Feasibility of 320-row area detector CT coronary angiography using 40 mL of contrast material: assessment of image quality and diagnostic accuracy

Kim, Rihyeon; Park, Eun‐Ah; Lee, Whal; Chung, Jin Wook

doi:10.1007/s00330-016-4275-9

Cited by 9 publications

(8 citation statements)

References 38 publications

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“…It is important to note that with the introduction of novel CT technologies, the amount of CM needed to achieve diagnostic quality has markedly decreased. In a recently published study by Kim et al, CM volume usage in coronary CTA performed with 320-row CT could be decreased from 60 to 40 ml with preserved image quality and diagnostic accuracy [ 16 ]. In addition, Felmly et al demonstrated that with the latest generation dual source CT a comprehensive transcatheter aortic valve replacement planning was feasible with reduced CM volumes [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

et al. 2017

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ObjectivesContrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA.MethodsPatients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol.Results2,445 consecutive patients were enrolled (mean age 60.6 ± 12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p = 0.034).ConclusionsFour-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA.Key Points • Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. • The saline pacer bolus substantially reduces the risk of CM extravasation. • The implementation of four-phasic injection-protocol is at no cost.

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Section: Discussionmentioning

confidence: 99%

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

et al. 2017

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“…[15]. Even less than 60 mL may be appropriate for newer wide-detector CT scanners [16,17]. Iterative reconstruction techniques and low tube potential (70-100 kV) have also favored a reduction in contrast dose.…”

Section: Radiation Exposure and Principle Cardiac Ct-related Risksmentioning

confidence: 99%

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

Baessato

Guglielmo

Muscogiuri

et al. 2020

JCM

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In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Recent studies evidence how defined plaque composition characteristics effectively relate to the risk of plaque instabilization and the overall ischemic burden. Fractional flow reserve from CCTA (FFR-CT) has been demonstrated as a reliable method for noninvasive functional evaluation of coronary lesions severity, while the assessment of perfusion imaging under stress conditions is growing as a useful tool for assessment of myocardial ischemia. Moreover, specific applications in procedural planning of transcatheter valve substitution and follow-up of heart transplantation have gained recent importance. This review illustrates the incremental role of CCTA, which can potentially revolutionize the diagnosis and management pathway within the wide clinical spectrum of CCS.

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“…Moreover, simultaneous developments in the iterative reconstruction technique in combination with low tube potential (70–100 kV) acquisition have contributed to a reduction in contrast material volume. Several researchers have reported the feasibility of using a lower volume (less than 60 mL) of contrast material in wide-detector CT scanners (131415). In 2011, Kumamaru et al (13) compared the image quality between the 60-mL and 80-mL contrast material injection protocols for CCTA by using 320-detector-row CT, and they reported that 96% of the coronary segments showed sufficient enhancement (> 300 Hounsfield units [HU]) when using the 60-mL protocol, thus supporting the general use of 60-mL protocols for clinical wide-area-detector CCTA.…”

Section: Technical Aspects Of the Wide-detector Ct Scanner Systemmentioning

confidence: 99%

“…Hein et al (14) reported the diagnostic image quality achieved using 40 mL of contrast material in prospective ECG-triggered CCTA with a 320-detector-row CT scanner; however, they only enrolled patients with body weight ≤ 85 kg, normal cardiac function, and low heart rate (≤ 65 beats per minute [bpm]). Several years later, Kim et al (15) reported that 320-detector-row CCTA with the 40-mL contrast material protocol showed comparable image quality and diagnostic accuracy to the conventional 60-mL protocol irrespective of patient-related factors; they applied an iterative reconstruction technique (AIDR 3D; Canon Medical Systems), tailored tube voltages (80, 100, and 120 kVp), and tailored contrast injection, which enabled manually-triggered scan commencement by an experienced operator. Nevertheless, optimal enhancement of the coronary arteries for accurate evaluation of coronary arterial stenosis or plaque characterization remains a matter of debate (161718).…”

Section: Technical Aspects Of the Wide-detector Ct Scanner Systemmentioning

confidence: 99%

“…Nevertheless, optimal enhancement of the coronary arteries for accurate evaluation of coronary arterial stenosis or plaque characterization remains a matter of debate (161718). Recently published papers proposed that attenuation values > 250–330 HU were acceptable and that values greater than 450 HU may lead to underestimation of coronary arterial stenosis (11121314151617181920).…”

Section: Technical Aspects Of the Wide-detector Ct Scanner Systemmentioning

confidence: 99%

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Clinical Applications of Wide-Detector CT Scanners for Cardiothoracic Imaging: An Update

Kang

2019

Korean J Radiol

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Technical developments in multidetector computed tomography (CT) have increased the number of detector rows on the z-axis, and 16-cm wide-area-coverage CT scanners have enabled volumetric scanning of the entire heart. Beyond coronary arterial imaging, such innovations offer several advantages during clinical imaging in the cardiothoracic area. The wide-detector CT scanner markedly reduces the image acquisition time to less than 1 second for coronary CT angiography, thereby decreasing the volume of contrast material and radiation dose required for the examination. It also eliminates stair-step artifacts, allowing robust improvements in myocardial function and perfusion imaging. Additionally, new imaging techniques for the cardiothoracic area, including subtraction imaging and free-breathing scans, have been developed and further improved by using the wide-detector CT scanner. This article investigates the technical developments in wide-detector CT scanners, summarizes their clinical applications in the cardiothoracic area, and provides a review of the recent literature.

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Feasibility of 320-row area detector CT coronary angiography using 40 mL of contrast material: assessment of image quality and diagnostic accuracy

Abstract: • 320-ADCT might enable reduction of contrast material volume. • A 40-mL contrast protocol for 320-ADCT provided acceptable image quality. • A 40-mL contrast protocol for 320-ADCT demonstrated sufficient diagnostic accuracy.

Cited by 9 publications

References 38 publications

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

Clinical Applications of Wide-Detector CT Scanners for Cardiothoracic Imaging: An Update

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