Contrast Enhancement in Cardiac MDCT: Comparison of Iodixanol 320 Versus Iohexol 350

Tsai, I-Chen; Lee, Tain; Tsai, W. S.; Chen, Min-Chi; Wu, Ming-Ju; Lee, Wen-Lieng; Ting, Hui-Ju

doi:10.2214/ajr.07.2541

Cited by 28 publications

(41 citation statements)

References 18 publications

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“…This also confirms an earlier study by Cademartiri et al [7] which evaluated iodixanol 320 versus iohexol 350 for coronary artery enhancement in 16-MDCT and found no significant difference (mean 333±51 H vs 320±55 H, respectively). Iodixanol, despite a lower iodine concentration than iohexol, still provides similar enhancement [8]. In this study, iohexol offered better vascular enhancement compared to iodixanol, even though they were all of diagnostic image quality.…”

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confidence: 53%

Comparison of contrast enhancement, image quality and tolerability in Coronary CT angiography using 4 contrast agents: A prospective randomized trial

Honoris¹,

Zhong²,

Chu³

et al. 2015

International Journal of Cardiology

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1Cardiac CT Angiography (CCTA) is a robust method for detecting obstructive CAD, with high sensitivity and specificity. Accuracy in analyzing coronary stenosis is reliant on quality of CCTA images and is largely heart rate dependent. 1,2 Several studies have suggested that low-osmolality contrasts affect heart rate variability, through hyperemia due to their interaction with endothelial cells and injection pain. 3,4 Iso-osmolality contrasts may not cause dilution which can degrade and affect intravascular enhancement. The beneficial effects of non-ionic contrast agents on image quality and resolution of CCTA and patient satisfaction is not well studied. We hypothesized that while image brightness varies by iodine content, both low-osmolality and iso-osmolality contrasts will yield high image quality and good safety profile. We undertook a prospective randomized trial to compare image quality, safety and patient tolerability between four contrasts with varying iodine contents: low-osmolal iohexol (350 mg I/mL) and iopamidol (370 I/mL) with two concentrations of iso-osmolal iodixanol (270 I/mL and 320 I/mL) during cardiac CT angiography.513 sequential subjects undergoing outpatient CCTA for evaluation of CAD in a single CT scanning center were enrolled into the study (mean age 57+/-11 years). Patients randomly received one of 4 different contrast agents: iodixanol 270, iodixanol 320, iohexol 350 or iopamidol 370. The CT readers (Level 3 cardiologists) were blinded to the contrast administration used. Inclusion Criteria: >18 years old, undergoing contrast-enhanced CCTA examination, provided written informed consent. Exclusion criteria: renal insufficiency (GFR<50), known contrast allergy, pregnancy or prior revascularization. A 64-detector MDCT (Lightspeed VCT, GE healthcare, Milwaukee, USA) was used for image acquisition and scanning protocols followed the prior studies protocols(5,6). A research assistant collected a survey quantifying side effects of different contrasts: flushing, headache, nausea, and pain at 2 injection site as mild, moderate or severe. Readers, blinded to the contrast media used, assessed image quality by measuring contrast enhancement in aorta, myocardium, left main, proximal Left Anterior Descending, proximal and distal Right Coronary arteries. Standardized regions of interest were used (1 cm) in the ascending aorta, mid-LV ventricle and left atrium on axial slices.The largest region of interest in each coronary artery was used (manually drawn on axial slices).Heart rate(HR) variability during the scan was evaluated. A comparison of the degree of contrast enhancement of the coronary lumen, as well as their differences on each of the contrast agents were measured, stratified by 100 kVp and 120 kVp acquisition. The image quality of 17 coronary artery segments was graded by two cardiologists in consensus with the use of a fourpoint scale (1= excellent, 2=good, 3=fair , 4= poor enhancement) blinded to contrast agent administration.Subjects' characteristics were collected prior to CCTA acquisiti...

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confidence: 53%

Comparison of contrast enhancement, image quality and tolerability in Coronary CT angiography using 4 contrast agents: A prospective randomized trial

Honoris¹,

Zhong²,

Chu³

et al. 2015

International Journal of Cardiology

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“…As mentioned above, several studies comparing the influence of different iodine concentrations of contrast medium on vascular and parenchymal enhancement have already been performed comparing different injection protocols for various body regions [10,[14][15][16][17][18][19][20][21][22][23]. Most of these studies set their focus on parenchymal contrast Obscured anatomic detail, enhancement not sufficient for diagnosis Blurred Extensive Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Intravascular or parenchymal enhancement is clearly affected by all major parameters of the injection protocol applied, including the total volume of contrast material, the iodine concentration, the injection rate and accordingly the duration of injection [1][2][3][5][6][7][8][9][10][11][12][13]. Different contrast material volumes or flow rates also contrast media with different iodine concentrations have been compared [10,[14][15][16][17][18][19][20][21][22][23]. Some studies reported that intravenous administration of contrast media with high iodine concentration yields higher intravascular and parenchymal attenuation than contrast media with a lower iodine concentration [16,17,19,21,22].…”

Section: Introductionmentioning

confidence: 99%

Which Iodine concentration in chest CT? – A prospective study in 300 patients

et al. 2008

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In computed tomography (CT) several contrast media with different iodine concentrations are available. The aim of this study is to prospectively compare contrast media with iodine concentrations of 300, 370 and 400 mg iodine/ml for chest- CT. 300 consecutive patients were prospectively enrolled, under a waiver of the local ethics committee. The first (second, third) 100 patients, received contrast medium with 300 (370, 400) mg iodine/ml. Injection protocols were adapted for an identical iodine delivery rate (1.3 mg/s) and total iodine load (33 g) for all three groups. Standardized MDCT of the chest (16 x 0.75 mm, 120 kVp, 100 mAseff.) was performed. Intravascular attenuation values were measured in the pulmonary trunk and the ascending aorta; subjective image quality was rated on a 3-point-scale. Discomfort during and after injection was evaluated. There were no statistically significant differences in contrast enhancement comparing the three contrast media at the pulmonary trunk (p = 0.3198) and at the ascending aorta (p = 0.0840). Image quality (p = 0.0176) and discomfort during injection (p = 0.7034) were comparable for all groups. General discomfort after injection of contrast media with 300 mg iodine/ml was statistically significant higher compared to 370 mg iodine/ml (p = 0.00019). Given identical iodine delivery rates of 1.3 g/s and iodine loads of 33 g, contrast media with concentrations of 300, 370 and 400 mg iodine/ml do not result in different intravascular enhancement in chest-CT.

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“…Such an ICM injection protocol consisting of a high flow rate and small ICM volume is essential to achieve both a steep up-slope and high peak of the time-contrast enhancement curve [33][34][35][36] with good phase separation.…”

Section: Patient Selectionmentioning

confidence: 99%

64-row MDCT perfusion of head and neck squamous cell carcinoma: technical feasibility and quantitative analysis of perfusion parameters

et al. 2010

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Contrast Enhancement in Cardiac MDCT: Comparison of Iodixanol 320 Versus Iohexol 350

Abstract: Iodixanol 320 can provide vascular enhancement in cardiac MDCT that is similar to iohexol 350. In the delayed phase, iodixanol 320 shows significantly higher delayed enhancement (7.7 H) in the LV myocardium than iohexol 350.

Cited by 28 publications

References 18 publications

Comparison of contrast enhancement, image quality and tolerability in Coronary CT angiography using 4 contrast agents: A prospective randomized trial

Comparison of contrast enhancement, image quality and tolerability in Coronary CT angiography using 4 contrast agents: A prospective randomized trial

Which Iodine concentration in chest CT? – A prospective study in 300 patients

64-row MDCT perfusion of head and neck squamous cell carcinoma: technical feasibility and quantitative analysis of perfusion parameters

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