Contrast Media Administration in Coronary Computed Tomography Angiography – A Systematic Review

Mihl, Casper; Maas, Monique; Turek, Jakub; Seehofnerová, Anna; Kok, Madeleine; Lobbes, Marc; Wildberger, Joachim E.; Das, Marco

doi:10.1055/s-0042-121609

Cited by 21 publications

(19 citation statements)

References 83 publications

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“…Intravascular attenuation depends on scanner settings (e.g., tube voltage or tube potential), and characteristics of the administered contrast media injection protocol (CM) (e.g., concentration, iodine delivery rate (IDR)), and patient-related factors (e.g., cardiac output (CO) and body weight (BW)) [7][8][9]. IDR, which refers to the grams of iodine injected per second, is the most important factor for achieving diagnostic intravascular attenuation in CCTA [10][11][12]. Intravascular attenuation should be high enough to assess the coronary arteries (≥325HU) [7].…”

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

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“…Стандартные протоколы контрастного усиления при исследовании сердца (в частности, КТ-коронарографии, как наиболее часто выполняемой томографической процедуры сердца) оптимизированы для левых камер сердца, и применимы при необходимости визуализации ЛП и легочных вен перед аблацией источников фибрилляции предсердий. Данный протокол представляет собой монофазное введение контрастного средства из расчёта 1 мл на кг веса пациента, либо добавление второй фазы в виде небольшого объема ФР [9]. Однако количество вводимого КС и длительность инфузии в данном случае не оптимизировано под оценку патологии правых отделов, постоянное поступление неконтрастированной крови из НПВ и растягивание хвоста болюса КС в верхней полой вене (ВПВ) приводит к значительной негомогенности содержимого камер и низкой контрастности по отношению к миокарду, к тому же значительная часть КС успевает покинуть правые отделы.…”

Section: обсуждение полученных результатовunclassified

The improvement of cardiac multispiral computed tomography protocol for planning interventional arrhythmia management

Kashtanova

Kondratyev

Kаrmаzаnovsky

et al. 2021

Vestnik aritmologii

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Purpose. Comparison of computer tomography (СT) contrast enhancement (CE) protocols for optimal visualization of cardiac chamber, definition it’s influence on results of non-invasive superficial cardiac mapping.Materials and methods. The study included 93 patients with heart rhythm disorders who planned catheter ablation of arrhythmia. Noninvasive cardiac mapping was made for topical diagnostics. It includes multichannel ECG-registration and CT with intravenous СE (1st group monophasic (50 patients), 2nd group split-bolus (18 patients), 3rd group with pre-bolus (25 patients). Qualitative and quantitative (measurement of mean blood attenuation in four chambers, calculation of ventricular-myocardial contrast-to-noise ratio VM-LV и VM-RV for left ventricle (LV) and right ventricle (RV), respectively) parameters were compared between groups. Fusion of ECG and CT data was made semi-automatic with diagnostic complex «Amycard 01К».Results. Regardless of CE technique was noted sufficient and homogeneous contrast attenuation of left atrium (LA) and LV (mean blood attenuation in LA more than 278 HU, LV 250 HU, VM-LV 0,582). Enhancement of right heart was insufficient with monophasic protocol, in most cases the average CT density was lower than 200 HU, VM-RV 0,256. Split-bolus protocol improves visualization of right atrium (RA) and RV (blood density in RA 258HU, RV 227HU, VM-RV 0,541), however there was heterogeneity of RA cavity because of artifacts from superior vena cava (VC) and unenhanced blood from inferior inferior VC. Using of pre-bolus increases contrast ratio between RA myocardium and blood due to increasing CT density of blood in inferior VC (blood density 294 HU). Quality of right ventricle CE was similar to 2nd group (blood density 264 HU, VM-RV 0,565).Conclusion. CE protocols split-bolus and with pre-bolus improve visualization of right ventricle, supporting the high level enhancement of left heart. Protocol with pre-bolus is preferable for exact differentiation of right atrial endocardial contour.

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“…Risk factors and significance of these CM-related sensations remain unclear [8]. Adverse reactions and sensations may be correlated with the iodine concentration of the CM, the injected volume, the injection rate or the site of the injection [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Iodine Concentrations on Patient-Reported Discomfort in Contrast-Enhanced Computed Tomography: A Prospective Comparative Trial

Vahldiek

Schaafs

Niehues

et al. 2020

Rofo

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Purpose Reducing contrast media injection speed while maintaining iodine flux is a promising workaround to lower or avoid contrast media-related discomfort during CT examinations. This approach demands contrast media with a higher concentration to guarantee excellent image quality. It remains unclear whether these concentration changes affect the patient’s experience. Thus, the aim of this study was to evaluate the influence of different concentrations of intravenous iodinated contrast media on patient discomfort during and after contrast media delivery. Materials and Methods Patients were randomized to receive either Iomeprol 400 mg/ml (group A) or 300 mg/ml (group B) during routinely scheduled CT examinations at our department. The iodine delivery rate and injection time were kept constant in both groups. After examination, study subjects completed a digital questionnaire on different CM-related sensation items using digital visual analogue scales. Results 253 consecutive patients were enrolled in a 6-month period. Most of the patients reported heat sensation in both groups (mean VAS: 5.3 mm in group A vs. 5.0 mm in group B, p = 0.5). Taste sensation also did not differ significantly between both groups (2.4 mm vs. 2.0 mm, p = 0.08). Pain sensation was reported to be significantly lower in group B patients (1.3 mm vs. 1.0 mm, p = 0.005), even though pain sensation in general was reported on a very low level. Other injection-related sensations were rarely reported. Conclusion Patient-reported discomfort during intravenous injection of high-concentration contrast media (400 mg/ml) was low and only marginally different when compared to the injection of contrast media with a lower concentration. The injection of highly concentrated contrast media showed comparable overall patient acceptance, allowing a reduction of the injection speed and volume during examinations. Key Points: Citation Format

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Contrast Media Administration in Coronary Computed Tomography Angiography – A Systematic Review

Cited by 21 publications

References 83 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)

The improvement of cardiac multispiral computed tomography protocol for planning interventional arrhythmia management

Effect of Different Iodine Concentrations on Patient-Reported Discomfort in Contrast-Enhanced Computed Tomography: A Prospective Comparative Trial

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