Individualized CT Angiography Protocols for the Evaluation of the Aorta: A Feasibility Study

Kok, Madeleine; Haan, M.W. de; Mihl, Casper; Eijsvoogel, Nienke G.; Hendriks, Babs M. F.; Sailer, Anna M.; Derks, Kris; Schnerr, R. S.; Schurink, Geert Willem H.; Wildberger, Joachim E.; Das, Marco

doi:10.1016/j.jvir.2016.01.009

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Increment of the radiation dose in extended aorta CTA was closely associated with the scan range. To decrease the radiation, Kok et al 25 proposed the new aorta CTA protocol with a 23–57% reduction of the radiation dose compared with standard CTA protocol. As an alternative to CTA, brain MRA may be a good choice for evaluating concurrent IAs in these patients, but MRA is likely to be limited under special circumstances, such as patients with claustrophobia, anxiety disorder, or economic hardship.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of intracranial aneurysms in patients with aortic dissection or aneurysm: feasibility of extended aorta CT angiography with involvement of intracranial arteries

Lee

Ahn

Cho

et al. 2016

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

High prevalence of intracranial aneurysms in patients with aortic dissection or aneurysm: feasibility of extended aorta CT angiography with involvement of intracranial arteries

Lee

Ahn

Cho

et al. 2016

J NeuroIntervent Surg

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“…CNR was determined as intravascular attenuation minus epicardial fat attenuation, divided by the standard deviation of the epicardial fat attenuation. Intravascular attenuation divided by the standard deviation of the intravascular attenuation was used to determine SNR [18,21,30].…”

Section: Image Analysis: Secondarymentioning

confidence: 99%

“…Many different techniques, varying from simple to complicated formulas with differing patient parameters have been suggested, e.g., BW, lean body weight (LBW), and CO [14]. Multiple studies show that individualization based on patients' BW or BW categories results in a diagnostic image quality throughout the patient population, together with decreased CM volumes [15][16][17][18].…”

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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“…Since radiation induced malignancies usually develop 10-20 years after exposure [24], the reduction of acquired radiation dose is not a main focus in TAVI-candidates whose average age is 80 years [6,8,14,15] with a mean survival of two to three years [25]. Nevertheless, radiation dose can be reduced through tube current modulation or lower tube potential protocols [26,27], even on older MDCT scanners [28]. Although max-systolic retrospectively ECG-gated imaging might not result in the lowest possible radiation and CM dose, these drawbacks do not outweigh the benefits.…”

Section: Discussionmentioning

confidence: 99%

Retrospectively ECG-gated helical vs. non-ECG-synchronized high-pitch CTA of the aortic root for TAVI planning

et al. 2020

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Background Multidetector computed tomography (MDCT) plays a key role in patient assessment prior to transcatheter aortic valve implantation (TAVI). However, to date no consensus has been established on what is the optimal pre-procedural imaging protocol. Variability in pre-TAVI acquisition protocols may lead to discrepancies in aortic annulus measurements and may potentially influence prosthesis size selection. Purpose The current study evaluates the magnitude of differences in aortic annulus measurements using max-systolic, end-diastolic, and non-ECG-synchronized imaging, as well as the impact of method on prosthesis size selection. Material and methods Fifty consecutive TAVI-candidates, who underwent retrospectively-ECG-gated CT angiography (CTA) of the aortic root, directly followed by non-ECG-synchronized high-pitch CT of the entire aorta, were retrospectively included. Aortic root dimensions were assessed at each 10% increment of the R-R interval (0-100%) and on the non-ECG-synchronized scan. Dimensional changes within the cardiac cycle were evaluated using a 1-way repeated ANOVA. Agreement in measurements between max-systole, end-diastole and non-ECGsynchronized scans was assessed with Bland-Altman analysis.

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Individualized CT Angiography Protocols for the Evaluation of the Aorta: A Feasibility Study

Cited by 12 publications

References 28 publications

High prevalence of intracranial aneurysms in patients with aortic dissection or aneurysm: feasibility of extended aorta CT angiography with involvement of intracranial arteries

High prevalence of intracranial aneurysms in patients with aortic dissection or aneurysm: feasibility of extended aorta CT angiography with involvement of intracranial arteries

Personalization of CM Injection Protocols in Coronary Computed Tomographic Angiography (People CT Trial)

Retrospectively ECG-gated helical vs. non-ECG-synchronized high-pitch CTA of the aortic root for TAVI planning

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