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Contrast Volume for Preoperative CT Angiography of the Aorta Based on Patient Heart Rate and Body Surface Area: A Pilot Study. J Belg Soc Radiol 2019; 103:57. [PMID: 31646268 PMCID: PMC6777198 DOI: 10.5334/jbsr.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To evaluate contrast agent dose reduction using an algorithm based on heart rate and body surface area. Methods: A prospective study with 55 patients undergoing aortic CT was performed. Contrast agent dose, enhancement and image quality between three study groups were compared. Group 1: a fixed, standard dose of 120 ml, group 2: contrast agent dose calculated based on heart rate and body surface area, group 3: additional dilution of 50% of the calculated dose based on heart rate and body surface area. Results: The mean contrast agent dose in group 2 was reduced by 15% (P < 0.01) with unchanged high visual scoring in comparison to group 1. In group 3, contrast agent dose reduction was 60% (P < 0.01); average image quality dropped 19% (P < 0.01) compared to group 1, but was still sufficient, except for two patients. Conclusions: Contrast agent dose was significantly reduced without compromising diagnostic efficacy using the proposed algorithm.
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Kumar DS, Bhat V, Gadabanahalli K, Kalyanpur A. Spectrum of Abdominal Aortic Disease in a Tertiary Health Care Setup: MDCT Based Observational Study. J Clin Diagn Res 2017; 10:TC24-TC29. [PMID: 28050476 DOI: 10.7860/jcdr/2016/21373.8928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Abdominal aortic disease is an important cause of clinical disability that requires early detection by imaging methods for prompt and effective management. Understanding regional disease pattern and prevalence has a bearing on healthcare management and resource planning. Non-invasive, conclusive imaging strategy plays an important role in the detection of disease. Multi-Detector Computed Tomography (MDCT) with its technological developments provides affordable, accurate and comprehensive imaging solution. AIM To evaluate regional demography of abdominal aortic disease spectrum detected using MDCT imaging data in a tertiary hospital. MATERIALS AND METHODS A descriptive study was conducted based on MDCT imaging data of patients who were investigated with clinical diagnosis of abdominal aortic disease, from March 2008-2010, over a period of 24 months. Patients were examined with the contrast-enhanced MDCT examination. Morphological diagnosis of the aortic disease was based on changes in relative aortic caliber, luminal irregularity, presence of wall calcification, dissection or thrombus and evidence of major branch occlusion. Patients were categorized into four groups based on imaging findings. MDCT information and associated clinical parameters were examined and correlated to management of patient. Descriptive statistical data, namely mean, standard deviation and frequency of disease were evaluated. RESULTS A total of 90 out of 210 patients (43%) were detected with the abdominal aortic abnormality defined by imaging criteria. Group I, comprising of patients with atherosclerosis -including those with complications, constituted 65.5% of the patients. Group II represented patients with aneurysms (45.5%). Group III, consisting of 32.2% of the patients, contained those with dissections. The rest of the patients, including patients with aorto-arteritis, were classified as group IV. Eight patients with aneurysm and one patient with aorto-arteritis were considered for surgical treatment. Ten patients with dissection underwent endovascular procedure. Rest of the patients was managed conservatively. CONCLUSION Aortic disease was observed in 43% of investigated patients. Atherosclerosis with and without aortic aneurysm constituted the largest group. MDCT provided comprehensive information about the lesion and associated complications. In view of the wider availability and desired imaging qualities, MDCT provided optimal information for diagnosis and management of aortic pathology. Majority of our patients (90%) were treated conservatively.
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Affiliation(s)
- Dg Santosh Kumar
- Consultant Radiologist, Narayana Health, Shaw Mazumdar Medical Center , Bengaluru, Karnataka, India
| | - Venkatraman Bhat
- Director of Imaging Services, Sr. Consultant, Department of Radiology, Narayana Health, Shaw Mazumdar Medical Center , Bengaluru, Karnataka, India
| | - Karthik Gadabanahalli
- Consultant Radiologist, Department of Radiology, Narayana Health, Teleradiology Solutions , Whitefield, Bengaluru, Karnataka, India
| | - Arjun Kalyanpur
- CEO, Teleradiology Solutions, Teleradiology Solutions , Whitefield, Bengaluru, Karnataka, India
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Gardner JB, Fruauff AM, Bhalla S, Katz DS. Computed tomography of nontraumatic thoracoabdominal aortic emergencies. Semin Roentgenol 2013; 49:143-56. [PMID: 24836490 DOI: 10.1053/j.ro.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Alana M Fruauff
- Department of Radiology, Winthrop-University Hospital, Mineola, NY
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY.
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64-Slice CT angiography of the abdominal aorta and abdominal arteries: comparison of the diagnostic efficacy of iobitridol 350 mgI/ml versus iomeprol 400 mgI/ml in a prospective, randomised, double-blind multi-centre trial. Eur Radiol 2009; 20:572-83. [PMID: 19789884 PMCID: PMC2822224 DOI: 10.1007/s00330-009-1600-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 08/13/2009] [Indexed: 12/20/2022]
Abstract
Purpose The purpose of this study was to assess the influence of iodine concentration on diagnostic efficacy in multi-detector-row computed tomography (MDCT) angiography of the abdominal aorta and abdominal arteries. Methods IRB approval and informed consent were obtained. In this double-blind trial, patients were randomised to undergo MDCT angiography of the abdominal arteries during administration of iobitridol (350 mgI/ml) or iomeprol (400 mgI/ml). Each centre applied its own technique for delivery of contrast medium, regardless of iodine concentration. Diagnostic efficacy, image quality, visualisation of the arterial wall and arterial enhancement were evaluated. A total of 153 patients received iobitridol and 154 received iomeprol. Results The ability to reach a diagnosis was “satisfactory” to “totally satisfactory” in 152 (99.3%) and 153 (99.4%) patients respectively. Image quality was rated as being “good” to “excellent” in 94.7 and 94.8% segments respectively. Similar results were observed for image quality of arterial walls (84.3 vs. 83.2%). The mean relative changes in arterial enhancement between baseline and arterial phase images showed no statistically significant differences. Conclusion This study demonstrated the non-inferiority of the 350 versus 400 mgI/ml iodine concentration, in terms of diagnostic efficacy, in abdominal MDCT angiography. It also confirmed the high robustness and reliability of this technique across multi-national practices.
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Effect of X-ray tube parameters, iodine concentration, and patient size on image quality in pulmonary computed tomography angiography: a chest-phantom-study. Invest Radiol 2008; 43:374-81. [PMID: 18496042 DOI: 10.1097/rli.0b013e3181690042] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this phantom study was to evaluate the contrast-to-noise ratio (CNR) in pulmonary computed tomography (CT)-angiography for 300 and 400 mg iodine/mL contrast media using variable x-ray tube parameters and patient sizes. We also analyzed the possible strategies of dose reduction in patients with different sizes. MATERIALS AND METHODS The segmental pulmonary arteries were simulated by plastic tubes filled with 1:30 diluted solutions of 300 and 400 mg iodine/mL contrast media in a chest phantom mimicking thick, intermediate, and thin patients. Volume scanning was done with a CT scanner at 80, 100, 120, and 140 kVp. Tube current-time products (mAs) varied between 50 and 120% of the optimal value given by the built-in automatic dose optimization protocol. Attenuation values and CNR for both contrast media were evaluated and compared with the volume CT dose index (CTDI(vol)). Figure of merit, calculated as CNR/CTDIvol, was used to quantify image quality improvement per exposure risk to the patient. RESULTS Attenuation of iodinated contrast media increased both with decreasing tube voltage and patient size. A CTDIvol reduction by 44% was achieved in the thin phantom with the use of 80 instead of 140 kVp without deterioration of CNR. Figure of merit correlated with kVp in the thin phantom (r = -0.897 to -0.999; P < 0.05) but not in the intermediate and thick phantoms (P = 0.09-0.71), reflecting a decreasing benefit of tube voltage reduction on image quality as the thickness of the phantom increased. Compared with the 300 mg iodine/mL concentration, the same CNR for 400 mg iodine/mL contrast medium was achieved at a lower CTDIvol by 18 to 40%, depending on phantom size and applied tube voltage. CONCLUSIONS Low kVp protocols for pulmonary embolism are potentially advantageous especially in thin and, to a lesser extent, in intermediate patients. Thin patients profit from low voltage protocols preserving a good CNR at a lower exposure. The use of 80 kVp in obese patients may be problematic because of the limitation of the tube current available, reduced CNR, and high skin dose. The high CNR of the 400 mg iodine/mL contrast medium together with lower tube energy and/or current can be used for exposure reduction.
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Fortuño Andrés JR, Falco i Fages J, Perendreu i Sans J, Branera i Pujol J, Bermúdez Bencerrey P, Bellmunt i Montoya S, Safont i Sala MR. [Multislice CT angiography in the study of aneurysm of the abdominal aorta: comparison of three different volumes of contrast agent]. RADIOLOGIA 2008; 50:225-30. [PMID: 18471387 DOI: 10.1016/s0033-8338(08)71968-4] [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: 11/19/2022]
Abstract
OBJECTIVE To prospectively and quantitatively compare the use of different volumes of contrast in 16-slice CT angiography for the study of aneurysms of the abdominal aorta before and/or after treatment. MATERIAL AND METHODS From November 2005 to March 2006, we included 63 consecutive patients referred for CT angiography for aneurysm of the abdominal aorta or for post-treatment follow-up. Each patient was randomly assigned to one of three groups: group A was administered 100 mL of contrast agent, group B 80 mL, and group C 60 mL. In all cases, contrast was administered with 40 mL of physiological serum at a rate of 4 ml/s. A 16-detector CT scanner was used. In the last 61 patients, attenuation was measured in different locations using circular ROIs. Hounsfield units were recorded in the first slice (initial contrast), in the last slice (final contrast), at their maximum value, and also at one-second intervals. RESULTS No statistically significant differences in the Hounsfield units recorded in the first slice, in the last slice, or in the maximum values were found between the different groups. Mean values were above 200 in 58 of 61 patients. Weight and body mass index (BMI) were negatively correlated with aortoiliac attenuation. CONCLUSION Using a 16-detector CT scanner enables the volume of contrast for studies of aneurysms of the abdominal aorta to be reduced considerably; however, 60 mL might not be sufficient for patients with high weight or BMI.
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Affiliation(s)
- J R Fortuño Andrés
- Unidad de Radiología Vascular e intervencionista. Corporación Sanitaria Parc Taulí. Hospital de Sabadell. Barcelona. España.
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Yoon DY, Lim KJ, Choi CS, Chang SK, Yun EJ, Seo YL, Lee YJ, Moon JH, Park SH, Song HK. Sixteen-Detector Row CT Angiography of the Brain. J Comput Assist Tomogr 2007; 31:671-6. [PMID: 17895775 DOI: 10.1097/rct.0b013e318031f53e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this prospective study was to investigate the effect of different volumes of contrast material on vascular enhancement in 16-channel multi-detector row computed tomographic angiography of the brain. METHODS A total of 194 patients were divided into 3 groups who received different volumes of contrast material: 100 (n = 62), 80 (n = 72), and 60 mL (n = 60). The attenuation values were measured on transverse images at 12 different intracranial vessels (right and left internal carotid arteries, A2s, M2s, and P2s, basilar artery, vein of Galen, superior sagittal sinus, and dominant sigmoid sinus). The image quality parameters (intra-arterial contrast, arterial delineation, venous contamination, and confidence in diagnosis) were graded by 2 observers in consensus using a 5-point scale. RESULTS The attenuation values at the left A2 segment, superior sagittal sinus, and sigmoid sinus were significantly lower in the 60-mL group than those in other groups, whereas no significant differences were found between the 3 groups for the remaining intracranial vessels. For qualitative evaluation, arterial delineation was rated higher in the 100- and 80-mL groups, whereas less venous contamination was found in the 60-mL group. There was no significant difference in overall image quality (the sum of the scores for 4 image quality parameters) between the 3 groups. CONCLUSIONS A contrast material volume of 60 mL (18 g iodine) provides excellent image quality of cerebral multi-detector row computed tomographic angiography comparable to those achievable with 100 and 80 mL.
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Affiliation(s)
- Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea.
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Lee CH, Goo JM, Bae KT, Lee HJ, Kim KG, Chun EJ, Park CM, Im JG. CTA Contrast Enhancement of the Aorta and Pulmonary Artery. Invest Radiol 2007; 42:486-90. [PMID: 17568270 DOI: 10.1097/rli.0b013e318032a9fe] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effect of saline chase injected at 2 different rates on computed tomography (CT) angiography. MATERIALS AND METHODS This study was approved by our institutional animal study committee. Three injection protocols were used; contrast injection (24 mL, 0.8 mL/s) without saline chase (protocol A), contrast injection with saline chase injected at the same rate as the contrast medium (protocol B), and contrast injection with saline chase injected at half the rate (0.4 mL/s) of the contrast medium (protocol C). In the 3 dogs used in our study, each of the protocols was applied twice for every dog resulting in a total of 18 sessions of monitoring scans. CT images were acquired every second at the fixed level of the aorta and pulmonary artery (PA). The duration of plateau, plateau deviation, and peak arterial enhancement were computed and compared using the Kruskall-Wallis and Mann-Whitney U test. RESULTS Peak contrast enhancements were significantly more delayed with protocol B than with protocol A in both the PA (B: 48 seconds, A: 30 seconds, P=0.024) and aorta (B: 46 seconds, A: 38 seconds, P=0.024). The duration of enhancement plateau was longer with protocol B than with protocol A in PA (B: 14.8 seconds, A: 9.0 seconds, P=0.002) and in aorta (B: 16.2 seconds, A: 11.6 seconds, P=0.004). Protocol C had the longest duration of plateau in both PA (34.5 seconds, P=0.002) and aorta (33.8 seconds, P=0.004) with uniform plateau enhancement. The peak enhancement values of protocol C, however, were substantially lower than that of protocol A and B in both the PA (A: 262 HU, B: 239 HU, C: 191 HU, P=0.001) and aorta (A: 263 HU, B: 268 HU, C: 210 HU, P=0.001). CONCLUSIONS Saline chase prolongs the duration of plateau and delays peak enhancement of the pulmonary artery and aorta. Saline chase injected at half the rate of contrast medium injection allowed more uniform and prolonged plateau contrast enhancement than other protocols.
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Affiliation(s)
- Chang Hyun Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Jongno-gu, and Seoul National University Hospital, Healthcare Gangnam Center, Gangnam-gu, Seoul, South Korea
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Yoon DY, You SY, Choi CS, Chang SK, Yun EJ, Seo YL, Park SJ, Lee YJ, Moon JH, Rho YS, Kim JH. Multi-detector row CT of the head and neck: comparison of different volumes of contrast material with and without a saline chaser. Neuroradiology 2006; 48:935-42. [PMID: 16977442 DOI: 10.1007/s00234-006-0146-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 07/29/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this study was to determine the effect of different volumes of contrast material with and without a saline chaser on tissue enhancement in multidetector row CT (MDCT) of the head and neck. METHODS In a blind prospective fashion, 120 patients were randomized into the following four groups: group 1, 80 ml contrast material administered at a flow rate of 2.0 ml/s; group 2, 80 ml followed by 40 ml saline at 2.0 ml/s; group 3, 60 ml at 1.5 ml/s; and group 4, 60 ml followed by 30 ml saline at 1.5 ml/s. The attenuation values of the carotid artery, internal jugular vein, and muscle were measured at an interval of 1.5 s in each patient. The degree of perivenous artifacts was subjectively assessed. RESULTS Mean attenuation values in the carotid artery and internal jugular vein were significantly higher in groups 1 and 2 than in groups 3 and 4. The width of the diagnostic window (both carotid and jugular enhancement >150 HU) were significantly longer in groups 1 and 2 than in groups 3 and 4. The addition of a saline chaser did not result in improved vascular enhancement or a wider diagnostic window, but reduced perivenous artifacts, compared with using contrast material alone. CONCLUSION Reduction of contrast material from 80 to 60 ml results in insufficient enhancement of neck vessels. In addition, the benefit of a saline chaser technique is not obvious except for its ability to reduce perivenous artifacts.
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Affiliation(s)
- Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701, South Korea.
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Johnson PT, Fishman EK. IV Contrast Selection for MDCT: Current Thoughts and Practice. AJR Am J Roentgenol 2006; 186:406-15. [PMID: 16423946 DOI: 10.2214/ajr.04.1902] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this article is to review studies evaluating how contrast concentration affects MDCT of the body and to report IV contrast infusion protocols from MDCT angiography and MDCT of abdominal tumors. CONCLUSION Higher concentrations (350 mg I/mL or greater) may improve visualization of small abdominal arteries. However, preliminary data comparing 300 mg I/mL to higher concentrations for MDCT of hypervascular hepatocellular carcinoma and pancreatic cancer have shown that higher concentrations may not increase tumor conspicuity.
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Affiliation(s)
- Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N Caroline St., Rm. 3251, Baltimore, MD 21287
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