT) technology have resulted in improved spatial and temporal resolution. Faster image acquisition enabled renal CT angiography to become a viable and effective noninvasive alternative in diagnosing renal vascular pathologies. However, with these advances, new challenges in contrast media administration have emerged. Poor synchronization between scanner and contrast media administration have reduced the consistency in image quality with poor spatial and contrast resolution. Comprehensive understanding of contrast media dynamics is essential in the design and implementation of contrast administration and image acquisition protocols. This review includes an overview of the parameters affecting renal artery opacification and current protocol strategies to achieve optimal image quality during renal CT angiography with iodinated contrast media, with current safety issues highlighted.

Recommendations for accurate CT diagnosis of suspected acute aortic syndrome (AAS)--on behalf of the British Society of Cardiovascular Imaging (BSCI)/British Society of Cardiovascular CT (BSCCT)

Accurate and timely assessment of suspected acute aortic syndrome is crucial in this life-threatening condition. Imaging with CT plays a central role in the diagnosis to allow expedited management. Diagnosis can be made using locally available expertise with optimized scanning parameters, making full use of recent advances in CT technology. Each imaging centre must optimize their protocols to allow accurate diagnosis, to optimize radiation dose and in particular to reduce the risk of false-positive diagnosis that may simulate disease. This document outlines the principles for the acquisition of motion-free imaging of the aorta in this context.

I.v. contrast administration with dual source 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications

OBJECTIVE

The purpose of this study was to compare the performance of a 20-gauge fenestrated catheter with an 18-gauge nonfenestrated catheter for i.v. contrast infusion during MDCT.

SUBJECTS AND METHODS

Two hundred five adult outpatients imaged on a dual-source 128-MDCT scanner with arterial phase body CT (flow rates, 5.0-7.5 mL/s) were randomized to either an 18-gauge nonfenestrated or 20-gauge fenestrated catheter. After randomization, any 18-gauge nonfenestrated subjects whose veins were deemed insufficient for that catheter gauge were assigned to a third cohort for placement of a 20-gauge fenestrated catheter. Catheter placement success, infusion rate, contrast volume, maximum pressure, complications, and aortic enhancement levels were recorded.

RESULTS

Catheters were placed on the first attempt in 97% (100/103) for 18-gauge nonfenestrated and 94% (96/102) for 20-gauge fenestrated placements and in two or fewer attempts in 99% of both groups. Mean infusion rates (5.74 mL/s for 18-gauge nonfenestrated and 5.58 mL/s for 20-gauge fenestrated placements) and aortic enhancement levels were not significantly different. Maximum pressure was higher with 20-gauge fenestrated catheters (mean ± SD, 230.5 ± 27.6 pounds per square inch [psi]) than 18-gauge nonfenestrated catheters (mean ± SD 215.6 ± 32.8 psi) (p = 0.002). One subject with an 18-gauge nonfenestrated catheter had a high-pressure alarm. In the third cohort, a 20-gauge fenestrated catheter was successfully placed in two or fewer attempts in 85% (28/33), with one minor extravasation attributed to vein insufficiency.

CONCLUSION

A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to i.v. contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.

Impact of iodine delivery rate with varying flow rates on image quality in dual-energy CT of patients with suspected pulmonary embolism

RATIONALE AND OBJECTIVES

To prospectively compare four contrast material injection protocols for dual-energy computed tomography (CT) pulmonary angiography (DE-CTPA) in patients with suspected pulmonary embolism (PE).

MATERIALS AND METHODS

One hundred twenty consecutive patients were randomized to contrast material injection protocols defined by different iodine concentrations and iodine delivery rates (IDRs): (A) 80 mL iopromide 370/4 mL/sec = IDR 1.4 gI/sec; (B) 80 mL iopromide 370 at 3 mL/sec = IDR 1.1 gI/sec; (C) 98 mL iopromide 300 at 4.9 mL/sec = IDR 1.4 gI/sec; and (D) 98 mL iopromide 300 at 3.7 mL/sec = IDR 1.1 gI/sec. Attenuation values were measured in the inflow tract (subclavian vein-superior vena cava-right atrium), target tract (right ventricle-pulmonary trunk-pulmonary arteries), and outflow tract (left atrium-left ventricle-ascending aorta). Two readers assessed subjective image quality of CTPA images and iodine perfusion maps. The number of artifacts due to hyperdense contrast material on iodine perfusion maps was recorded.

RESULTS

Target tract attenuation was highest for protocol A with 374 ± 98 Hounsfield units (HU) (highly concentrated contrast material/high IDR). This was significant compared to protocols B and D (P = .0118, P = .0427) but not compared to protocol C (P = .3395). No significant difference in target tract attenuation was found between protocols B (309 ± 80 HU), protocol C (352 ± 119 HU), and D (325 ± 74 HU). CTPA and iodine perfusion map image quality for protocol A was rated significantly higher compared to all other protocols (median score = 5/4; P < .0001 for both) with moderate interreader agreement (κ = 0.58/0.47). Protocols A and B displayed increased artifacts on iodine perfusion maps compared to protocols C and D (3 versus 2).

CONCLUSION

Despite increased artifacts on iodine perfusion maps, highly concentrated iodinated contrast material combined with high flow rates provides improved diagnostic image quality and has the highest target-tract attenuation for DE-CTPA protocols.

Identification of the iodine concentration that yields the highest intravascular enhancement in MDCT angiography

OBJECTIVE

The objective of our study was to identify the iodine concentration that yields the highest intravascular contrast enhancement in MDCT angiography by intraindividual comparison in an animal model.

MATERIALS AND METHODS

Six pigs underwent repeated chest MDCT examinations under standardized conditions using the same contrast medium (iopromide) with different iodine concentrations (150, 240, 300, and 370 mg I/mL). The contrast injection protocol was adapted to ensure an identical iodine delivery rate of 1.5 g I/s and the same total iodine dose of 300 mg/kg of body weight for all studies. Dynamic CT scans were acquired at the levels of the pulmonary artery and the ascending and descending aorta. Pulmonary and aortic peak enhancement values as well as time to peak (TTP) were calculated from time-enhancement curves.

RESULTS

Pulmonary and aortic peak contrast enhancement values were significantly higher with the 240 and 300 mg I/mL contrast media than the 150 and 370 mg I/mL contrast media (e.g., ascending aorta: 240 vs 150, p = 0.0070; 300 vs 150, p = 0.0096; 240 vs 370, p = 0.0262; 300 vs 370, p = 0.0079). TTP values tended to be lower for the 150 mg I/mL contrast medium than for the contrast media with higher iodine concentrations.

CONCLUSION

Comparison of contrast media with iodine concentrations ranging from 150 to 370 mg I/mL showed that contrast enhancement was significantly improved with the use of 240 and 300 mg I/mL contrast media given a fixed identical iodine delivery and normalized total iodine load in a porcine model. Contrast media with a moderate iodine concentration are most suitable for obtaining the highest intravascular contrast enhancement in CT angiography.

[Assessment of the effects of administering a saline solution flush after contrast medium injection using different injection durations and flush methods]

The purpose of administering a saline solution flush after contrast medium injection is to more effectively utilize the contrast medium remaining in the vessels from the subclavian vein to the superior vena cava. In order to investigate the effects of administering a saline solution flush after a contrast medium injection, we evaluated the effects of various contrast medium injection durations and injection methods on the time-density curve (TDC) using a custom-made TDC measurement phantom. The TDC was found to have a biphasic appearance, showing a rapid increase after the arrival of contrast medium in the target region followed by a slower increase from an inflection point at 25 s after the start of contrast medium injection, reflecting the differences in circulatory dynamics for each duration. The results showed that the effect of saline solution flush was allowed the differences by contrast medium duration at the inflection point. Specifically, when the saline solution flush was administered before the inflection point, the CT number was increased, and when it was administered after the inflection point, contrast enhancement was prolonged. With regard to the method in which the saline solution flush is administered before the inflection point, it was found that injecting a mixture of contrast medium and saline solution before the saline solution flush reduced the degree of inflection of the TDC, resulting in a more stable TDC.

Effect of varying contrast material iodine concentration and injection technique on the conspicuity of hepatocellular carcinoma during 64-section MDCT of patients with cirrhosis

OBJECTIVES

The aim of this study was to compare the intraindividual effects of contrast material with two different iodine concentrations on the conspicuity of hepatocellular carcinoma (HCC) and vascular and hepatic contrast enhancement during multiphasic, 64-section multidetector row CT (MDCT) in patients with cirrhosis using two contrast medium injection techniques.

METHODS

Patients were randomly assigned to one of two groups with an equal iodine dose but different contrast material injection techniques: scheme A, fixed injection duration (25 s), and scheme B, fixed injection flow rate (4 ml s(-1)). For each group, patients were randomised to receive both moderate-concentration contrast medium (MCCM) and high-concentration contrast medium (HCCM) during two CT examinations within 3 months. Enhancement of the aorta, liver and portal vein and the tumour-to-liver contrast-to-noise ratio (CNR) were compared between MCCM and HCCM.

RESULTS

30 patients (mean age 59 years; range 45-80 years; 16 patients in scheme A and 14 in scheme B) with a total of 31 confirmed HCC nodules were prospectively enrolled. For scheme B, the mean contrast enhancement of the aorta and tumour-to-liver CNR were significantly higher with HCCM than with MCCM during the hepatic arterial phase (+350.5 HU vs +301.1 HU, p = 0.001, and +7.5 HU vs +5.5 HU, p = 0.004). For both groups, there was no significant difference between MCCM and HCCM for all other comparisons.

CONCLUSION

For a constant injection flow rate, HCCM significantly improves the conspicuity of HCC lesions and aortic enhancement during the hepatic arterial phase on 64-section MDCT in patients with cirrhosis.

Comparison of varying injection rates of saline chasers on intravascular contrast enhancement for dynamic CT in cattle

Dynamic CT was performed in five normal Holstein calves to investigate the effect of saline chasers on intravascular contrast enhancement when administered at three different rates. The five calves were imaged using dynamic CT in a crossover study design. Group A was administered only contrast medium (600 mg iodine/kg, 4 ml/s), while groups B, C and D were administered contrast medium at 30 per cent reduction followed by saline chasers injected at 2, 4 and 8 ml/s, respectively. Attenuation values were obtained from the right and left maxillary arteries and dorsal sagittal sinus. Maximum enhancement value and mean value of the enhancement plateau obtained from the maxillary arteries were significantly lower in group B than in the other groups. The duration of the enhancement plateau was longer in group C than in groups B and D (P<0.05).

Intravenous contrast medium administration and scan timing at CT: considerations and approaches

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.