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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...

Posterolateral tibiotalar joint injection offers an alternative to the more commonly used anterior approach, particularly in cases of severe anterior predominant arthrosis. An additional advantage of this technique is that the ankle stays in the same position between the initial planning of the needle trajectory and the visualization of contrast flowing into the joint.