Low volume contrast CTPA in patients with renal dysfunction

Singh, Tushar; Lam, Kay-Vin; Murray, Conor

doi:10.1111/j.1754-9485.2011.02243.x

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…The CM volume commonly applied in CTPA of non-obese patients varies between 60 and 100 ml [29, 33, 34]. According to the literature, a minimum attenuation value of 211 to 250 HU in PA permits reliable exclusion of acute and chronic thromboembolism [35, 36]. The mean attenuation of about 400 HU inside the PA in our study using only 40ml of CM markedly exceeded these values.…”

Section: Discussionmentioning

confidence: 48%

CT Pulmonary Angiography at Reduced Radiation Exposure and Contrast Material Volume Using Iterative Model Reconstruction and iDose4 Technique in Comparison to FBP

et al. 2016

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PurposeTo assess image quality of CT pulmonary angiography (CTPA) at reduced radiation exposure (RD-CTPA) and contrast medium (CM) volume using two different iterative reconstruction (IR) algorithms (iDose4 and iterative model reconstruction (IMR)) in comparison to filtered back projection (FBP).Materials and Methods52 patients (body weight < 100 kg, mean BMI: 23.9) with suspected pulmonary embolism (PE) underwent RD-CTPA (tube voltage: 80 kV; mean CTDIvol: 1.9 mGy) using 40 ml CM. Data were reconstructed using FBP and two different IR algorithms (iDose4 and IMR). Subjective and objective image quality and conspicuity of PE were assessed in central, segmental, and subsegmental arteries.ResultsNoise reduction of 55% was achieved with iDose4 and of 85% with IMR compared to FBP. Contrast-to-noise ratio significantly increased with iDose4 and IMR compared to FBP (p<0.05). Subjective image quality was rated significantly higher at IMR reconstructions in comparison to iDose4 and FBP. Conspicuity of central and segmental PE significantly improved with the use of IMR. In subsegmental arteries, iDose4 was superior to IMR.ConclusionsCTPA at reduced radiation exposure and contrast medium volume is feasible with the use of IMR, which provides improved image quality and conspicuity of pulmonary embolism in central and segmental arteries.

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Section: Discussionmentioning

confidence: 48%

CT Pulmonary Angiography at Reduced Radiation Exposure and Contrast Material Volume Using Iterative Model Reconstruction and iDose4 Technique in Comparison to FBP

et al. 2016

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“…Various past literature have reported on the use of a smaller dose of contrast media in CTPA[7-9]. In a former study carried out at our centre[7], we have established the feasibility of using a 75 mL of contrast in a higher concentration (350 mg/mL Iodine/Ioversol), compared to 100 mL of a standard concentration (300 mg/mL Iodine/Ioversol).…”

Section: Discussionmentioning

confidence: 94%

“…This finding was also reported in a Randomised Clinical Trial published in the same year[8], which further established the use of a lower energy tube (80 kVp vs 100 kVp) for a reduced dose of radiation. In a different single cohort study[9], the authors have evaluated the practicality of CTPA with 30 mL of contrast medium in patients with renal impairment. Although it was stated that only one out of 24 scans were non-diagnostic, the reported average opacification (247 HU) in the main pulmonary arteries is notably lower than that found in our study and is below the 250 HU threshold that we have used.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography pulmonary angiography using a 20% reduction in contrast medium dose delivered in a multiphasic injection

Chen

Mattar

Abdulkarim

2017

WJR

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AIMTo evaluate the feasibility of reducing the dose of iodinated contrast agent in computed tomography pulmonary angiography (CTPA).METHODSOne hundred and twenty-seven patients clinically suspected of having pulmonary embolism underwent spiral CTPA, out of whom fifty-seven received 75 mL and the remaining seventy a lower dose of 60 mL of contrast agent. Both doses were administered in a multiphasic injection. A minimum opacification threshold of 250 Hounsfield units (HU) in the main pulmonary artery is used for assessing the technical adequacy of the scans.RESULTSMean opacification was found to be positively correlated to patient age (Pearson’s correlation 0.4255, P < 0.0001) and independent of gender (male:female, 425.6 vs 450.4, P = 0.34). When age is accounted for, the study and control groups did not differ significantly in their mean opacification in the main (436.8 vs 437.9, P = 0.48), left (416.6 vs 419.8, P = 0.45) or the right pulmonary arteries (417.3 vs 423.5, P = 0.40). The number of sub-optimally opacified scans (the mean opacification in the main pulmonary artery < 250 HU) did not differ significantly between the study and control groups (7 vs 10).CONCLUSIONA lower dose of iodine contrast at 60 mL can be feasibly used in CTPA without resulting in a higher number of sub-optimally opacified scans.

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“…Contrast-enhanced CT arteriography has rapidly replaced ventilation-perfusion scanning as the imaging modality of choice for diagnosing PE, especially with the advent of multi-detector CT scanners that allow analysis of the pulmonary arteries and detection of emboli at the subsegmental level 26,28–30 . However, CT angiography can cause contrast medium-induced nephropathy (CIN), which is the third most common cause of in-hospital acute renal failure, 31–33 conferring significant morbidity and mortality. Therefore, a method of imaging the pulmonary vasculature without the use of contrast would represent a dramatic improvement in the risk/benefit profile of diagnostic testing for all patients suspected of having PEs and especially those who are at risk for CIN.…”

Section: Discussionmentioning

confidence: 99%

Technical Note: Contrast free angiography of the pulmonary vasculature in live mice using a laboratory x‐ray source

et al. 2016

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Purpose:In vivo imaging of the pulmonary vasculature in small animals is difficult yet highly desirable in order to allow study of the effects of a host of dynamic biological processes such as hypoxic pulmonary vasoconstriction. Here the authors present an approach for the quantification of changes in the vasculature.Methods:A contrast free angiography technique is validated in silico through the use of computer-generated images and in vivo through microcomputed tomography (μCT) of live mice conducted using a laboratory-based x-ray source. Subsequent image processing on μCT data allowed for the quantification of the caliber of pulmonary vasculature without the need for external contrast agents. These measures were validated by comparing with quantitative contrast microangiography in the same mice.Results:Quantification of arterial diameters from the method proposed in this study is validated against laboratory-based x-ray contrast microangiography. The authors find that there is a high degree of correlation (R = 0.91) between measures from microangiography and their contrast free method.Conclusions:A technique for quantification of murine pulmonary vasculature without the need for contrast is presented. As such, this technique could be applied for longitudinal studies of animals to study changes to vasculature without the risk of premature death in sensitive mouse models of disease. This approach may also be of value in the clinical setting.

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Low volume contrast CTPA in patients with renal dysfunction

Abstract: Low-volume CTPA is technically feasible and provides excellent enhancement of the pulmonary arterial tree.

Cited by 6 publications

References 27 publications

CT Pulmonary Angiography at Reduced Radiation Exposure and Contrast Material Volume Using Iterative Model Reconstruction and iDose4 Technique in Comparison to FBP

CT Pulmonary Angiography at Reduced Radiation Exposure and Contrast Material Volume Using Iterative Model Reconstruction and iDose4 Technique in Comparison to FBP

Computed tomography pulmonary angiography using a 20% reduction in contrast medium dose delivered in a multiphasic injection

Technical Note: Contrast free angiography of the pulmonary vasculature in live mice using a laboratory x‐ray source

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