OJRad  Vol.5 No.4 , December 2015
Evaluation of a Reduced Contrast Media Protocol in Thoracoabdominal Aortic High Pitch CT-Angiography
ABSTRACT
Objectives: The aim is to evaluate contrast enhancement and density distribution in non-ECG-synchronized high-pitch aortoiliacal CT-angiography. Methods: 84 patients underwent clinically indicated thoracoabdominal CTA between February 2011 and May 2012 using high-pitch technique for arterial phase and an individually tailored contrast-media protocol depending on weight-class and scan duration. Standardized measurement of intravascular density is performed and accessed by multi plane reformations (MPR) orthogradly to vessels centerline. Results for 1.5 cm slices are statistically evaluated on per slice, per vessel segment ascending aortic, aortic arch, descending and abdominal aorta, right and left iliacal artery (common and external) and per patient level, regarding left-ventricular function and renal impairment. Results: In mean 53.1 ± 7.4 ml contrast-medium is administered for aortoiliacal examination. 4841 slices with mean density 280.0 ± 63 HU are analyzed. In 84.2% (n = 4074), diagnostic quality is delivered. Regarding vessel segments, mean enhancement scored ≥ 255.5 except weight-class 5. Adjusted to homogeneity of bolus by excluding examinations with failed bolus triggering (14%), weight-class 1 to 3 provides 100% to 75% entirely diagnostic datasets, where amount is inadequate in weight-classes 4 (62%) and 5 (2%). Conclusions: CM protocol produces moderate but diagnostic vessel enhancement with little CM (mean = 50.7 ± 6 ml) in patients smaller than 86 kg (weight-class 1 to 3) independently to left ventricular or renal function. Failure rate requires precise bolus triggering.

Cite this paper
Reinartz, S. , Karnitzschky, D. , Kuhl, C. and Mahnken, A. (2015) Evaluation of a Reduced Contrast Media Protocol in Thoracoabdominal Aortic High Pitch CT-Angiography. Open Journal of Radiology, 5, 177-188. doi: 10.4236/ojrad.2015.54025.
References
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http://dx.doi.org/10.1007/s10406-005-0166-x

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http://dx.doi.org/10.1148/radiol.10090908

[4]   Karlo, C., Leschka, S., Goetti, R.P., Feuchtner, G., Desbiolles, L., et al. (2011) High-Pitch Dual-Source CT Angiography of the Aortic Valve-Aortic Root Complex without ECG-Synchronization. European Radiology, 21, 205-212.
http://dx.doi.org/10.1007/s00330-010-1907-3

[5]   Fleischmann, D. and Kamaya, A. (2009) Optimal Vascular and Parenchymal Contrast Enhancement: The Current State of the Art. Radiologic Clinics of North America, 47, 13-26.
http://dx.doi.org/10.1016/j.rcl.2008.10.009

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[8]   Goetti, R., Baumuller, S., Feuchtner, G., Stolzmann, P., Karlo, C., et al. (2010) High-Pitch Dual-Source CT Angiography of the Thoracic and Abdominal Aorta: Is Simultaneous Coronary Artery Assessment Possible? American Journal of Roentgenology, 194, 938-944.
http://dx.doi.org/10.2214/AJR.09.3482

[9]   Bolen, M.A., Popovic, Z.B., Tandon, N., Flamm, S.D., Schoenhagen, P. and Halliburton, S.S. (2012) Image Quality, Contrast Enhancement, and Radiation Dose of ECG-Triggered High-Pitch CT versus Non-ECG-Triggered Standard-Pitch CT of the Thoracoabdominal Aorta. American Journal of Roentgenology, 198, 931-938.
http://dx.doi.org/10.2214/AJR.11.6921

[10]   Puippe, G.D., Winklehner, A., Hasenclever, P., Plass, A., Frauenfelder, T. and Baumueller, S. (2012) Thoraco-Abdominal High-Pitch Dual-Source CT Angiography: Experimental Evaluation of Injection Protocols with an Anatomical Human Vascular Phantom. European Journal of Radiology, 81, 2592-2596.
http://dx.doi.org/10.1016/j.ejrad.2011.12.021

[11]   Beeres, M., Schell, B., Mastragelopoulos, A., Herrmann, E., Kerl, J.M., et al. (2012) High-Pitch Dual-Source CT Angiography of the Whole Aorta without ECG Synchronisation: Initial Experience. European Radiology, 22, 129-137.
http://dx.doi.org/10.1007/s00330-011-2257-5

[12]   Fleischmann, D. (2005) How to Design Injection Protocols for Multiple Detector-Row CT Angiography (MDCTA). European Radiology, 15, E60-E65.
http://dx.doi.org/10.1007/s10406-005-0166-x

[13]   Weininger, M., Barraza, J.M., Kemper, C.A., Kalafut, J.F., Costello, P. and Schoepf, U.J. (2011) Cardiothoracic CT Angiography: Current Contrast Medium Delivery Strategies. AJR. American Journal of Roentgenology, 196, W260-W272.
http://dx.doi.org/10.2214/AJR.10.5814

[14]   Bae, K.T. (2010) Intravenous Contrast Medium Administration and Scan Timing at CT: Considerations and Approaches. Radiology, 256, 32-61.
http://dx.doi.org/10.1148/radiol.10090908

[15]   Karlo, C., Leschka, S., Goetti, R.P., Feuchtner, G., Desbiolles, L., et al. (2011) High-Pitch Dual-Source CT Angiography of the Aortic Valve-Aortic Root Complex without ECG-Synchronization. European Radiology, 21, 205-212.
http://dx.doi.org/10.1007/s00330-010-1907-3

[16]   Fleischmann, D. and Kamaya, A. (2009) Optimal Vascular and Parenchymal Contrast Enhancement: The Current State of the Art. Radiologic Clinics of North America, 47, 13-26.
http://dx.doi.org/10.1016/j.rcl.2008.10.009

[17]   Seifarth, H., Puesken, M., Kalafut, J.F., Wienbeck, S., Wessling, J., et al. (2009) Introduction of an Individually Optimized Protocol for the Injection of Contrast Medium for Coronary CT Angiography. European Radiology, 19, 2373-2382.
http://dx.doi.org/10.1007/s00330-009-1421-7

[18]   Yang, W.J., Chen, K.M., Liu, B., Pang, L.F., Zhang, H., et al. (2012) Contrast Media Volume Optimization in High-Pitch Dual-Source CT Coronary Angiography: Feasibility Study. The International Journal of Cardiovascular Imaging, 29, 245-252.

[19]   Goetti, R., Baumuller, S., Feuchtner, G., Stolzmann, P., Karlo, C., et al. (2010) High-Pitch Dual-Source CT Angiography of the Thoracic and Abdominal Aorta: Is Simultaneous Coronary Artery Assessment Possible? American Journal of Roentgenology, 194, 938-944.
http://dx.doi.org/10.2214/AJR.09.3482

[20]   Bolen, M.A., Popovic, Z.B., Tandon, N., Flamm, S.D., Schoenhagen, P. and Halliburton, S.S. (2012) Image Quality, Contrast Enhancement, and Radiation Dose of ECG-Triggered High-Pitch CT versus Non-ECG-Triggered Standard-Pitch CT of the Thoracoabdominal Aorta. American Journal of Roentgenology, 198, 931-938.
http://dx.doi.org/10.2214/AJR.11.6921

[21]   Puippe, G.D., Winklehner, A., Hasenclever, P., Plass, A., Frauenfelder, T. and Baumueller, S. (2012) Thoraco-Abdominal High-Pitch Dual-Source CT Angiography: Experimental Evaluation of Injection Protocols with an Anatomical Human Vascular Phantom. European Journal of Radiology, 81, 2592-2596.
http://dx.doi.org/10.1016/j.ejrad.2011.12.021

[22]   Beeres, M., Schell, B., Mastragelopoulos, A., Herrmann, E., Kerl, J.M., et al. (2012) High-Pitch Dual-Source CT Angiography of the Whole Aorta without ECG Synchronisation: Initial Experience. European Radiology, 22, 129-137.
http://dx.doi.org/10.1007/s00330-011-2257-5

 
 
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