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Girón-Arango L, Peng P. Spread of injectate in pericapsular nerve group block: a Rashomon effect? Reg Anesth Pain Med 2024:rapm-2024-105870. [PMID: 39106987 DOI: 10.1136/rapm-2024-105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 08/09/2024]
Affiliation(s)
- Laura Girón-Arango
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philip Peng
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Stammen L, Mihl C, Vandewall J, Pennetta F, Hersbach A, Wildberger JE, Martens B. Influence of Contrast Media Temperature and Concentration on Patient Comfort and Safety in Computed Tomography: CATCHY II Trial. Invest Radiol 2024; 59:577-582. [PMID: 38240647 DOI: 10.1097/rli.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Previous research on the necessity to reduce the viscosity of contrast media (CM) by either prewarming CM before injection during computed tomography (CT) or by using less concentrated CM has yielded conflicting results. In addition, there is limited evidence on patient comfort. OBJECTIVES The aim of the study was to examine if prewarming CM, with varying CM concentrations, is superior to CM at room temperature, with respect to patient comfort and safety in CT. MATERIALS AND METHODS All elective patients scheduled for contrast-enhanced CT scans at Maastricht University Medical Center+ between October 27, 2021 and October 31, 2022 were eligible for inclusion when a questionnaire evaluating patient comfort was completed. This 1-year period was divided into 4 intervals (4 groups): group 1 (370 mg I/mL, 37°C), group 2 (370 mg I/mL, room temperature), group 3 (300 mg I/mL, 37°C), and group 4 (300 mg I/mL, room temperature). All CT scans were performed using state of the art equipment (Siemens Healthineers; SOMATOM Force and SOMATOM Definition AS, Forchheim, Germany). Contrast media injections were performed using a dual-head power injector (Stellant; Bayer Healthcare, Berlin, Germany) and individualized to body weight and/or tube voltage, depending on the CM protocols. After the CT scan, patients completed a questionnaire covering the primary outcomes comfort, pain, and adverse events such as feelings of heat, nausea, vomiting, itchiness, urticaria, difficulty breathing, dizziness, goosebumps, or an odd taste. Technicians were asked to report any adverse events, including extravasation and allergic-like reactions. The secondary outcome involved attenuation (in Hounsfield unit, HU), which was evaluated by assessing the HU of the coronary arteries for vascular CT, and liver enhancement in portal venous CT. The Kruskal-Wallis test was used for continuous scale outcomes and χ 2 tests for examining adverse events. RESULTS Results showed no significant differences examining comfort score ( P = 0.054), pain sensation ( P = 0.469), extravasation ( P = 0.542), or allergic-like reaction ( P = 0.253). Significant differences among the 4 groups were found with respect to heat sensation and dizziness ( P = 0.005 and P = 0.047, respectively), showing small effect sizes. All other adverse effects showed no significant results. No significant differences were observed in coronary attenuation among the 4 groups in coronary CT angiography ( P = 0.113). When analyzing attenuation in portal venous CT scans, significant differences were found among the 4 groups ( P = 0.008). CONCLUSIONS Administrating prewarmed CM is nonsuperior compared with CM at room temperature in relation to patient comfort and safety, regardless of CM concentration. These findings suggest that prewarming CM before usage is unnecessary, which will improve the efficiency of daily clinical workflow and brings environmentally friendly benefits.
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Affiliation(s)
- Lion Stammen
- From the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (L.S., C.M., J.V., F.P., A.H., J.E.W., B.M.); and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands (L.S., C.M., J.E.W., B.M.)
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Wagner MG, Whitehead JF, Periyasamy S, Laeseke PF, Speidel MA. Spatiotemporal frequency domain analysis for blood velocity measurement during embolization procedures. Med Phys 2024; 51:1726-1737. [PMID: 37665770 PMCID: PMC10909916 DOI: 10.1002/mp.16715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Currently, determining procedural endpoints and treatment efficacy of vascular interventions is largely qualitative and relies on subjective visual assessment of digital subtraction angiography (DSA) images leading to large interobserver variabilities and poor reproducibility. Quantitative metrics such as the residual blood velocity in embolized vessel branches could help establish objective and reproducible endpoints. Recently, velocity quantification techniques based on a contrast enhanced X-ray sequence such as qDSA and 4D DSA have been proposed. These techniques must be robust, and, to avoid radiation dose concerns, they should be compatible with low dose per frame image acquisition. PURPOSE To develop and evaluate a technique for robust blood velocity quantification from low dose contrast enhanced X-ray image sequences that leverages the oscillating signal created by pulsatile blood flow. METHODS The proposed spatiotemporal frequency domain (STF) approach quantifies velocities from time attenuation maps (TAMs) representing the oscillating signal over time for all points along a vessel centerline. Due to the time it takes a contrast bolus to travel along the vessel centerline, the resulting TAM resembles a sheared sine wave. The shear angle is related to the velocity and can be determined in the spatiotemporal frequency domain after applying the 2D Fourier transform to the TAM. The approach was evaluated in a straight tube phantom using three different radiation dose levels and compared to ultrasound transit-time-based measurements. The STF velocity results were also compared to previously published approaches for the measurement of blood velocity from contrast enhanced X-ray sequences including shifted least squared (SLS) and phase shift (PHS). Additionally, an in vivo porcine study (n = 8) was performed where increasing amounts of embolic particles were injected into a hepatic or splenic artery with intermittent velocity measurements after each injection to monitor the resulting reduction in velocity. RESULTS At the lowest evaluated dose level (average air kerma rate 1.3 mGy/s at the interventional reference point), the Pearson correlation between ultrasound and STF velocity measurements was99 % $99\%$ . This was significantly higher (p < 0.0001 $p < 0.0001$ ) than corresponding correlation results between ultrasound and the previously published SLS and PHS approaches (91 $\hskip.001pt 91$ and93 % $93\%$ , respectively). In the in vivo study, a reduction in velocity was observed in85.7 % $85.7\%$ of cases after injection of 1 mL,96.4 % $96.4\%$ after 3 mL, and100.0 % $100.0\%$ after 4 mL of embolic particles. CONCLUSIONS The results show good agreement of the spatiotemporal frequency domain approach with ultrasound even in low dose per frame image sequences. Additionally, the in vivo study demonstrates the ability to monitor the physiological changes due to embolization. This could provide quantitative metrics during vascular procedures to establish objective and reproducible endpoints.
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Affiliation(s)
- Martin G Wagner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Joseph F Whitehead
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarvesh Periyasamy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Nawras M, Alyousif Z, Beran A, Elsamaloty H. The relationship between iodinated contrast material temperature and adverse reactions: A meta-analysis of 307,329 injections. Clin Imaging 2023; 100:54-59. [PMID: 37216743 DOI: 10.1016/j.clinimag.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The effect of iodinated contrast material (CM) temperature on injection pressures and viscosity has been well established. However, the effect of extrinsic warming of CM on allergic reactions and extravasations remains unclear. The purpose of this study is to compare the rates of allergic reactions and extravasations between warmed CM to room temperature CM. METHODS We conducted a comprehensive systematic search using PubMed, Embase, and Web of Science databases for all studies that assess the impact of warmed CM on adverse reactions. The primary outcomes of our study were allergic reaction and extravasation rates. We calculated weighted pooled odds ratios (OR) and 95% confidence intervals (CI) for all outcomes using the random-effects model. A P-value <0.05 was considered statistically significant. We conducted subgroup analyses based on the viscosity of the CM. RESULTS A total of five studies, including 307,329 CM injections (86,676 at room temperature and 220,653 warmed to 37 °C), were included in the analysis. For high viscosity CM, pre-warming was associated with significantly lower allergic reaction rates (OR: 0.59, 95% CI: 0.49-0.72, P < 0.00001). There was no significant difference in rates of extravasation for high viscosity CM (OR: 0.53, 95% CI: 0.20-1.43, P = 0.21). DISCUSSION Our meta-analysis suggests that warming CM to 37 °C is a safe and effective approach to reduce the risk of allergic reactions and physiologic reactions during injection of high-viscosity CM. However, there was no significant difference in extravasation rates between warmed and room temperature CM, regardless of viscosity.
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Affiliation(s)
- Mohamad Nawras
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
| | - Zakaria Alyousif
- University of Toledo College of Health and Human Services, Toledo, OH, USA
| | - Azizullah Beran
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Haitham Elsamaloty
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA; University of Toledo Department of Radiology, Toledo, OH, USA
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Chang S, Jung JI, Beck KS. Low Tube Voltage Chest Computed Tomography With Enhancement Using Low-Concentration Iodinated Contrast Media: Comparison of 240 mg/mL Versus 300 mg/mL Iodinated Contrast Media. Can Assoc Radiol J 2023; 74:127-136. [PMID: 35593132 DOI: 10.1177/08465371221102631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose: To evaluate the image quality of low voltage chest computed tomography with enhancement (CECT) using low-concentration-iodine contrast media (LCCM). Method: From 9 December to 19 December 2019, three different protocols were used for 263 patients undergoing chest CECT. Chest CECT was done using routine (300 mgI/ml contrast media with 100 kVp) protocol (group 1), LCCM (240 mgI/ml contrast media)-100 kVp protocol (group 2) and LCCM-80 kVp protocol (group 3) in 91, 97 and 75 patients, respectively. The overall diagnostic acceptability, anatomical depiction, noise and contrast-related artifacts were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and figure of merit (FOM) in the aorta and the main pulmonary trunk were measured. Results: The overall diagnostic acceptability scores were not significantly different between groups 1 and 2 (P = .261); group 3 demonstrated significantly lower overall diagnostic acceptability score compared with group 1 (P = .011) or group 2 (P < .001). However, in CECT with iterative reconstruction (IR), the overall diagnostic acceptability scores did not show significant difference among 3 groups. Group 3 showed significantly lower effective radiation dose compared with group 1 (2.33 vs 1.22 mSv, P < .001) or group 2 (2.28 vs .22 mSv, P < .001). Conclusions: In 100 kVp chest CECT, the image quality of using 240 mg/mL iodinated contrast media is comparable to that using 300 mg/mL iodine contrast media, regardless of application of IR; with IR, chest CECT using 80 kVp and 240 mg/mL iodinated contrast media results in acceptable image quality and lower radiation dose.
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Affiliation(s)
- Suyon Chang
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Im Jung
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyongmin S Beck
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Du Y, Wang YN, Wang Q, Qi XH, Shi GF, Jia LT, Wang XM, Shi JB, Liu FY, Wang LJ, Liu X. A comparison of the use of contrast media with different iodine concentrations for enhanced computed tomography. Front Physiol 2023; 14:1141135. [PMID: 37064921 PMCID: PMC10101225 DOI: 10.3389/fphys.2023.1141135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/03/2023] [Indexed: 04/18/2023] Open
Abstract
Objective: In this study, we compared the enhancement of blood vessels and liver parenchyma on enhanced computed tomography (CT) of the upper abdomen with two concentrations of contrast media (400 and 300 mg I/mL) based on similar iodine delivery rate (IDR) of 0.88 and 0.9 g I/s and iodine load of 450 mg I/kg. Methods: We randomly assigned 160 patients into two groups: iomeprol 400 mg I/mL (A group) and iohexol 300 mg I/mL (B group). The CT attenuation values of the main anatomical structures in the two groups with different scanning phases were measured and the image quality of the two groups was analyzed and compared. The peak pressure and local discomfort (including fever and pain) during contrast medium injection were recorded. Results: The mean attenuation value of the abdominal aorta was 313.6 ± 29.6 in the A group and 322.4 ± 30.1 in the B group during the late arterial phase (p = 0.8). Meanwhile, the mean enhancement values of the portal vein were 176.2 ± 19.3 and 165.9 ± 24.5 in the A and B groups, respectively, during the portal venous phase (p = 0.6). The mean CT values of liver parenchyma were 117.1 ± 15.3 and 108.8 ± 18.7 in the A and B groups, respectively, during the portal venous phase (p = 0.9). There was no statistical difference in image quality, peak injection pressure (psi), and local discomfort between the two groups (p > 0.05). Conclusion: When a similar IDR and the same iodine load are used, CT images with different concentrations of contrast media have the same subjective and objective quality, and can meet the diagnostic needs.
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McDermott MC, Sartoretti T, Mihl C, Pietsch H, Alkadhi H, Wildberger JE. Third-Generation Cardiovascular Phantom: The Next Generation of Preclinical Research in Diagnostic Imaging. Invest Radiol 2022; 57:834-840. [PMID: 35703259 DOI: 10.1097/rli.0000000000000894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Different types of preclinical research tools used in the field of diagnostic imaging such as dynamic flow circulation phantoms have built the foundation for optimization and advancement of clinical procedures including new imaging techniques. The objective was to introduce a third-generation phantom, building on the limitations of earlier versions and unlocking new opportunities for preclinical investigation. MATERIAL AND METHODS A third-generation phantom was designed and constructed comprising physiological vascular models from head to toe, including a 4-chamber heart with embedded heart valves and a controllable electromechanical pump. The models include modular segments, allowing for interchangeability between healthy and diseased vessels. Clinical sanity checks were performed using the phantom in combination with a dual-head power injector on a third-generation dual-source computed tomography scanner. Contrast media was injected at 1.5 g I/s, and the phantom was configured with a cardiac output of 5.3 L/min. Measurements of mean transit times between key vascular landmarks and peak enhancement values in Hounsfield units (HUs) were measured to compare with expected in vivo results estimated from literature. RESULTS Good agreement was obtained between literature reference values from physiology and measured results. Contrast arrival between antecubital vein and right ventricle was measured to be 13.1 ± 0.3 seconds. Transit time from right ventricle to left ventricle was 12.0 ± 0.2 seconds, from left internal carotid artery to left internal jugular vein 7.7 ± 0.4 seconds, and 2.9 ± 0.2 seconds from aortic arch to aortic bifurcation. The peak enhancement measured in the regions of interest was between 336 HU and 557 HU. CONCLUSIONS The third-generation phantom demonstrated the capability of simulating physiologic in vivo conditions with accurate contrast media transport timing, good repeatability, and expected enhancement profiles. As a nearly complete cardiovascular system including a functioning 4-chamber heart and interchangeable disease states, the third-generation phantom presents new opportunities for the expansion of preclinical research in diagnostic imaging.
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Affiliation(s)
| | | | | | | | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Individualized Contrast Media Application Based on Body Weight and Contrast Enhancement in Computed Tomography of Livers without Steatosis. Diagnostics (Basel) 2022; 12:diagnostics12071551. [PMID: 35885457 PMCID: PMC9322492 DOI: 10.3390/diagnostics12071551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
This study analyzes the homogeneity in liver attenuation of a body-weight-based protocol compared to a semi-fixed protocol. Patients undergoing abdominal multiphase computed tomography received 0.500 g of iodine (gI) per kilogram of body weight. Liver attenuation and enhancement were determined using regions of interest on scans in the pre-contrast and portal venous phases. The outcomes were analyzed for interpatient uniformity in weight groups. The subjective image quality was scored using a four-point Likert scale (excellent, good, moderate, and nondiagnostic). A total of 80 patients were included (56.3% male, 64 years, 78.0 kg) and were compared to 80 propensity-score-matched patients (62.5% male, 63 years, 81.7 kg). The liver attenuation values for different weight groups of the TBW-based protocol were not significantly different (p = 0.331): 109.1 ± 13.8 HU (≤70 kg), 104.6 ± 9.70 HU (70−90 kg), and 105.1 ± 11.6 HU (≥90 kg). For the semi-fixed protocol, there was a significant difference between the weight groups (p < 0.001): 121.1 ± 12.1 HU (≤70 kg), 108.9 ± 11.0 HU (70−90 kg), and 105.0 ± 9.8 HU (≥90 kg). For the TBW-based protocol, the enhancement was not significantly different between the weight groups (p = 0.064): 46.2 ± 15.1 HU (≤70 kg), 59.3 ± 6.8 HU (70−90 kg), and 52.1 ± 11.7 HU (≥90 kg). Additionally, for the semi-fixed protocol, the enhancement was not significantly different between the weight groups (p = 0.069): 59.4 ± 11.0 HU (≤70 kg), 53.0 ± 10.3 HU (70−90 kg), and 52.4 ± 7.5 HU (≥90 kg). The mean administered amount of iodine per kilogram was less for the TBW-based protocol compared to the semi-fixed protocol: 0.499 ± 0.012 and 0.528 ± 0.079, respectively (p = 0.002). Of the TBW-based protocol, 17.5% of the scans scored excellent enhancement quality, 76.3% good, and 6.3% moderate. Of the semi-fixed protocol, 70.0% scored excellent quality, 21.3% scored good, and 8.8% scored moderate. In conclusion, the TBW-based protocol increased the interpatient uniformity of liver attenuation but not the enhancement in the portal venous phase compared to the semi-fixed protocol, using an overall lower amount of contrast media and maintaining good subjective image quality.
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Martens B, Wildberger JE, Van Kuijk SMJ, De Vos-Geelen J, Jeukens CRLPN, Mihl C. Influence of Contrast Material Temperature on Patient Comfort and Image Quality in Computed Tomography of the Abdomen: A Randomized Controlled Trial. Invest Radiol 2022; 57:85-89. [PMID: 34280944 DOI: 10.1097/rli.0000000000000807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND International guideline recommendations on safe use of contrast media (CM) are conflicting regarding the necessity to prewarm iodinated CM. PURPOSE Aim of the study was to evaluate the effects of room temperature CM compared with prewarmed CM on image quality, safety, and patient comfort in abdominal computed tomography (CT). METHODS CATCHY (Contrast Media Temperature and Patient Comfort in Computed Tomography of the Abdomen) is a double-blinded, randomized noninferiority trial. Between February and August 2020, 218 participants referred for portal venous abdominal CT were prospectively and randomly assigned to 1 of 2 groups. All patients received iopromide at 300 mg I/mL: group 1 at room temperature (~23°C [~73°F]) and group 2 prewarmed to body temperature (37°C [99°F]). A state-of-the-art individualized CM injection protocol was used, based on body weight and adapted to tube voltage. Primary outcome was absolute difference in mean liver attenuation between groups, calculated with a 2-sided 95% confidence interval. The noninferiority margin was set at -10 HU. Secondary outcomes were objective (signal-to-noise ratio and contrast-to-noise ratio) and subjective image quality; CM extravasations and other adverse events; and participant comfort (5-point scale questionnaire) and pain (numeric rating scale). This trial is registered with ClinicalTrials.gov (NCT04249479). RESULTS The absolute difference in mean attenuation between groups was + 4.23 HU (95% confidence interval, +0.35 to +8.11; mean attenuation, 122.2 ± 13.1 HU in group 1, 118.0 ± 15.9 HU in group 2; P = 0.03). Signal-to-noise ratio, contrast-to-noise ratio, and subjective image quality were not significantly different between groups (P = 0.53, 0.23, and 0.99 respectively). Contrast extravasation occurred in 1 patient (group 2), and no other adverse events occurred. Comfort scores were significantly higher in group 1 than in group 2 (P = 0.03); pain did not significantly differ (perceived P > 0.99; intensity P = 0.20). CONCLUSIONS Not prewarming iodinated CM was found noninferior in abdominal CT imaging. Prewarming conferred no beneficial effect on image quality, safety, and comfort, and might therefore no longer be considered a prerequisite in state-of-the art injection protocols for parenchymal imaging.
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Affiliation(s)
| | | | - Sander M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center
| | | | - Cécile R L P N Jeukens
- From the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center
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O'Sullivan KJ, Kermavnar T, Gorski KA, Arnous S, O'Sullivan LW. Warmed contrast media temperature loss in traditional manifold systems during angiographic procedures. Acta Radiol 2021; 63:1627-1633. [PMID: 34747192 DOI: 10.1177/02841851211055393] [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: 11/15/2022]
Abstract
BACKGROUND Extrinsic warming of contrast media (CM) to 37 °C before angiographic procedures is performed to improve bolus kinetics and avoid potential adverse effects. Extrinsically warmed CM readily loses temperature after removal from the warming cabinet, but the extent of its cooling has not been previously investigated. PURPOSE To assess temperature loss of extrinsically warmed CM in tubing of traditional angiographic manifolds during simulated angiography. MATERIAL AND METHODS In total, 35 scheduled diagnostic angiographic procedures were observed in a hospital setting. Relevant time points of CM use during the procedures were recorded. The shortest, median, and longest procedures were then simulated in the experimental laboratory to measure CM temperatures at specific times at three locations along the tubing system. RESULTS The angiographic procedures lasted 7.0-26.6 min (median = 11.7 min), with the total duration dependent primarily on the time from contrast being removed from the warming cabinet to the commencement of imaging. During the simulated procedures, consistent patterns of temperature loss were observed. By the last simulated angiographic run, injected CM temperature decreased by 7.4-16.4 °C, depending on procedure length. Most of the heat loss occurred in the tubing between the CM bottle and coronary control syringe. CONCLUSION During angiographic procedures, prewarmed CM loses its temperature rapidly with the duration of exposure to ambient room temperature. If no additional measures are employed to maintain its temperature outside of the warming cabinet, extrinsic warming has limited impact on injected CM temperature.
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Affiliation(s)
- Kevin J. O'Sullivan
- School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Tjaša Kermavnar
- School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | | | | | - Leonard W. O'Sullivan
- School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, School of Design and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
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Abstract
Ultra-high molecular weight polyethylene (UHMWPE) can be made radiopaque for medical imaging applications through the diffusion of an iodised oil-based contrast agent (Lipiodol Ultra Fluid). A similar process is used for Vitamin E incorporated polyethylene which provides antioxidant properties. This study aimed to investigate the critical long-term properties of oil-infused medical polyethylene after 4 weeks of accelerated thermal ageing. Samples treated with an oil (Vitamin E or Lipiodol) had a higher oxidation stability than currently used medical grade polyethylene, indicated by a smaller increase in oxidation index after ageing (Vitamin E + 36%, Lipiodol +40%, Untreated +136%, Thermally treated +164%). The tensile properties of oil treated polyethylene after ageing were significantly higher than the Untreated and Thermally treated controls (p<0.05) indicating less mechanical degradation. There was also no alteration in the percentage crystallinity of oil treated samples after ageing, though the radiopacity of the Lipiodol treated samples reduced by 54% after ageing. The leaching of oil with time was also investigated; the leaching of Lipiodol and Vitamin E followed the same trend and reached a steady state by two weeks. Overall, it can be concluded that the diffusion of an oil-based fluid into polyethylene not only increases the oxidative and chemical stability of polyethylene but also adds additional functionality (e.g. radiopacity) providing a more suitable material for long-term medical applications.
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Affiliation(s)
- Fedra P Zaribaf
- Centre for Therapeutic Innovation, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Harinderjit S Gill
- Centre for Therapeutic Innovation, Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Elise C Pegg
- Centre for Therapeutic Innovation, Department of Mechanical Engineering, University of Bath, Bath, UK
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de Jong DJ, Veldhuis WB, Wessels FJ, de Vos B, Moeskops P, Kok M. Towards Personalised Contrast Injection: Artificial-Intelligence-Derived Body Composition and Liver Enhancement in Computed Tomography. J Pers Med 2021; 11:jpm11030159. [PMID: 33668286 PMCID: PMC7996171 DOI: 10.3390/jpm11030159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/11/2022] Open
Abstract
In contrast-enhanced computed tomography, total body weight adapted contrast injection protocols have proven successful in achieving a homogeneous enhancement of vascular structures and liver parenchyma. However, because solid organs have greater perfusion than adipose tissue, the lean body weight (fat-free mass) rather than the total body weight is theorised to cause even more homogeneous enhancement. We included 102 consecutive patients who underwent a multiphase abdominal computed tomography between March 2016 and October 2019. Patients received contrast media (300 mgI/mL) according to bodyweight categories. Using regions of interest, we measured the Hounsfield unit (HU) increase in liver attenuation from unenhanced to contrast-enhanced computed tomography. Furthermore, subjective image quality was graded using a four-point Likert scale. An artificial intelligence algorithm automatically segmented and determined the body compositions and calculated the percentages of lean body weight. The hepatic enhancements were adjusted for iodine dose and iodine dose per total body weight, as well as percentage lean body weight. The associations between enhancement and total body weight, body mass index, and lean body weight were analysed using linear regression. Patients had a median age of 68 years (IQR: 58–74), a total body weight of 81 kg (IQR: 73–90), a body mass index of 26 kg/m2 (SD: ±4.2), and a lean body weight percentage of 50% (IQR: 36–55). Mean liver enhancements in the portal venous phase were 61 ± 12 HU (≤70 kg), 53 ± 10 HU (70–90 kg), and 53 ± 7 HU (≥90 kg). The majority (93%) of scans were rated as good or excellent. Regression analysis showed significant correlations between liver enhancement corrected for injected total iodine and total body weight (r = 0.53; p < 0.001) and between liver enhancement corrected for lean body weight and the percentage of lean body weight (r = 0.73; p < 0.001). Most benefits from personalising iodine injection using %LBW additive to total body weight would be achieved in patients under 90 kg. Liver enhancement is more strongly associated with the percentage of lean body weight than with the total body weight or body mass index. The observed variation in liver enhancement might be reduced by a personalised injection based on the artificial-intelligence-determined percentage of lean body weight.
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Affiliation(s)
- Daan J. de Jong
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
| | - Wouter B. Veldhuis
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
| | - Frank J. Wessels
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
| | - Bob de Vos
- Quantib-U, Padualaan 8, 3584 CH Utrecht, The Netherlands; (B.d.V.); (P.M.)
| | - Pim Moeskops
- Quantib-U, Padualaan 8, 3584 CH Utrecht, The Netherlands; (B.d.V.); (P.M.)
| | - Madeleine Kok
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
- Correspondence: ; Tel.: +31-88-75555-55
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Feasibility of Low Volume of High-Concentration Iodinated Contrast Medium With 70 kVp Tube Voltage on High-Pitch Dual-Source Computed Tomography Angiography in Children With Congenital Heart Disease. J Comput Assist Tomogr 2021; 45:52-58. [PMID: 32740051 DOI: 10.1097/rct.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of high-concentration iodinated contrast medium (CM) with 70 kVp tube voltage on high-pitch dual-source computed tomography (DSCT) in children with congenital heart disease (CHD). METHODS Fifty-eight CHD patients underwent high-pitch DSCT in 2 protocols: 70 kVp tube voltage, 1.0 mL/kg CM volume, 370 mg I/mL concentration (group A); 80 kVp tube voltage, 1.5 mL/kg CM volume, 350 mg I/mL concentration (group B). The diagnostic accuracy, image quality, iodine delivery rate, iodine dose, and radiation dose were compared. RESULTS There was no significant difference in the diagnostic accuracy (P > 0.05), image quality (P > 0.05) and iodine delivery rate (P > 0.05) between the 2 groups. The iodine dose (P < 0.05) and radiation dose (P < 0.05) in group A were significantly lower than those in group B. CONCLUSIONS Reduction in iodine dose and radiation exposure can be achieved with 70 kVp high-pitch DSCT by administering a smaller volume of high-concentration CM in children with CHD.
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Contrast Saline Mixture DualFlow Injection Protocols for Low-Kilovolt Computed Tomography Angiography: A Systematic Phantom and Animal Study. Invest Radiol 2020; 55:785-791. [PMID: 33156586 DOI: 10.1097/rli.0000000000000706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate a contrast media (CM)-saline mixture administration with DualFlow (DF) to adapt injection protocols to low-kilovolt (kV) computed tomography angiography (CTA). MATERIALS AND METHODS In both a circulation phantom and animal model (5 Goettingen minipigs), 3 injection protocols were compared in dynamic thoracic CTA: (a) DF injection protocol at 80 kV with a iodine delivery rate (IDR) of 0.9 gI/s, a flowrate of 5 mL/s injected with a 60%/40% ratio of iopromide (300 mgI/mL) and saline (dose contrast medium 180 mgI/kg body weight [BW]); (b) reference CTA was performed at 120 kV and a 40% higher iodine dose applied at higher IDR (1.5 gI/s, 5 mL/s iopromide [300 mgI/mL]; no simultaneously administered saline; 300 mgI/kg BW); and (c) conventional single-flow (SF) protocol with identical IDR as the DF protocol at 80 kV (0.9 gI/s, 3 mL/s iopromide [300 mgI/mL]; no simultaneously administered saline; 180 mgI/kg BW). All 3 injection protocols are followed by a saline chaser applied at the same flow rate as the corresponding CM injection. Time attenuation curves representing the vascular bolus shape were generated for pulmonary trunk and descending aorta. RESULTS In the circulation phantom, pulmonary and aortic time attenuation curves for the 80 kV DF injection protocols do not significantly differ from the 80 kV SF and the 120 kV SF reference. In the animal model, the 80 kV DF protocol shows similar pulmonal and aortic peak enhancement when compared with the 120 kV SF and 80 kV SF protocols. Also, the bolus length above an attenuation level of 300 HU reveals no significant differences between injection protocols. However, the time to peak was significantly shorter for the 80 kV DF when compared with the 80 kV SF protocol (15.78 ± 1.9 seconds vs 18.24 ± 2.0 seconds; P = 0.008). CONCLUSION DualFlow injection protocols can be tailored for low-kV CTA by reducing the IDR while overall flow rate remains unchanged. Although no differences in attenuation were found, DF injections offer a shorter time to peak closer to the reference 120 kV protocol.This allows the use of DF injection protocols to calibrate bolus density in low-kV CTA and yields the potential for a more individualized CM administration.
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Schöckel L, Jost G, Seidensticker P, Lengsfeld P, Palkowitsch P, Pietsch H. Developments in X-Ray Contrast Media and the Potential Impact on Computed Tomography. Invest Radiol 2020; 55:592-597. [DOI: 10.1097/rli.0000000000000696] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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McDermott M, Kemper C, Barone W, Jost G, Endrikat J. Impact of CT Injector Technology and Contrast Media Viscosity on Vascular Enhancement: Evaluation in a Circulation Phantom. Br J Radiol 2020; 93:20190868. [PMID: 32017607 PMCID: PMC7217576 DOI: 10.1259/bjr.20190868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Michael McDermott
- Bayer U.S. LLC, Bayer Pharmaceuticals, Radiology R&D, Indianola, PA 15051, USA
| | - Corey Kemper
- Bayer U.S. LLC, Bayer Pharmaceuticals, Radiology R&D, Indianola, PA 15051, USA
| | - William Barone
- Bayer U.S. LLC, Bayer Pharmaceuticals, Radiology R&D, Indianola, PA 15051, USA
| | - Gregor Jost
- Bayer AG, MR & CT Contrast Media Research, Berlin, Germany
| | - Jan Endrikat
- Bayer AG, Radiology R&D, 13353 Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, 66421 Homburg/Saar, Germany
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Shimamura K, Kubo T, Ino Y, Shiono Y, Matsuo Y, Kitabata H, Terada K, Emori H, Katayama Y, Khalifa AKM, Takahata M, Wada T, Higashioka D, Kashiwagi M, Kuroi A, Tanaka A, Hozumi T, Akasaka T. Intracoronary pressure increase due to contrast injection for optical coherence tomography imaging. J Cardiol 2019; 75:296-301. [PMID: 31500960 DOI: 10.1016/j.jjcc.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) requires intracoronary injection of contrast media to remove blood from the field of view during image acquisition. Contrast injection may cause a temporal increase in intracoronary pressure. The aim of this study was to compare the intracoronary pressure during contrast injection between OCT and coronary angiography. METHODS We measured intracoronary pressure by using a pressure guidewire during contrast injection for OCT and angiography in 30 coronary arteries (mean fractional flow reserve = 0.90 ± 0.03). Contrast media was injected into coronary artery through the guiding catheter by using a mechanical injector pump. RESULTS Intracoronary pressure before contrast injection was similar between OCT and angiography (systolic pressure: 123 ± 18 mmHg vs. 122 ± 19 mmHg, p = 0.863). Intracoronary pressure was increased due to contrast injection in both OCT (systolic pressure: 123 ± 18 mmHg to 132 ± 18 mmHg, p < 0.001) and angiography (systolic pressure: 122 ± 19 mmHg to 128 ± 19 mmHg, p < 0.001). The increase in intracoronary pressure was slightly greater in OCT compared with angiography (absolute increase of systolic pressure: 9 ± 2 mmHg vs. 6 ± 1 mmHg, p < 0.001; and relative increase of systolic pressure: 8 ± 2% vs. 5 ± 1%, p < 0.001). Intracoronary pressure during contrast injection was not significantly different between OCT and angiography (systolic pressure: 132 ± 18 mmHg vs. 128 ± 19 mmHg, p = 0.831). CONCLUSIONS Contrast injection for OCT induced significant but small increase in intracoronary pressure compared with that for angiography.
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Affiliation(s)
- Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kosei Terada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yosuke Katayama
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Amir Kh M Khalifa
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Higashioka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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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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19
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Zhang B, Liu J, Dong Y, Guo B, Lian Z, Yu H, Luo X, Mo X, Zhang L, Huang W, Ouyang F, Li X, Liang C, Zhang S. Extrinsic warming of low-osmolality iodinated contrast media to 37°C reduced the rate of allergic-like reaction. Allergy Asthma Proc 2018; 39:e55-e63. [PMID: 30401329 DOI: 10.2500/aap.2018.39.4160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Although there is good evidence that warming of contrast media changes the bolus kinetics and injection pressure of iodinated contrast media, there has been little evidence that it affects clinical adverse event rates in a meaningful way. Objective: To determine whether the extrinsic warming of low-osmolality iodinated contrast media to 37°C reduced adverse reactions. Methods: Data on adverse reactions were collected from two cohorts, one of which used contrast media at room temperature and the other in which contrast media were warmed to 37°C before administration. Adverse reactions, including allergic-like and physiological reactions, were reviewed. We compared the incidence rates of adverse reactions between the two cohorts by using the χ2 test. Results: A total of 70,446 injections in cohort 1 and 203,873 injections in cohort 2 were included. Extrinsic warming reduced the rate of allergic-like reactions to iopromide 370, iopamidol 370, and iohexol 350 (0.32% in cohort 1 versus 0.21% in cohort 2, p = 0.003; 0.14% versus 0.10%, p = 0.046; and 0.32% versus 0.13%, p = .003, respectively). However, the physiological reaction rates could not be reduced (p = 0.057, p = 0.107, and p = 0.962, respectively). The extrinsic warming of iopromide 300 could not reduce adverse reaction rates (allergic-like reaction rates: 0.21% versus 0.16%, p = 0.407; physiological reaction rates: 0.17% versus 0.13%, p = 0.504). Conclusion: Extrinsic warming to 37°C before intravenous administration was associated with a reduction in the rate of allergic-like reactions to iopromide 370, iopamidol 370, and iohexol 350.
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Affiliation(s)
- Bin Zhang
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Jing Liu
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Yuhao Dong
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Baoliang Guo
- Department of Radiology, The First People's Hospital of Shunde, Foshan, Guangdong, P.R. China
| | - Zhouyang Lian
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Hui Yu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guizhou, P.R. China
| | - Xiaoning Luo
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Xiaokai Mo
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Lu Zhang
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Wenhui Huang
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Fusheng Ouyang
- Department of Radiology, The First People's Hospital of Shunde, Foshan, Guangdong, P.R. China
| | - Xinyun Li
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Changhong Liang
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Shuixing Zhang
- From the Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
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Impact of Contrast Media Concentration on Low-Kilovolt Computed Tomography Angiography. Invest Radiol 2018; 53:264-270. [DOI: 10.1097/rli.0000000000000437] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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van Hamersvelt RW, Eijsvoogel NG, Mihl C, de Jong PA, Schilham AMR, Buls N, Das M, Leiner T, Willemink MJ. Contrast agent concentration optimization in CTA using low tube voltage and dual-energy CT in multiple vendors: a phantom study. Int J Cardiovasc Imaging 2018. [PMID: 29516228 DOI: 10.1007/s10554-018-1329-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We investigated the feasibility and extent to which iodine concentration can be reduced in computed tomography angiography imaging of the aorta and coronary arteries using low tube voltage and virtual monochromatic imaging of 3 major dual-energy CT (DECT) vendors. A circulation phantom was imaged with dual source CT (DSCT), gemstone spectral imaging (GSI) and dual-layer spectral detector CT (SDCT). For each scanner, a reference scan was acquired at 120 kVp using routine iodine concentration (300 mg I/ml). Subsequently, scans were acquired at lowest possible tube potential (70, 80, 80 kVp, respectively), and DECT-mode (80/150Sn, 80/140 and 120 kVp, respectively) in arterial phase after administration of iodine (300, 240, 180, 120, 60, 30 mg I/ml). Objective image quality was evaluated using attenuation, CNR and dose corrected CNR (DCCNR) measured in the aorta and left main coronary artery. Average DCCNR at reference was 227.0, 39.7 and 60.2 for DSCT, GSI and SDCT. Maximum iodine concentration reduction without loss of DCCNR was feasible down to 180 mg I/ml (40% reduced) for DSCT (DCCNR 467.1) and GSI (DCCNR 46.1) using conventional CT low kVp, and 120 mg I/ml (60% reduced) for SDCT (DCCNR 171.5) using DECT mode. Low kVp scanning and DECT allows for 40-60% iodine reduction without loss in image quality compared to reference. Optimal scan protocol and to which extent varies per vendor. Further patient studies are needed to extend and translate our findings to clinical practice.
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Affiliation(s)
- Robbert W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Nienke G Eijsvoogel
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Arnold M R Schilham
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Nico Buls
- Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Marco Das
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Martin J Willemink
- Department of Radiology, University Medical Center Utrecht, Utrecht University, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Patient Comfort During Contrast Media Injection in Coronary Computed Tomographic Angiography Using Varying Contrast Media Concentrations and Flow Rates: Results From the EICAR Trial. Invest Radiol 2017; 51:810-815. [PMID: 27164459 DOI: 10.1097/rli.0000000000000284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pain sensation and extravasation are potential drawbacks of contrast media (CM) injection during computed tomographic angiography. The purpose was to evaluate safety and patient comfort of higher flow rates in different CM protocols during coronary computed tomographic angiography. METHODS Two hundred consecutive patients of a double-blind randomized controlled trial (NCT02462044) were analyzed. Patients were randomized to receive 94 mL of prewarmed iopromide 240 mg I/mL at 8.3 mL/s (group I), 75 mL of 300 mg I/mL at 6.7 mL/s (group II), or 61 mL of 370 mg I/mL at 5.4 mL/s (group III), respectively. Iodine delivery rate (2.0 g I/s) and total iodine load (22.5 g I) were kept identical. Outcome was defined as intravascular enhancement, patient comfort during injection, and injection safety, expressed as the occurrence of extravasation. Patients completed a questionnaire for comfort, pain, and stress during CM injection. Comfort was graded using a 5-point scale, 1 representing "very bad" and 5 "very well." Pain was graded using a 10-point scale, 0 representing "no pain" and 10 "severe pain." Stress was graded using a 5-point scale, 1 representing "no stress" and 5 "unsustainable stress." RESULTS Mean enhancement levels within the coronary arteries were as follows: 437 ± 104 Hounsfield units (HU) (group I), 448 ± 111 HU (group II), and 447 ± 106 HU (group III), with P ≥ 0.18. Extravasation occurred in none of the patients. Median (interquartile range) for comfort, pain, and stress was, respectively, 4 (4-5), 0 (0-0), and 1 (1-2), with P ≥ 0.68. CONCLUSIONS High flow rates of prewarmed CM were safely injected without discomfort, pain, or stress. Therefore, the use of high flow rates should not be considered a drawback for CM administration in clinical practice.
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Lell MM, Fleischmann U, Pietsch H, Korporaal JG, Haberland U, Mahnken AH, Flohr TG, Uder M, Jost G. Relationship between low tube voltage (70 kV) and the iodine delivery rate (IDR) in CT angiography: An experimental in-vivo study. PLoS One 2017; 12:e0173592. [PMID: 28319203 PMCID: PMC5358883 DOI: 10.1371/journal.pone.0173592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
Objective Very short acquisition times and the use of low-kV protocols in CTA demand modifications in the contrast media (CM) injection regimen. The aim of this study was to optimize the use of CM delivery parameters in thoraco-abdominal CTA in a porcine model. Materials and methods Six pigs (55–68 kg) were examined with a dynamic CTA protocol (454 mm scan length, 2.5 s temporal resolution, 70 s total acquisition time). Four CM injection protocols were applied in a randomized order. 120 kV CTA protocol: (A) 300 mg iodine/kg bodyweight (bw), IDR = 1.5 g/s (flow = 5 mL/s), injection time (ti) 12 s (60 kg bw). 70 kV CTA protocols: 150 mg iodine/kg bw: (B) IDR = 0.75 g/s (flow = 2.5 mL/s), ti = 12 s (60 kg bw); (C) IDR = 1.5 g/s (flow = 5 mL/s), ti = 12 s (60 kg bw); (D) IDR = 3.0 g/s (flow = 10 mL/s), ti = 3 s (60 kg bw). The complete CM bolus shape was monitored by creating time attenuation curves (TAC) in different vascular territories. Based on the TAC, the time to peak (TTP) and the peak enhancement were determined. The diagnostic window (relative enhancement > 300 HU), was calculated and compared to visual inspection of the corresponding CTA data sets. Results The average relative arterial peak enhancements after baseline correction were 358.6 HU (A), 356.6 HU (B), 464.0 HU (C), and 477.6 HU (D). The TTP decreased with increasing IDR and decreasing ti, protocols A and B did not differ significantly (systemic arteries, p = 0.843; pulmonary arteries, p = 0.183). The delay time for bolus tracking (trigger level 100 HU; target enhancement 300 HU) for single-phase CTA was comparable for protocol A and B (3.9, 4.3 s) and C and D (2.4, 2.0 s). The scan window time frame was comparable for the different protocols by visual inspection of the different CTA data sets and by analyzing the TAC. Conclusions All protocols provided sufficient arterial enhancement. The use of a 70 kV CTA protocol is recommended because of a 50% reduction of total CM volume and a 50% reduced flow rate while maintaining the bolus profile. In contrast to pulmonary arterial enhancement, the systemic arterial enhancement improved only slightly increasing the IDR from 1.5 g/s to 3 g/s because of bolus dispersion of the very short bolus (3s) in the lungs.
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Affiliation(s)
- Michael M. Lell
- Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuernberg, Germany
- * E-mail:
| | - Ulrike Fleischmann
- Department of Radiology, Friedrich-Alexander University Erlangen, Erlangen, Germany
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer Healthcare, Berlin, Germany
| | | | | | | | | | - Michael Uder
- Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuernberg, Germany
- Imaging Science Institute (ISI) Erlangen, Erlangen, Germany
| | - Gregor Jost
- MR and CT Contrast Media Research, Bayer Healthcare, Berlin, Germany
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Apitzsch J, Jost G, Bonifer E, Keulers A, Pietsch H, Mahnken AH. Revival of monophasic contrast injection protocols: superiority of a monophasic injection protocol compared to a biphasic injection protocol in high-pitch CT angiography. Acta Radiol 2016; 57:1210-6. [PMID: 26663210 DOI: 10.1177/0284185115618546] [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: 04/09/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Biphasic injection protocols are frequently used because they yield homogenous contrast enhancement. We hypothesize that with faster scanners and shorter scan times, biphasic injection protocols are no longer necessary. PURPOSE To evaluate whether a monophasic injection protocol is equivalent to a biphasic protocol in terms of contrast enhancement and homogeneity. MATERIAL AND METHODS Repeated high-pitch CTA (pitch 3) and conventional standard-pitch computed tomography angiography (CTA) (pitch 1.2) from the cervical region to the symphysis was performed in seven beagles (11.2 ± 2.5 kg) in a cross-over study design. Arterial contrast enhancement was measured along the z-axis in the ascending, descending, and abdominal aorta and the iliac arteries. The z-axis is the longitudinal axis of the human body and at the same time the direction in which the CT table is moving. The data were analyzed using repeated measures ANOVA with a post-hoc t-test and visual assessment of the scans. RESULTS In high-pitch CTA, monophasic injection protocols were superior to biphasic injection protocols in enhancement levels (P < 0.05) and enhancement homogeneity along the z-axis (P < 0.05). In conventional CTA, enhancement levels did not differ. Contrast homogeneity was better for biphasic protocols. CONCLUSION High-pitch CTA monophasic injection protocols are superior to biphasic injection protocols, due to a higher and more homogeneous contrast enhancement with the same amount of contrast medium used.
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Affiliation(s)
- Jonas Apitzsch
- UKGM Marburg University Hospital, Diagnostic and Interventional Radiology, Marburg, Germany
| | - Gregor Jost
- Bayer Healthcare, MR and CT Contrast Media Research, Berlin, Berlin, Germany
| | - Elisabeth Bonifer
- Department of Radiology, Giessen University Hospital, Giessen, Hessen, Germany
| | - Annika Keulers
- UKGM Marburg University Hospital, Diagnostic and Interventional Radiology, Marburg, Germany
| | - Hubertus Pietsch
- Bayer Healthcare, MR and CT Contrast Media Research, Berlin, Berlin, Germany
| | - Andreas Horst Mahnken
- UKGM Marburg University Hospital, Diagnostic and Interventional Radiology, Marburg, Germany
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Kok M, Mihl C, Hendriks BMF, Altintas S, Kietselaer BLJH, Wildberger JE, Das M. Optimizing contrast media application in coronary CT angiography at lower tube voltage: Evaluation in a circulation phantom and sixty patients. Eur J Radiol 2016; 85:1068-74. [PMID: 27161054 DOI: 10.1016/j.ejrad.2016.03.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/09/2016] [Accepted: 03/20/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Madeleine Kok
- Department of Radiology, Maastricht University Medical Center, The Netherlands; CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Casper Mihl
- Department of Radiology, Maastricht University Medical Center, The Netherlands; CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Babs M F Hendriks
- Department of Radiology, Maastricht University Medical Center, The Netherlands.
| | - Sibel Altintas
- CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center, The Netherlands.
| | - Bas L J H Kietselaer
- Department of Radiology, Maastricht University Medical Center, The Netherlands; CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center, The Netherlands.
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical Center, The Netherlands; CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Marco Das
- Department of Radiology, Maastricht University Medical Center, The Netherlands; CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
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Computed Tomography Angiography With High Flow Rates: An In Vitro and In Vivo Feasibility Study. Invest Radiol 2016; 50:464-9. [PMID: 25816214 DOI: 10.1097/rli.0000000000000153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aims of this study were to test high-flow application of contrast media (CM) using novel high-flow needles and to assess injection- and flow-related parameters in a circulation phantom and in an in vivo population. MATERIALS AND METHODS A circulation phantom simulating physiological parameters was used. Preheated CM (300 mg/mL) was injected at flow rates varying between 5 and 15 mL/s through a novel 18-gauge high-flow intravenous injection needle. In addition, feasibility of these high-flow needles was tested with administration of flow rates of 9 mL/s in 20 patients referred for pre-transcatheter aortic valve implantation assessment. Injection parameters (eg, peak pressures, peak flow rates) in both phantom and in vivo setup were continuously monitored by a data acquisition program. Attenuation at predefined levels of the aorta (eg, aortic root to common femoral arteries) was measured in all patients to determine clinical applicability. RESULTS In the phantom setup, injection rates up to 15 mL/s were feasible. An enhancement plateau was reached at 11 mL/s (464 [20] HU). In patients, no pressure- or flow-related complications (eg, extravasation) were recorded (mean [SD] peak pressure, 154 [8] psi; mean [SD] peak flow rate, 9.2 [0.1 mL/s; range, 9.1-9.6]). Diagnostic attenuation values were reached at all predefined levels of the aorta (330.8 [113.1] HU to 622.9 [81.5] HU). CONCLUSIONS These results indicate that injections with 9 mL/s using high-flow injection needles are safe. The pressure limit of 325 psi was not reached, and the injections resulted in diagnostic attenuation values. Using this dedicated needle, high flow rates should not be considered a drawback for CM application in routine CT angiography examinations.
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Automated Tube Voltage Selection for Radiation Dose Reduction in CT Angiography Using Different Contrast Media Concentrations and a Constant Iodine Delivery Rate. AJR Am J Roentgenol 2016; 205:1332-8. [PMID: 26587942 DOI: 10.2214/ajr.14.13957] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this study was to systematically investigate radiation dose reduction using automated tube voltage selection during CT angiography (CTA) and to evaluate the impact of contrast medium (CM) injection protocols on dose reduction. MATERIALS AND METHODS A circulation phantom containing the thoracic and abdominal vasculature was used. Four different concentrations of CM (iopromide 300 and 370 mg I/mL and iomeprol 350 and 400 mg I/mL) were administered while maintaining an identical iodine delivery rate (1.8 g I/s) and total iodine load (20.0 g). Three different scanning protocols for CTA of the thoracoabdominal aorta were used: protocol A, no dose modulation; protocol B, automated tube current modulation (CARE Dose4D); and protocol C, automated tube voltage selection (CARE kV). The dose-length product was recorded to calculate the effective dose. Attenuation values (in Hounsfield units), image noise levels, and signal-to-noise ratios (SNRs) in six predefined intravascular sites (three thoracic and three abdominal) were measured by two readers. All values were analyzed using the Kruskal-Wallis test and two-way ANOVA. RESULTS There was a significant reduction in the effective dose (in millisieverts) for protocols B (mean ± SD, 2.03 ± 0.1 mSv) and C (1.00 ± 0.0 mSv) compared with protocol A (4.34 ± 0.0 mSv). The dose was reduced by 53% for protocol B and by 77% for protocol C. No significant differences were found in the effective dose among the different CM injection protocols within the scanning protocols; all p values were > 0.05. The attenuation values and SNRs were comparable among all the different CM injection protocols; all p values were > 0.05. CONCLUSION A large radiation dose reduction (77%) can be achieved using automated tube voltage selection independent of the CM injection protocol.
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Hendriks BMF, Kok M, Mihl C, Bekkers SCAM, Wildberger JE, Das M. Individually tailored contrast enhancement in CT pulmonary angiography. Br J Radiol 2016; 89:20150850. [PMID: 26689096 DOI: 10.1259/bjr.20150850] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose was to evaluate individually shaped contrast media (CM) delivery in CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE). METHODS 100 consecutive emergency patients with clinical suspicion of PE were evaluated. High-pitch CTPA was performed on a second-generation dual-source CT using the following parameters: 100 kV, 200-250 mAsref, rotation time 0.28 s, 128 × 0.6 mm col. and image reconstruction 1.0/0.8 mm (B30f). Group 1 (n = 50) then received a fixed CM bolus (300 = mgI ml(-1), volume = 90 ml and flow rate = 6 ml s(-1)); Group 2 (n = 50) received a body weight-adapted CM bolus determined by dedicated contrast injection software. For analysis, groups were further subdivided into low-weight (40-75 kg) and high-weight (76-117 kg) groups. Technical image quality was graded using a four-point Likert scale (1 = non-diagnostic; 2 = diagnostic; 3 = good and 4 = excellent image quality) at the level of the pulmonary trunk and pulmonary arteries. Objective image quality analysis was performed by measuring contrast enhancement in Hounsfield units (HU) at the same levels. Attenuation levels > 180 HU were considered diagnostic. RESULTS All examinations were graded as diagnostic at each level. The individual minimum pulmonary attenuation was 184 and 270 HU for Group 1 and 2, respectively. Mean attenuation was as follows: Group 1: 475 ± 105 HU (40-75 kg) and 402 ± 115 HU (76-117 kg), p < 0.03. Group 2: 424 ± 76 HU (40-75 kg) and 418 ± 100 HU (76-117 kg), p = 0.8. For Group 2, CM volumes were: 55 ± 5 ml (40-75 kg) and 66 ± 5 ml (76-117 kg), leading to 16-51% CM reduction. CONCLUSION Even under emergency conditions, individualized CM protocols can provide diagnostic and robust image quality in CTPA for PE with a substantial reduction of CM volume for lower weight patients, compared with a fixed CM protocol. ADVANCES IN KNOWLEDGE CM volume can substantially be reduced by using individualized CM protocols in CT angiography for PE without compromising the diagnostic image quality.
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Affiliation(s)
- Babs M F Hendriks
- 1 Departments of Radiology, Maastricht University Medical Center, Maastricht, Netherlands.,2 CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands
| | - Madeleine Kok
- 1 Departments of Radiology, Maastricht University Medical Center, Maastricht, Netherlands.,2 CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands
| | - Casper Mihl
- 1 Departments of Radiology, Maastricht University Medical Center, Maastricht, Netherlands.,2 CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sebastiaan C A M Bekkers
- 2 CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands.,3 Departments of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joachim E Wildberger
- 1 Departments of Radiology, Maastricht University Medical Center, Maastricht, Netherlands.,2 CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marco Das
- 1 Departments of Radiology, Maastricht University Medical Center, Maastricht, Netherlands.,2 CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands
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Mihl C, Kok M, Altintas S, Kietselaer BLJH, Turek J, Wildberger JE, Das M. Evaluation of individually body weight adapted contrast media injection in coronary CT-angiography. Eur J Radiol 2016; 85:830-6. [PMID: 26971431 DOI: 10.1016/j.ejrad.2015.12.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/14/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Contrast media (CM) injection protocols should be customized to the individual patient. Aim of this study was to determine if software tailored CM injections result in diagnostic enhancement of the coronary arteries in computed tomography angiography (CTA) and if attenuation values were comparable between different weight categories. MATERIALS AND METHODS 265 consecutive patients referred for routine coronary CTA were scanned on a 2nd generation dual-source CT. Group 1 (n=141) received an individual CM bolus based on weight categories (39-59 kg; 60-74 kg; 75-94 kg; 95-109 kg) and scan duration ('high-pitch: 1s; "dual-step prospective triggering": 7s), as determined by contrast injection software (Certegra™ P3T, Bayer, Berlin, Germany). Group 2 (n=124) received a standard fixed CM bolus; Iopromide 300 mgI/ml; volume: 75 ml; flow rate: 7.2 ml/s. Contrast enhancement was measured in all proximal and distal coronary segments. Subjective and objective image quality was evaluated. Statistical analysis was performed using SPSS (IBM, version 20.0). RESULTS For group 1, mean attenuation values of all segments were diagnostic (>325 HU) without statistical significant differences between different weight categories (p>0.17), proximal vs. distal: 449 ± 65-373 ± 58 HU (39-59 kg); 443 ± 69-367 ± 81 HU (60-74 kg); 427 ± 59-370 ± 61 HU (75-94 kg); 427 ± 73-347 ± 61 HU (95-109 kg). Mean CM volumes were: 55 ± 6 ml (39-59 kg); 61 ± 7 ml (60-74 kg); 71 ± 8 ml (75-94 kg); 84 ± 9 ml (95-109 kg). For group 2, mean attenuation values were not all diagnostic with differences between weight categories (p<0.01), proximal vs. distal: 611 ± 142-408 ± 69 HU (39-59 kg); 562 ± 135-389 ± 98 HU (60-74 kg); 481 ± 83-329 ± 81 HU (75-94 kg); 420 ± 73-305 ± 35 HU (95-109 kg). Comparable image noise and image quality were found between groups (p ≥ 0.330). CONCLUSIONS Individually tailored CM injection protocols yield diagnostic attenuation and a more homogeneous enhancement pattern between different weight groups. CM volumes could be reduced for the majority of patients utilizing individualized CM bolus application.
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Affiliation(s)
- Casper Mihl
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Madeleine Kok
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sibel Altintas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Bas L J H Kietselaer
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Jakub Turek
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
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Reproducibility of VPCT parameters in the normal pancreas: comparison of two different kinetic calculation models. Acad Radiol 2015; 22:1099-105. [PMID: 26112056 DOI: 10.1016/j.acra.2015.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/17/2015] [Accepted: 04/29/2015] [Indexed: 01/21/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the reproducibility of volume computed tomographic perfusion (VPCT) measurements in normal pancreatic tissue using two different kinetic perfusion calculation models at three different time points. MATERIALS AND METHODS Institutional ethical board approval was obtained for retrospective analysis of pancreas perfusion data sets generated by our prospective study for liver response monitoring to local therapy in patients experiencing unresectable hepatocellular carcinoma, which was approved by the institutional review board. VPCT of the entire pancreas was performed in 41 patients (mean age, 64.8 years) using 26 consecutive volume measurements and intravenous injection of 50 mL of iodinated contrast at a flow rate of 5 mL/s. Blood volume(BV) and blood flow (BF) were calculated using two mathematical methods: maximum slope + Patlak analysis versus deconvolution method. Pancreas perfusion was calculated using two volume of interests. Median interval between the first and the second VPCT was 2 days and between the second and the third VPCT 82 days. Variability was assessed with within-patient coefficients of variation (CVs) and Bland-Altman analyses. Interobserver agreement for all perfusion parameters was calculated using intraclass correlation coefficients (ICCs). RESULTS BF and BV values varied widely by method of analysis as did within-patient CVs for BF and BV at the second versus the first VPCT by 22.4%/50.4% (method 1) and 24.6%/24.0% (method 2) measured in the pancreatic head and 18.4%/62.6% (method 1) and 23.8%/28.1% (method 2) measured in the pancreatic corpus and at the third versus the first VPCT by 21.7%/61.8% (method 1) and 25.7%/34.5% (method 2) measured also in the pancreatic head and 19.1%/66.1% (method 1) and 22.0%/31.8% (method 2) measured in the pancreatic corpus, respectively. Interobserver agreement measured with ICC shows fair-to-good reproducibility. CONCLUSIONS VPCT performed with the presented examinational protocol is reproducible and can be used for monitoring purposes. Best reproducibility was obtained with both methods for BF and with method 2 also for BV data for both follow-up studies.
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Evaluation of A New Bolus Tracking–Based Algorithm for Predicting A Patient-Specific Time of Arterial Peak Enhancement in Computed Tomography Angiography. Invest Radiol 2015; 50:531-8. [DOI: 10.1097/rli.0000000000000160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Optimizing Contrast Media Injection Protocols in State-of-the Art Computed Tomographic Angiography. Invest Radiol 2015; 50:161-7. [DOI: 10.1097/rli.0000000000000119] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Quantitative Evaluation of the Performance of a New Test Bolus–Based Computed Tomographic Angiography Contrast-Enhancement–Prediction Algorithm. Invest Radiol 2015; 50:1-8. [DOI: 10.1097/rli.0000000000000088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paparo F, Garello I, Bacigalupo L, Marziano A, Galletto Pregliasco A, Rollandi L, Puppo C, Mattioli F, Puntoni M, Rollandi GA. CT of the abdomen: Degree and quality of enhancement obtained with two concentrations of the same iodinated contrast medium with fixed iodine delivery rate and total iodine load. Eur J Radiol 2014; 83:1995-2000. [DOI: 10.1016/j.ejrad.2014.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/09/2014] [Accepted: 07/15/2014] [Indexed: 01/21/2023]
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