Influence of Respiratory Position on Contrast Attenuation in Pulmonary CT Angiography: A Prospective Randomized Clinical Trial

Raczeck, Paul; Minko, Peter; Graeber, Stefan; Fries, Peter; Seidel, Roland; Buecker, Arno; Stroeder, Jonas

doi:10.2214/ajr.15.15176

Cited by 13 publications

(12 citation statements)

References 25 publications

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“…Determination of the contrast bolus arrival time is individualized applying either the test-bolus method or bolus tracking. The best patient's breathing maneuver during data acquisition of pCTA, however, is still a matter of debate [2][3][4][5]. Deep inspiration might lead to increased influx of non-contrast-enhanced blood from the inferior vena cava (IVC) to the right atrium, thus diluting or even interrupting the contrast material influx [4].…”

Section: Introductionmentioning

confidence: 99%

“…A small prospectively randomized clinical trial, including 28 patients with suspected PE, suggested pCTA should be performed in resting expiratory state [5]. Attenuation of the blood pool in the cardiac chambers, pulmonary artery and ascending aorta was measured and compared in a larger, but retrospective study including 145 pCTA-examinations in inspiratory and 181 in expiration [2].…”

Section: Introductionmentioning

confidence: 99%

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Improving Contrast Enhancement in Pulmonary CTA: The value of breathing maneuvers

Manava

Galster

Schoen

et al. 2020

European Journal of Radiology Open

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Purpose To investigate contrast dynamics and artifacts associated with different breathing maneuvers during pulmonary computed tomography angiography (pCTA) in a prospective randomized clinical trial. Method Three different breathing maneuvers (inspiration, expiration, Mueller) were randomly assigned to 146 patients receiving pCTA for suspected pulmonary embolism (PE). Contrast enhancement of central and peripheral arteries and imaging quality of lung parenchyma were compared and analyzed. Results were compared by using the analysis of variances (ANOVA) and Kruskal-Wallis-Test. Results Mean enhancement in the pulmonary trunk was highest during breath-hold in inspiration (293 HU, range 195–460 HU) compared to Mueller (259 HU, range 136–429 HU, p = 0022) and expiration (267 HU, range 115–376 HU). This was similar for the right pulmonary artery (inspiration 289 HU, range 173–454 HU; Mueller 250 HU, range 119–378 HU; p = 0.007; expiration 257 HU, range 114–366 HU; p = 0.032) and left pulmonary artery (inspiration 280.3 HU, range 170–462 HU; Mueller 245 HU, range 111–371 HU; p = 0.016; expiration 252 HU, range 110–371 HU). Delineation of peripheral arteries was significantly better in inspiration vs Mueller (p = 0.006) and expiration (p = 0.049). Assessment of the lung parenchyma was significantly better in inspiration vs Mueller (p = 0.013) or expiration (p < 0.001). Conclusions Resting inspiratory position achieved the highest enhancement levels in central and peripheral pulmonary arteries and best image quality of the pulmonary parenchyma in comparison to other breathing maneuvers. It is necessary to train the maneuver prior to the examination in order to avoid deep inspiration with the risk of suboptimal opacification of the pulmonary arteries.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving Contrast Enhancement in Pulmonary CTA: The value of breathing maneuvers

Manava

Galster

Schoen

et al. 2020

European Journal of Radiology Open

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“…One possible cause is the use of breath-hold in end-inspiration. A recent study has shown that pulmonary CTA should be performed in the resting expiratory position [25]. The image quality of pulmonary artery depiction in CTA can be further improved by using a weight-adapted contrast bolus [26].…”

Section: Discussionmentioning

confidence: 99%

Coronary computed tomography angiography (CCTA): effect of bolus-tracking ROI positioning on image quality

Nebelung¹,

Brauer²,

Seppelt³

et al. 2020

Eur Radiol

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Objectives The aim of the study was to evaluate the effect of bolus-tracking ROI positioning on coronary computed tomography angiography (CCTA) image quality. Methods In this retrospective monocentric study, all patients had undergone CCTA by step-and-shoot mode to rule out coronary artery disease within a cohort at intermediate risk. Two groups were formed, depending on ROI positioning (left atrium (LA) or ascending aorta (AA)). Each group contained 96 patients. To select pairs of patients, propensity score matching was used. Image quality with regard to coronary arteries as well as pulmonary arteries was evaluated using quantitative and qualitative scores. Results In terms of the coronary arteries, there was no significant difference between both groups using quantitative (SNR AA 14.92 vs. 15.46; p = 0.619 | SNR LM 19.80 vs. 20.30; p = 0.661 | SNR RCA 24.34 vs. 24.30; p = 0.767) or qualitative scores (4.25 vs. 4.29; p = 0.672), respectively. With regard to pulmonary arteries, we found significantly higher quantitative (SNR RPA 8.70 vs. 5.89; p < 0.001 | SNR LPA 9.06 vs. 6.25; p < 0.001) and qualitative scores (3.97 vs. 2.24; p < 0.001) for ROI positioning in the LA than for ROI positioning in the AA. Conclusions ROI positioning in the LA or the AA results in comparable image quality of CT coronary arteriography, while positioning in the LA leads to significantly higher image quality of the pulmonary arteries. These results support ROI positioning in the LA, which also facilitates triple-rule-out CT scanning. Key Points • ROI positioning in the left atrium or the ascending aorta leads to comparable image quality of the coronary arteries. • ROI positioning in the left atrium results in significantly higher image quality of the pulmonary arteries. • ROI positioning in the left atrium is feasible to perform triple-rule-out CTA.

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“…When flow artefact is suspected, a repeat expiratory CTPA with more delayed and prolonged contrast injection is recommended. [6][7][8]…”

Section: Customer Servicementioning

confidence: 99%

Flow artefact mimicking pulmonary embolism in pulmonary hypertension

et al. 2020

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Influence of Respiratory Position on Contrast Attenuation in Pulmonary CT Angiography: A Prospective Randomized Clinical Trial

Abstract: Pulmonary CTA should be performed in the resting expiratory position, and patients should be instructed to avoid inspiration to achieve the highest possible attenuation in the pulmonary arteries.

Cited by 13 publications

References 25 publications

Improving Contrast Enhancement in Pulmonary CTA: The value of breathing maneuvers

Improving Contrast Enhancement in Pulmonary CTA: The value of breathing maneuvers

Coronary computed tomography angiography (CCTA): effect of bolus-tracking ROI positioning on image quality

Flow artefact mimicking pulmonary embolism in pulmonary hypertension

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