Evaluation of individually body weight adapted contrast media injection in coronary CT-angiography

Mihl, Casper; Kok, Madeleine; Altintas, Sibel; Kietselaer, Bas; Turek, Jakub; Wildberger, Joachim E.; Das, Marco

doi:10.1016/j.ejrad.2015.12.031

Cited by 36 publications

(42 citation statements)

References 30 publications

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“…Many different techniques, varying from simple to complicated formulas with differing patient parameters have been suggested, e.g., BW, lean body weight (LBW), and CO [14]. Multiple studies show that individualization based on patients' BW or BW categories results in a diagnostic image quality throughout the patient population, together with decreased CM volumes [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Personalization of CM Injection Protocols in Coronary Computed Tomographic Angiography (People CT Trial)

Eijsvoogel

Hendriks

Nelemans

et al. 2020

Contrast Media & Molecular Imaging

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Aim. To evaluate the performance of three contrast media (CM) injection protocols for cardiac computed tomography angiography (CCTA) based on body weight (BW), lean BW (LBW), and cardiac output (CO). Materials and methods. A total of 327 consecutive patients referred for CCTA were randomized into one of the three CM injection protocols, where CM injection was based on either BW (112 patients), LBW (108 patients), or CO (107 patients). LBW and CO were calculated via formulas. All scans were ECG-gated and performed on a third-generation dual-source CT with 70–120 kV (automated tube voltage selection) and 100 kVqual.ref/330 mAsqual.ref. CM injection protocols were also adapted to scan time and tube voltage. The primary outcome was the proportion of patients with optimal intravascular attenuation (325–500 HU). Secondary outcomes were mean and standard deviation of intravascular attenuation values (HU), contrast-to-noise ratio (CNR), and subjective image quality with a 4-point Likert scale (1 = poor/2 = sufficient/3 = good/4 = excellent). The t-test for independent samples was used for pairwise comparisons between groups, and a chi-square test (χ2) was used to compare categorical variables between groups. All p values were 2-sided, and a p<0.05 was considered statistically significant. Results. Mean overall HU and CNR were 423 ± 60HU/14 ± 3 (BW), 404 ± 62HU/14 ± 3 (LBW), and 413 ± 63HU/14 ± 3 (CO) with a significant difference between groups BW and LBW (p=0.024). The proportion of patients with optimal intravascular attenuation (325–500 HU) was 83.9%, 84.3%, and 86.9% for groups BW, LBW, and CO, respectively, and between-group differences were small and nonsignificant. Mean CNR was diagnostic (≥10) in all groups. The proportion of scans with good-excellent image quality was 94.6%, 86.1%, and 90.7% in the BW, LBW, and CO groups, respectively. The difference between proportions was significant between the BW and LBW groups. Conclusion. Personalization of CM injection protocols based on BW, LBW, and CO, and scan time and tube voltage in CCTA resulted in low variation between patients in terms of intravascular attenuation and a high proportion of scans with an optimal intravascular attenuation. The results suggest that personalized CM injection protocols based on LBW or CO have no additional benefit when compared with CM injection protocols based on BW.

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Section: Introductionmentioning

confidence: 99%

Personalization of CM Injection Protocols in Coronary Computed Tomographic Angiography (People CT Trial)

Eijsvoogel

Hendriks

Nelemans

et al. 2020

Contrast Media & Molecular Imaging

View full text Add to dashboard Cite

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“…In Zhang's study ( 14 ), the effective dose (ED) was reduced to 0.2 mSv, when 70 kVp scanning was adopted in coronary CT angiography (CCTA) for patients with body mass index (BMI) < 25 kg/m 2 . In addition, 70 kVp scanning could largely enhance the image contrast which could consequently decrease the contrast media volume and reduce risk for contrast-induced nephropathy ( 15 16 ). Nevertheless, 70 kVp scanning has some limitations, which include an increase in image noise and compromise in image quality (IQ).…”

Section: Introductionmentioning

confidence: 99%

High-Pitch Coronary CT Angiography at 70 kVp Adopting a Protocol of Low Injection Speed and Low Volume of Contrast Medium

et al. 2017

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ObjectiveTo evaluate the feasibility and image quality (IQ) of prospectively high-pitch coronary CT angiography (CCTA) with low contrast medium injection rate at 70 kVp.Materials and MethodsOne hundred and four patients with suspected coronary artery disease (body mass index < 26 kg/m2, sinus rhythm and heart rate < 70 beats/min) were prospectively enrolled and randomly divided into two groups. In group A and group B, 28 mL and 40 mL of 370 mgI/mL iodinated contrast media was administrated at a flow rate of 3.5 and 5 mL/s, respectively. CT values, noise, signal-to-noise ratio, contrast-to-noise ratio (CNR) of the proximal segments of coronary arteries and subjective IQ were evaluated.ResultsThe CT values and noise in group A were significantly lower than those in group B (434–485 Hounsfield units [HU] vs. 772–851 HU, all p < 0.001; 17.8–22.3 vs. 23.3–26.4, all p < 0.005). The CNRs of the right coronary artery and left main artery showed no statistical difference between the two groups (42.1 ± 13.8 vs. 36.8 ± 16.0, p = 0.074; 38.7 ± 10.6 vs. 38.1 ± 17.0, p = 0.819). No statistical difference was observed between the two groups in IQ scores (3.04 ± 0.75 vs. 3.0 ± 0.79, p = 0.526) and diagnostic ratio (96.1% [50/52] vs. 94.2% [49/52], p = 0.647).ConclusionProspective high-pitch CCTA at 70 kVp with 28 mL of contrast media and injection rate of 3.5 mL/s could provide diagnostic IQ for normal-weight patients with heart rate of < 70 beats/min.

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“…This effect can be used to decrease the amount of CM. Additionally, Mihl, et al 23) reported that using CM injection protocols based on weight categories could reduce CM volume and provide diagnostically sufficient image quality in coronary CTA. In our study, the volume of CM was set according to body weight, and it was therefore possible to set the CM volume more appropriately.…”

Section: Discussionmentioning

confidence: 99%

Clinical Advantages of Using Low Tube Voltage in Third-Generation 192-Slice Dual-Source Computed Tomographic Angiography Before Transcatheter Aortic Valve Implantation

et al. 2019

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Low-voltage computed tomographic angiography (CTA) is a highly effective technique to reduce contrast media volume. We sought to examine the suitability of low tube voltage CTA with a reduced contrast media volume protocol using third-generation 192-slice dual-source CT in patients undergoing transcatheter aortic valve implantation (TAVI). CTA was performed to aid TAVI planning for 40 consecutive patients with severe aortic stenosis. For the first 10 patients (120/100 kV group), we used a conventional tube voltage combined CTA protocol (an ECG-gated helical scan; 120 kV, non-gated helical scan; 100 kV). For the subsequent 30 patients (70-kV group), we adopted a low tube voltage CTA protocol. We evaluated vascular attenuation, image noise, contrast-to-noise ratio (CNR), and renal function. The mean contrast media (CM) volume was 77.7 ± 17.7 mL in the 120/100-kV group and 30.9 ± 6.3 mL in the 70-kV group (P < 0.001). In the images of the aortic valve complex, the mean attenuation was not significant difference for both groups. In the images of the aorto-femoral arteries, mean attenuation was > 250 Hounsfield Units and CNR was > 10 in all vascular segments for both groups. There was no significant difference in the change of renal function in the 70-kV group, but renal function in the 120/100-kV group decreased within 1-3 months after CTA. Low tube voltage CTA using third-generation dual-source CT is suitable to assess procedural planning for TAVI. This approach maintains image quality and reduces the required CM volume.

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Evaluation of individually body weight adapted contrast media injection in coronary CT-angiography

Cited by 36 publications

References 30 publications

Personalization of CM Injection Protocols in Coronary Computed Tomographic Angiography (People CT Trial)

Personalization of CM Injection Protocols in Coronary Computed Tomographic Angiography (People CT Trial)

High-Pitch Coronary CT Angiography at 70 kVp Adopting a Protocol of Low Injection Speed and Low Volume of Contrast Medium

Clinical Advantages of Using Low Tube Voltage in Third-Generation 192-Slice Dual-Source Computed Tomographic Angiography Before Transcatheter Aortic Valve Implantation

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