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Varughese NA, Panakkal NC, Nair VT, Kadavigere R, Lakshmi V, Sukumar S. Effect of patient characteristics on aortic attenuation in iodinated contrast-enhanced Abdominopelvic CT: A retrospective study. Radiography (Lond) 2024; 30 Suppl 1:94-101. [PMID: 39106556 DOI: 10.1016/j.radi.2024.07.012] [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: 05/26/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Contrast Enhanced Computed Tomography (CECT) abdomen and pelvis is a common imaging procedure. Hospitals typically follow fixed protocols of contrast volume administration for triple-phase CECT abdomen and pelvis scans and have found that patients are either underdosed or overdosed with respect to their body habitus. The aim of the study was to correlate different patient characteristics such as Total body weight (TBW), Lean Body Mass (LBM), Body Mass Index (BMI), Body Surface Area (BSA) and Blood Volume (BV) with aortic enhancement in the arterial and portal venous phases for CECT Abdomen and pelvis. METHODS A total of 106 patients who underwent triple-phase CECT abdomen & pelvis were retrospectively studied. A circular region-of-interest (ROI) of 100 mm2 was positioned on descending aorta for unenhanced, arterial, and portal venous phases to measure the aortic enhancement in Hounsfield's units. Measure of contrast attenuation (ΔH) was calculated from the difference of CT values on unenhanced images and contrast images. Correlation analysis was performed to evaluate the relation of patient body characteristics with aortic enhancement. RESULTS Correlation analysis revealed that BMI exhibited the least correlation when compared to the other characteristics in both arterial (r = -0.3; p = 0.002) and portovenous phases (r = -0.35; p < 0.001) whereas TBW, LBW, BSA and BV reported moderate inverse correlations. BV was found to be the strongest of all characteristics under linear regression. CONCLUSION The study supports the use of protocols that adjust contrast volume to either TBW, LBW, BSA, or BV for CT abdomen and pelvis scan. IMPLICATION OF PRACTICE The right body parameter ensures optimal contrast enhancement, improving the visualization of anatomical structures and helps in adapting tailored contrast injection protocols.
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Affiliation(s)
- N A Varughese
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - N C Panakkal
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - V T Nair
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - R Kadavigere
- Radio-diagnosis & Imaging, Department of Radio Diagnosis & Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - V Lakshmi
- Department of Data Sciences, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - S Sukumar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Ladder-Like Low Iodine Delivery Rate Injection Protocols Based on BMI at 70 KV by Automated Tube Voltage Selection in Coronary CTA. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7804015. [PMID: 35924071 PMCID: PMC9308544 DOI: 10.1155/2022/7804015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the feasibility of reducing the injection velocity and volume of contrast agent according to BMI, and the effect of body weight (BW), body surface area(BSA), body mass index(BMI),and blood volume (BV) on aortic contrast enhancement when the voltage of third-generation dual-source CT is selected at 70 KV. Methods A total of 280 patients selected at 70 KV were randomly divided into an experimental group and a control group. Each group was divided into 7 subgroups according to BMI ≤20, 20–21, 21-22, 22-23, 23-24, 24-25, and 25–26. The experimental group uses 2.3/2.4/2.5/2.6/2.7/2.8/2.9 ml/s injection speed with 350 mgI/ml contrast agents according to the subgroups; injection time was fixed at 10 s. In the control group, the fixed injection flow rate was 3.5 ml/s, time was 12 s with a total of 42 ml. Subjects in both groups were inspected to adaptive prospective ECG-gating sequence scanning, and subjective and objective image quality of the two groups were compared using Student's t-test. BMI, BSA, and BV were calculated from the patient's body weight and height. We assess the relationship between aortic attenuation and BW, BMI, BV, and BSA using regression analysis or correlation analysis. Results Significant differences exist in vascular enhancement between the two groups; SNR and CNR of objective image quality in the experimental group were lower than those in the control group (P < 0.05). Both groups had the same subjective image scores (P > 0.05). The number of vessels in the optimal enhancement range counts more in the experimental group than in the control group (χ2 value = 334.25, P < 0.05). In the control group, a weak to medium correlation was seen between vascular enhancement and BMI (r = −0.20), BW (r = −0.42), BSA (r = −0.46), and BV (r = −0.48) (P < 0.05 for all). Conclusions Compared to BW, BSA, and BV, a weaker negative correlation exists between vascular enhancement and BMI when ATVS selects 70 KV. However, as a much easier way to operate, the stepped low flow and low-contrast agent injection based on BMI was feasible, and the image quality was more homogenized than that of the control group.
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Abazid RM, Smettei OA, Almeman A, Sayed S, Alsaqqa H, Abdelmageed SM, Alharbi FJ, Alhabib AM, Al-Mallah MH. Fat volume measurements as a predictor of image noise in coronary computed tomography angiography. J Saudi Heart Assoc 2018; 31:32-40. [PMID: 30559578 PMCID: PMC6289940 DOI: 10.1016/j.jsha.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/19/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Image noise can negatively affect the overall quality of coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to evaluate the relationship between image noise and fat volumes in the chest wall. We also aimed to compare these with other patient-specific predictors of image noise, such as body weight (BW) and body mass index (BMI). Methods We undertook a cross-sectional, single-center study. A tube voltage of 100 kV was used for patients with BW <85 kg and 120 kV for BW ≥85 kg. The image noise in the aortic root, single-slice fat volume (SFV) at the level of the left main coronary artery and the total fat volume of the chest (TFV) were analyzed. Results A total of 132 consecutive patients were enrolled (mean age ± standard deviation, 51 ± 11 years; 64% male). The mean image noise was 30.5 ± 11 Hounsfield units (HU). We found that patients with image noise >30 HU had significantly higher SFV (75 ± 33 vs. 51 ± 24, p < 0.0001) and TFV (2206 ± 927 vs. 1815 ± 737, p < 0.01) compared with patients having noise ≤30 HU, whereas BW and BMI showed no significant difference (78 ± 13 vs. 81 ± 14, p < 0.34) and (28.7 ± 4.7 vs. 26.8 ± 3.8, p < 0.19), respectively. Linear regression analysis showed that image noise has better correlation with SFV (R = 0.399; p < 0.0001); and TFV (R = 0, p < 0.009) than BMI (R = 0.154, p < 0.039) and BW (R = -0.102, p = 0.12). Conclusions Fat volume measurements of the chest wall can predict CCTA image noise better than other patient-specific predictors, such as BW and BMI.
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Affiliation(s)
- Rami M. Abazid
- Department of Cardiology, Cardiac Imaging, Prince Sultan Cardiac Center–Qassim PSCCQ, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
- Corresponding author at: Department of Cardiology, Prince Sultan Cardiac Center–Qassim (PSCCQ), Postal Code 2290, Buraydah, Al-Qassim, Saudi Arabia.
| | - Osama A. Smettei
- Department of Cardiology, Cardiac Imaging, Prince Sultan Cardiac Center–Qassim PSCCQ, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Ahmad Almeman
- Department of pharmacology, Qassim University, Qassim, Buraydah, Saudi Arabia
| | - Sawsan Sayed
- Department of Cardiology, Cardiac Imaging, Prince Sultan Cardiac Center–Qassim PSCCQ, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Hanaa Alsaqqa
- Department of Cardiology, Cardiac Imaging, Prince Sultan Cardiac Center–Qassim PSCCQ, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Salma M. Abdelmageed
- Department of Cardiology, Cardiac Imaging, Prince Sultan Cardiac Center–Qassim PSCCQ, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Fahad J. Alharbi
- Department of Cardiology, Cardiac Imaging, Prince Sultan Cardiac Center–Qassim PSCCQ, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Abdullah M. Alhabib
- Department of Cardiology, Cardiac Imaging, Prince Sultan Cardiac Center–Qassim PSCCQ, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Mouaz H. Al-Mallah
- Department of Medicine, Wayne State University, Detroit, MI, USA
- Cardiac Imaging, King Abdul-Aziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia
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Zhu X, Yu Y, Xu D, Zhang H, Tang L. Coronary angiography using second-generation dual source computed tomography: Feasibility of low dose and low flow rate to achieve appropriate individual contrast enhancement using a test bolus-based contrast medium protocol-A CONSORT compliant article. Medicine (Baltimore) 2018; 97:e11425. [PMID: 30024514 PMCID: PMC6086535 DOI: 10.1097/md.0000000000011425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Improved contrast enhancement consistency can be achieved using an individualized contrast media (CM) protocol. This study aimed to assess the feasibility of a low-dose, low-flow rate CM protocol to achieve appropriate individual contrast enhancement using a newly advocated individualized test bolus-based protocol for second-generation dual-source computed tomography angiography.CM containing iodine (370 mg I/mL) was used in this study. A CM flow rate of 3.5 mL/s for patients with a body mass index (BMI) <25.0 kg/m, and 4.5 mL/s for those with BMI ≥25.0 kg/m was used in group 1 (n = 189). An individualized test-bolus based contrast injection protocol was then derived from the information gained from the test bolus and coronary enhancements in group 1. The proposed individualized test-bolus based CM injection protocol was applied in group 2 (n = 219). Ascending aortic attenuations (AAo) were measured and compared with both groups.The contrast enhancement consistency of AAo in group 2 improved significantly (31.8 vs 56.3 Hounsfield units [HU]; P < .001). The number of patients in group 2 with a contrast flow rate ≤3 mL/s was 63 (28.8%), with 77 (35.2%) using a contrast dose ≤40 mL. In group 2, no significant differences in mean AAo were found among subgroups with contrast flow rates ≤3.0, 3.1 to 4.0, 4.1 to 5.0 and >5.0 mL/s (351, 344, 346, and 348 HU, respectively), nor among subgroups with contrast doses ≤40, 41 to 50, 51 to 60, and >60 mL (349, 345, 344, and 350 HU, respectively).Improved individual contrast enhancement uniformity can be achieved using an individualized CM protocol tailored to a test bolus. Approximately, one-third of patients received CM at a flow rate of no more than 3 mL/s and a total dose of no more than 40 mL.
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Affiliation(s)
- Xiaomei Zhu
- Radiological Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Yusheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Jiangning District
| | - Dinghu Xu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Jiangning District
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Jiangning District
| | - Lijun Tang
- Radiological Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Yang X, Huang W, Liu W, Zhu Y, Xu Y, Yang G, Tang L, Zhu X. The Influence of Contrast Agent's Osmolarity on Iodine Delivery Protocol in Coronary Computed Tomography Angiography: Comparison Between Iso-Osmolar Iodixanol-320 and Low-Osmolar Iomeprol-370. J Comput Assist Tomogr 2017; 42:62-67. [PMID: 28708716 DOI: 10.1097/rct.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aims to assess whether iodine-contained contrast agents with different osmolarity affect iodine delivery protocol during coronary computed tomography angiography (CCTA). METHODS Patients who underwent CCTA were randomized to receive contrast media either iodixanol-320 (iso-osmolar group) or iopromide-370 (low-osmolar group). Contrast protocols were recorded. Tube voltage of 100 kV was chosen for patients with body mass index of less than or equal to 25 (n = 224) and tube voltage of 120 kV for patients with body mass index of greater than 25 (n = 165). Both groups applied automatic current modulation technique. Mean contrast enhancement of the ascending aorta, left main coronary artery, and descending aorta was calculated. Simulated contrast flow rate and iodine delivery rate (IDR) to reach a mean contrast enhancement level of 350 HU were calculated. RESULTS A total of the 389 patients were enrolled in the study. To achieve the same contrast enhancement of 350 HU, iso-osmolar group required higher simulated contrast flow rate (3.90 vs 3.62 mL/s, P = 0.017) but lower simulated IDR (1.34 vs 1.25 g/s, P = 0.024) compared with low-osmolar group. CONCLUSIONS To maintain a similar level of contrast enhancement during CCTA, iodixanol-320 needs larger contrast flow rate with lower IDR compared with low-osmolar iopromide-370.
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Zhu X, Zhu Y, Liu W, Yang G, Su Z, Tang L, Xu Y. Improved image-quality consistency in coronary CT angiography using a test-bolus-based individually tailored contrast medium injection protocol. Clin Radiol 2016; 71:1113-9. [PMID: 27170220 DOI: 10.1016/j.crad.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/20/2016] [Accepted: 04/01/2016] [Indexed: 11/20/2022]
Abstract
AIM To develop and validate a test bolus (TB)-based quantitative model to create an individualised contrast medium injection protocol for use at coronary computed tomography angiography (CCTA) to improve patient-to-patient uniformity of intracoronary attenuation. MATERIALS AND METHODS In the model-building phase, 175 patients who underwent CCTA using a traditional contrast medium injection protocol were recruited. A personalised injection equation was proposed according to the relationship between aortic enhancement and the haemodynamic parameters obtained from the TB. In the model-validation phase, a target aortic enhancement of 350 HU was set. Two hundred and fifteen additional CCTA examinations were performed using the proposed personalised injection model. Comparisons of inter-individual variability between the traditional and the proposed personalised injection protocol were performed. RESULTS In the model-building phase, a high positive correlation between aortic enhancement and the haemodynamic parameters obtained from the TB was found. As a result, a personalised injection equation was determined using linear regression. In the model-validation phase, the average aortic enhancement was 350.5 HU, without significant differences from the preset level. Using the TB-based personalised injection protocol, inter-individual variability of aortic enhancement was significantly reduced (71.8 versus 38.9 HU, p<0.001) and patients who were scanned at 100 kVp had a reduction in the average contrast medium flow rate from 4.1 to 3.2 ml/s (p<0.001). CONCLUSIONS The proposed TB-based injection protocol can achieve a desired preset and stable aortic enhancement.
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Affiliation(s)
- X Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Y Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - W Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - G Yang
- Lab. of Image Science & Technology, School of Computer Science and Engineering, Southeast University, 2 Sipailou, Nanjing 210096, Jiangsu, China
| | - Z Su
- GE Healthcare, 12f Building A, E-town International Center, No. 10 Ronghua Road, Business Development Area, Beijing, 100176, China
| | - L Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Y Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
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Durmus T, Luhur R, Daqqaq T, Schwenke C, Knobloch G, Huppertz A, Hamm B, Lembcke A. Individual selection of X-ray tube settings in computed tomography coronary angiography: Reliability of an automated software algorithm to maintain constant image quality. Eur J Radiol 2016; 85:963-71. [PMID: 27130057 DOI: 10.1016/j.ejrad.2016.03.004] [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: 02/10/2015] [Revised: 02/28/2016] [Accepted: 03/02/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate a software tool that claims to maintain a constant contrast-to-noise ratio (CNR) in high-pitch dual-source computed tomography coronary angiography (CTCA) by automatically selecting both X-ray tube voltage and current. METHODS A total of 302 patients (171 males; age 61±12years; body weight 82±17kg, body mass index 27.3±4.6kg/cm(2)) underwent CTCA with a topogram-based, automatic selection of both tube voltage and current using dedicated software with quality reference values of 100kV and 250mAs/rotation (i.e., standard values for an average adult weighing 75kg) and an injected iodine load of 222mg/kg. RESULTS The average radiation dose was estimated to be 1.02±0.64mSv. All data sets had adequate contrast enhancement. Average CNR in the aortic root, left ventricle, and left and right coronary artery was 15.7±4.5, 8.3±2.9, 16.1±4.3 and 15.3±3.9 respectively. Individual CNR values were independent of patients' body size and radiation dose. However, individual CNR values may vary considerably between subjects as reflected by interquartile ranges of 12.6-18.6, 6.2-9.9, 12.8-18.9 and 12.5-17.9 respectively. Moreover, average CNR values were significantly lower in males than females (15.1±4.1 vs. 16.6±11.7 and 7.9±2.7 vs. 8.9±3.0, 15.5±3.9 vs. 16.9±4.6 and 14.7±3.6 vs. 16.0±4.1 respectively). CONCLUSION A topogram-based automatic selection of X-ray tube settings in CTCA provides diagnostic image quality independent of patients' body size. Nevertheless, considerable variation of individual CNR values between patients and significant differences of CNR values between males and females occur which questions the reliability of this approach.
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Affiliation(s)
- Tahir Durmus
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
| | - Reny Luhur
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Tareef Daqqaq
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | | | - Gesine Knobloch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Alexander Lembcke
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
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Feasibility of 320-row area detector CT coronary angiography using 40 mL of contrast material: assessment of image quality and diagnostic accuracy. Eur Radiol 2016; 26:3802-3810. [DOI: 10.1007/s00330-016-4275-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 12/28/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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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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Effect of Right-Sided Versus Left-Sided Contrast Injection on Intra-arterial Opacification Characteristics of Head and Neck Computed Tomography Angiograms and Interactions With Patient Sex, Weight, and Cardiac Output. J Comput Assist Tomogr 2015; 39:752-9. [PMID: 26295189 DOI: 10.1097/rct.0000000000000273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to support the standard clinical assumption that preferential right-sided injection (RSI) over left-sided injection (LSI) results in improved head and neck computed tomography angiograms and to determine which patients most benefit from RSIs. METHODS Head and neck computed tomography angiograms of 453 RSIs and 419 LSIs were included. Interactions between injection side, age, weight, body mass index, and left ventricular ejection fraction with mean vessel Hounsfield units (HU) were compared. Statistical analysis was performed using 2-tailed Student t tests, Mann-Whitney U tests, and simple linear (SL) and multiple linear regressions. RESULTS Right-sided injection yielded higher HU for patients older than 40 years (eg, RSI of the right common carotid artery [RCCA] vs LSI of the RCCA; P < 0.01). Body mass index (eg, RCCA; r = -0.31, P < 0.01 [SL]) and weight (eg, RCCA; r = -0.39, P < 0.01 [SL]) were negatively correlated with HU. Female had higher HU (mean ± SE, +39.7 ± 7.6 HU; P < 0.01 [multiple linear]). Left ventricular ejection fraction had no interactions with injection side or HU. CONCLUSIONS The findings support preferential RSI in patients older than 40 years with higher body mass index and weight, particularly male.
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Seehofnerová A, Kok M, Mihl C, Douwes D, Sailer A, Nijssen E, de Haan MJW, Wildberger JE, Das M. Feasibility of low contrast media volume in CT angiography of the aorta. Eur J Radiol Open 2015; 2:58-65. [PMID: 26937437 PMCID: PMC4750622 DOI: 10.1016/j.ejro.2015.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives Using smaller volumes of contrast media (CM) in CT angiography (CTA) is desirable in terms of cost reduction and prevention of contrast-induced nephropathy (CIN). The purpose was to evaluate the feasibility of low CM volume in CTA of the aorta. Methods 77 patients referred for CTA of the aorta were scanned using a standard MDCT protocol at 100 kV. A bolus of 50 ml CM (Iopromide 300 mg Iodine/ml) at a flow rate of 6 ml/s was applied (Iodine delivery rate IDR = 1.8 g/s; Iodine load 15 g) followed by a saline bolus of 40 ml at the same flow rate. Scan delay was determined by the test bolus method. Subjective image quality was assessed and contrast enhancement was measured at 10 anatomical levels of the aorta. Results Diagnostic quality images were obtained for all patients, reaching a mean overall contrast enhancement of 324 ± 28 HU. Mean attenuation was 350 ± 60 HU at the thoracic aorta and 315 ± 83 HU at the abdominal aorta. Conclusions A straightforward low volume CM protocol proved to be technically feasible and led to CTA examinations reaching diagnostic image quality of the aorta at 100 kV. Based on these findings, the use of a relatively small CM bolus can be incorporated into routine clinical imaging.
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Affiliation(s)
- Anna Seehofnerová
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Madeleine Kok
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dave Douwes
- Siemens Nederland N.V., Healthcare Sector, Customer Service Prinses Beatrixlaan 800, 2595 BN Den Haag, The Netherlands
| | - Anni Sailer
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Estelle Nijssen
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michiel J W de Haan
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
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An individualized contrast material injection protocol with respect to patient-related factors for dual-source CT coronary angiography. Clin Radiol 2014; 69:e86-92. [DOI: 10.1016/j.crad.2013.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/11/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
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Kidoh M, Nakaura T, Nakamura S, Awai K, Utsunomiya D, Namimoto T, Harada K, Yamashita Y. Novel contrast-injection protocol for coronary computed tomographic angiography: contrast-injection protocol customized according to the patient's time-attenuation response. Heart Vessels 2013; 29:149-55. [PMID: 23512260 DOI: 10.1007/s00380-013-0338-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/01/2013] [Indexed: 01/03/2023]
Abstract
We developed a new individually customized contrast-injection protocol for coronary computed tomography (CT) angiography based on the time-attenuation response in a test bolus, and investigated its clinical applicability. We scanned 60 patients with suspected coronary diseases using a 64-detector CT scanner, who were randomly assigned to one of two protocols. In protocol 1 (P1), we estimated the contrast dose to yield a peak aortic attenuation of 400 HU based on the time-attenuation response to a small test-bolus injection (0.3 ml/kg body weight) delivered over 9 s. Then we administered a customized contrast dose over 9 s. In protocol 2 (P2), the dose was tailored to the patient's body weight; this group received 0.7 ml/kg body weight with an injection duration of 9 s. We compared the two protocols for dose of contrast medium, peak attenuation, variations in attenuation values of the ascending aorta, and the success rate of adequate attenuation (250-350 HU) of the coronary arteries. The contrast dose was significantly smaller in P1 than in P2 (36.9 ± 9.2 vs 43.1 ± 7.0 ml, P < 0.01). Peak aortic attenuation was significantly less under P1 than under P2 (384.1 ± 25.0 vs 413.5 ± 45.7, P < 0.01). The mean variation (standard deviation) of the attenuation values was smaller in P1 than in P2 (25.0 vs 45.7, P < 0.01). The success rate of adequate attenuation of the coronary arteries was significantly higher with P1 than with P2 (85.0 vs 65.8 %, P < 0.01). P1 facilitated a reduction in the contrast dose, reduced the individual variations in peak aortic attenuation, and achieved optimal coronary CT attenuation (250-350 HU) more frequently than P2.
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Affiliation(s)
- Masafumi Kidoh
- Diagnostic Radiology, Amakusa Medical Center, Kameba 854-1, Amakusa, Kumamoto, 863-0046, Japan,
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Zhu X, Zhu Y, Xu H, Yang G, Tang L, Xu Y. Dual-source CT coronary angiography involving injection protocol with iodine load tailored to patient body weight and body mass index: estimation of optimal contrast material dose. Acta Radiol 2013; 54:149-55. [PMID: 23171529 DOI: 10.1258/ar.2012.120362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Body mass index (BMI) has a positive linear influence on arterial attenuation at coronary CT angiography involving injection protocol with dose linearly tailored to body weight (BW). Excessive contrast material may inadvertently be given in heavier patients when the dose is determined by BW only. PURPOSE To investigate the effect of injection protocol with dose of contrast material (CM) tailored to BW and BMI on coronary arterial attenuation, contrast-to-noise ratio, and image noise at dual-source CT coronary angiography (DSCT-CA). MATERIAL AND METHODS A total of 233 consecutive patients (mean age, 60.2 years) undergoing DSCT-CA were included. Image acquisition protocol was standardized (120 kV, 380 mAs, and retrospective electrocardiograph-triggered DSCT-CA). CM dosage calculation was randomly categorized into groups: a BW group and a BW-BMI group. CM flow rate in both groups was calculated as dosage divided by scan time plus 8 s. Correlations between BW, BMI, and attenuations of ascending aorta (AA) above coronary ostia, left main coronary artery (LM), proximal right coronary artery (RCA), left anterior descending (LAD), and left circumflex artery (LCX), contrast to noise ratio of LM (LMCNR) and RCA (RCACNR), and image noise were evaluated with simple linear regression for two groups individually. RESULTS In BW group, attenuations of AA and coronary arteries showed positive linear correlations to BW and BMI. In contrast, no relationships were found in BW-BMI group. LMCNR and RCACNR were inversely determined by BW and BMI in both groups. Image noise increased with BW and BMI increasing in two groups. CONCLUSION BMI has a positive linear influence on arterial attenuation with fixed iodine per BW. The injection protocol with CM dose tailored to BW and BMI is reasonable during DSCT-CA.
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Affiliation(s)
- Xiaomei Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Yinsu Zhu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Hai Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Guanyu Yang
- Laboratory of Image Science & Technology, School of Computer Science and Engineering, Southeast University, Nanjing, Jiangsu, China
| | - Lijun Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Yi Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
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