CT Angiography in the Lower Extremity Peripheral Artery Disease Feasibility of an Ultra-Low Volume Contrast Media Protocol

Abstract

PurposeThe ALARA principle is not only relevant for effective dose (ED) reduction, but also applicable for contrast media (CM) management. Therefore, the aim was to evaluate the feasibility of an ultra-low CM protocol in the assessment of peripheral artery disease (PAD). Materials and methodsFifty PAD patients were scanned on third-generation dual-source computed tomography, from diaphragm to the forefoot, as follows: tube voltage: 70 kV, reference effective tube current: 90 mAs, collimation: 192 × 2 × 0.6 mm, with individualized acquisition timing. The protocol ED (mSv) was quantified with dedicated software. CM protocol consisted of 15 ml test bolus and 30 ml main bolus (300 mgI/ml) injected at 5 ml/s, followed by a 40 ml saline chaser at the same flow rate. Aorto-popliteal bolus transit time was used to calculate the overall acquisition time and delay. Objective (hounsfield units—HU; contrast-to-noise ratio—CNR) and subjective image quality (four-point Likert score) were assessed at different anatomical regions from the aorta down to the forefoot.ResultsMean attenuation values were exceeding 250 HU from aorta down to the anterior tibial artery with CNR < 13. However, decline in attenuation was observed in more distal region with mean values of 165 and 199 HU, in left and right dorsalis pedis artery, respectively. Mode subjective image quality from the level of aorta down to the popliteal segment was excellent; below the knee mode score was good. The mean ED per protocol was 1.1 ± 0.5 mSv.ConclusionUse of an ultra-low CM volume protocol at 70 kV is feasible in the evaluation of PAD, resulting in good to excellent image quality with mean ED of 1.1 ± 0.5 mSv.Level of evidenceLevel 3, Local non-random sample

Quick Evaluation of Lower Leg Ischemia in Patients with Peripheral Arterial Disease by Time Maximum Intensity Projection CT Angiography: A Pilot Study

“…A recent CT scanner provides dynamic CTA with scan ranges up to 60 cm in length with the shuttle mode, which is helpful for lower leg dyn-CTA. In addition to a longer scan range, the tube voltage of 70 kV was workable in runoff CTA to reduce the radiation dose in previous studies [22,23], as well as 45 mL of contrast medium, which was less than half the amount of routine runoff CTA [22]. In this study, a low tube voltage of 70 kV for dyn-CTA made the DLP 396.9 ± 0.1 mGy × cm.…”

Quick evaluation of lower leg ischemia in patients with peripheral arterial disease by time maximum intensity projection CT angiography: a pilot study

“…Newer CT scanners provide dynamic CTA with scan ranges up to 60 cm in length in shuttle mode, which is useful for lower leg dyn-CTA. In addition to a longer scan range, the tube voltage of 70 kV in runoff CTA helped reduce the radiation dose in previous studies [ 22 , 23 ], as did the 45 mL of contrast medium, which is less than half the amount used in routine runoff CTA [ 22 ]. In this study, a low tube voltage of 70 kV for dyn-CTA resulted in a DLP of 396.9 ± 0.1 mGy × cm.…”

Detection of peripheral artery disease in patients with ischemic heart disease. A quick guide for medical practitioners

“…Современная МСКТ-АГ с рентгеноконтрастным усилением -неинвазивная, доступная методика, которая позволяет получить ангиографические изображения высокого разрешения с трехмерной реконструкцией любого сосудистого бассейна. Как диагностическая методика МСКТ-АГ постепенно вытесняет инвазивную ангиографию (ИАГ), которая преимущественно выполняется во время эндоваскулярного вмешательства [18,19]. МСКТ-АГ может использоваться и для мониторинга состояния, и контроля эффективности лечения.…”