Feasibility of low contrast media volume in CT angiography of the aorta

Anna Seehofnerová, Madeleine Kok, Casper Mihl, Dave Douwes, Anni Sailer, Estelle Nijssen, Michiel J W de Haan, Joachim E Wildberger, Marco Das, Anna Seehofnerová, Madeleine Kok, Casper Mihl, Dave Douwes, Anni Sailer, Estelle Nijssen, Michiel J W de Haan, Joachim E Wildberger, Marco Das

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.

Keywords: Angiography; Aorta; Computed tomography; Contrast media.

Figures

Fig. 1
Fig. 1
Anatomic areas of ROIs placement.
Fig. 2
Fig. 2
Attenuation [HU] at different anatomic regions.
Fig. 3
Fig. 3
Attenuation in different anatomic regions and aorta protocols.
Fig. 4
Fig. 4
SNR and CNR at different anatomic regions.
Fig. 5
Fig. 5
Correlation of CNR and BMI.

References

    1. Yamamuro M., Tadamura E., Kanao S., Wu Y.W., Tambara K., Komeda M. Coronary angiography by 64-detector row computed tomography using low dose of contrast material with saline chaser: influence of total injection volume on vessel attenuation. J Comput Assist Tomogr. 2007;31(2):272–280.
    1. Becker C.R., Hong C., Knez A., Leber A., Bruening R., Schoepf U.J. Optimal contrast application for cardiac 4-detector-row computed tomography. Invest Radiol. 2003;38(11):690–694.
    1. Bae K.T., Seeck B.A., Hildebolt C.F., Tao C., Zhu F., Kanematsu M. Contrast enhancement in cardiovascular MDCT: effect of body weight, height, body surface area, body mass index, and obesity. AJR Am J Roentgenol. 2008;190(3):777–784.
    1. Bae K.T. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256(1):32–61.
    1. Puippe G.D., Winklehner A., Hasenclever P., Plass A., Frauenfelder T., Baumueller S. Thoraco-abdominal high-pitch dual-source CT angiography: experimental evaluation of injection protocols with an anatomical human vascular phantom. Eur J Radiol. 2012;81(10):2592–2596.
    1. Kumamaru K.K., Steigner M.L., Soga S., Signorelli J., Bedayat A., Adams K. Coronary enhancement for prospective ECG-gated single R-R axial 320-MDCT angiography: comparison of 60- and 80-mL iopamidol 370 injection. AJR Am J Roentgenol. 2011;197(4):844–850.
    1. Yanaga Y., Awai K., Nakaura T., Oda S., Funama Y., Bae K.T. Effect of contrast injection protocols with dose adjusted to the estimated lean patient body weight on aortic enhancement at CT angiography. AJR Am J Roentgenol. 2009;192(4):1071–1078.
    1. Tschugunow A., Puesken M., Juergens K.U., Beyer F., Buerke B., Seifarth H. Optimization of scan delay for routine abdominal 64-slice CT with body weight-adapted application of contrast material. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 2009;181(7):683–690.
    1. Zhu X., Zhu Y., Xu H., Tang L., Xu Y. The influence of body mass index and gender on coronary arterial attenuation with fixed iodine load per body weight at dual-source CT coronary angiography. Acta Radiol. 2012;53(6):637–642.
    1. Cao L., Du X., Li P., Sun Z., Zhang Q., Li K. Optimization of contrast medium protocol in CT coronary arteriography: constant injection dose rate adapted to body weight. Acta Radiol. 2011;52(6):608–612.
    1. Keil S., Plumhans C., Behrendt F.F., Das M., Stanzel S., Mühlenbruch G. MDCT angiography of the pulmonary arteries: intravascular contrast enhancement does not depend on iodine concentration when injecting equal amounts of iodine at standardized iodine delivery rates. Eur Radiol. 2008;18(8):1690–1695.
    1. Kishimoto M., Doi S., Shimizu J., Lee K.J., Iwasaki T., Miyake Y. Influence of osmolarity of contrast medium and saline flush on computed tomography angiography: comparison of monomeric and dimeric iodinated contrast media with different iodine concentrations at an identical iodine delivery rate. Eur J Radiol. 2010;76(1):135–139.
    1. Behrendt F.F., Pietsch H., Jost G., Keil S., Mottaghy F.M., Günther R.W. Low-osmolar monomeric versus iso-osmolar dimeric contrast media: an intra-individual comparison in CT angiography using an animal model. J Med Imaging Radiation Oncol. 2011;55(2):170–175.
    1. Diehm N., Pena C., Benenati J.F., Tsoukas A.I., Katzen B.T. Adequacy of an early arterial phase low-volume contrast protocol in 64-detector computed tomography angiography for aortoiliac aneurysms. J Vasc Surg. 2008;47(3):492–498.
    1. Hunsaker A.R., Oliva I.B., Cai T., Trotman-Dickenson B., Gill R.R., Hatabu H. Contrast opacification using a reduced volume of iodinated contrast material and low peak kilovoltage in pulmonary CT angiography: objective and subjective evaluation. AJR Am J Roentgenol. 2010;195(2):W118–W124.
    1. Szucs-Farkas Z., Schibler F., Cullmann J., Torrente J.C., Patak M.A., Raible S. Diagnostic accuracy of pulmonary CT angiography at low tube voltage: intraindividual comparison of a normal-dose protocol at 120 kVp and a low-dose protocol at 80 kVp using reduced amount of contrast medium in a simulation study. AJR Am J Roentgenol. 2011;197(5):W852–W859.
    1. Nijhof W.H., van der Vos C.S., Anninga B., Stegehuis P.L., Jager G.J., Rutten M.J. Reduced contrast medium in abdominal aorta CTA using a multiphasic injection technique. Eur J Radiol. 2013;82(2):252–257.
    1. Nijhof W.H., van der Vos C.S., Anninga B., Jager G.J., Rutten M.J. Reduction of contrast medium volume in abdominal aorta CTA: multiphasic injection technique versus a test bolus volume. Eur J Radiol. 2013
    1. McCollough C.H., Primak A.N., Braun N., Kofler J., Yu L., Christner J. Strategies for reducing radiation dose in CT. Radiol Clin N Am. 2009;47(1):27–40.
    1. Walsh S.R., Tang T., Gaunt M.E., Boyle J.R. Contrast-induced nephropathy. J Endovasc Ther: Off J Int Soc Endovasc Spec. 2007;14(1):92–100.
    1. From A.M., Bartholmai B.J., Williams A.W., Cha S.S., McDonald F.S. Mortality associated with nephropathy after radiographic contrast exposure. Mayo Clin Proc Mayo Clin. 2008;83(10):1095–1100.
    1. Davidson C., Stacul F., McCullough P.A., Tumlin J., Adam A., Lameire N. Contrast medium use. Am J Cardiol. 2006;98(6A):42K–58K.
    1. Holmquist F., Hansson K., Pasquariello F., Bjork J., Nyman U. Minimizing contrast medium doses to diagnose pulmonary embolism with 80-kVp multidetector computed tomography in azotemic patients. Acta Radiol. 2009;50(2):181–193.
    1. Viteri-Ramírez G., García-Lallana A., Simón-Yarza I., Broncano J., Ferreira M., Pueyo J.C. Low radiation and low-contrast dose pulmonary CT angiography: comparison of 80 kVp/60 ml and 100 kVp/80 ml protocols. Clin Radiol. 2012;67(9):833–839.
    1. Wu C.C., Lee E.W., Suh R.D., Levine B.S., Barack B.M. Pulmonary 64-MDCT angiography with 30 mL of IV contrast material: vascular enhancement and image quality. AJR Am J Roentgenol. 2012;199(6):1247–1251.
    1. Bae K.T., Tran H.Q., Heiken J.P. Multiphasic injection method for uniform prolonged vascular enhancement at CT angiography: pharmacokinetic analysis and experimental porcine model. Radiology. 2000;216(3):872–880.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다