Right Heart: Split-Bolus Injection of Diluted Contrast Medium for Visualization at Coronary CT Angiography

Kerl, J. Matthias; Ravenel, James G.; Nguyen, Shaun A.; Surányi, Pál; Thilo, Christian; Costello, Philip; Bautz, W.; Schoepf, U. Joseph

doi:10.1148/radiol.2472070856

Cited by 105 publications

(58 citation statements)

References 20 publications

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“…For all patients, the same nonionic contrast medium was used (Ultravist 370, Bayer-Schering Pharma, Berlin, Germany) and injected using a triphasic injection protocol to ensure adequate opacification of the coronary arteries and the right ventricle [19].…”

Section: Injection Protocolsmentioning

confidence: 99%

Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography

Seifarth

Puesken

Kalafut³

et al. 2009

Eur Radiol

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The aim of this study was to determine whether individually tailored protocols for the injection of contrast medium (CM) result in higher and more homogeneous vascular attenuation throughout the coronary arteries at coronary CT angiography compared with conventional injection protocols using fixed injection parameters. Of 120 patients included in the study, 80 patients were randomized into two groups. Group 1 received 80 mL of CM at 6 mL/s. For group 2 injection parameters were individually adjusted to patient weight, the duration of CT data acquisition, and attenuation parameters following a test bolus. In the control group (group 3) the volume of CM was adjusted to the duration of CT data acquisition and injected at 5 mL/s. Attenuation was measured in the proximal, middle, and distal right coronary artery (RCA), in the proximal and middle left anterior descending artery (LAD), and in cranial and caudal sections of both ventricles. Patient parameters, scan delay, and scan duration did not differ significantly between the groups. Mean CM volume was 82.5 mL (flow rate 5.1 mL/s) in group 2 and 73.5 mL in group 3. Attenuation in both RCA and LAD was significantly higher for group 2 vs. group 3 (RCA: 414.9 + or - 49.9)-396.1(+ or - 52.1) HU vs. 366.0(+ or - 64.3)-341.6(+ or - 72.5) HU; LAD: 398.9(+ or - 48.6)-364.6(+ or - 44.6) HU vs. 356.3(+ or - 69.5)-323.0(+ or - 67.2) HU). For group 1 vs. group 2 only attenuation in the distal RCA differed significantly: 396.1(+ or - 52.1) vs. 370.7(+ or - 70.5) HU. Individually tailored CM injection protocols yield higher attenuation, especially in the distal segments of the coronary vessels, compared with injection protocols using fixed injection parameters.

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Section: Injection Protocolsmentioning

confidence: 99%

Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography

Seifarth

Puesken

Kalafut³

et al. 2009

Eur Radiol

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show abstract

“…A reduced left venticular ejection fraction can result in delayed and changed contrast wash-in in the atrium due to the lower cardiac output and associated lower blood flow velocities [25]. The contrast media injection protocol can also affect the absolute and relative HU ratios due to the consequent variations in contrast wash-in, which may also explain differences in the diagnostic performance of the HU ratio between the left atrium, left atrial appendage, and ascending aorta [26]. Although the contrast injection protocols in the various studies are similar to the one used in the present study, they may have contributed to changed contrast dynamics in connection due to differences in heart rhythm and rate.…”

mentioning

confidence: 99%

Can Contrast-Enhanced Multi-Detector Computed Tomography Replace Transesophageal Echocardiography for the Detection of Thrombogenic Milieu and Thrombi in the Left Atrial Appendage: A Prospective Study with 124 Patients

Homsi

Nath²,

Luetkens

et al. 2015

Fortschr Röntgenstr

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Purpose: To assess the diagnostic value of contrast-enhanced multi-detector computed tomography (MD-CT) for identifying patients with left atrial appendage (LAA) thrombus or circulatory stasis. Materials and Methods: 124 patients with a history of atrial fibrillation and/or cerebral ischemia (83 men, mean age 58.6???12.4 years) and with a clinical indication for MD-CT of the heart and for transesophageal echocardiography (TEE) were included in the study. LAA thrombus or thrombogenic milieu was visually identified in TEE and MD-CT. In addition, MD-CT was analyzed quantitatively measuring the Hounsfield units (HU) of the left atrium (LA), the LAA and the ascending aorta (AA), and calculating the HU ratios LAA/AA (HU [LAA/AA]) und LAA/LA (HU [LAA/LA]). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated. Results: The prevalence of a thrombus or thrombogenic milieu as assessed by TEE was 21.8?%. The HU ratio was lower in patients with thrombus or thrombogenic milieu (HU [LAA/AA]: 0.590???0.248 vs. 0.909???0.141; p?

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“…However, in many patients, the saline chaser bolus flushes contrast in the right cardiac chambers so effectively that it is unable to discern the internal structures (valve, papillary muscles, etc.) and to distinguish the wall from the lumen 24 .…”

Section: Discussionmentioning

confidence: 99%

Triphasic Contrast Agent Injection in 64-MDCT Coronary Artery Angiography

et al. 2014

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Purpose: To evaluate image quality and cardiovascular enhancement after triphasic injection in 64-slice-CT coronary angiography (c-CTA). Methods: c-CTA of twenty-two asymptomatic patients following triphasic injection (65ml-contrast bolus + mixed 30ml-contrast and 20ml-saline bolus + 50ml-saline chaser) were retrospectively reviewed. Attenuation in the great vessels, cardiac chambers, and coronary arteries in 13 places were measured by region of interest. Also, differences in enhancement between the right coronary artery (RCA) and the right cardiac chambers (RCA versus right atrium or RA; RCA versus right ventricle or RV) were analyzed. Quality of images and contrast-related streak artifacts were subjectively assessed by 2 radiologists in consensus on a 4-point scale. Results: There was excellent enhancement in the coronary arteries (mean range 395.84-429.90 Hounsfield Units or HU), ascending aorta (mean 448.58 HU), descending aorta (mean 433.49 HU), and pulmonary artery (mean 385.45 HU). There was adequate difference in attenuation between RCA versus RA (mean range 126.12-148.43 HU) and RCA versus RV (mean range 50.34-72.66 HU). There was high and inhomogeneous attenuation in the superior vena cava (mean 509.23 HU). The quality of images was considered good (mean 1.6; 1 = excellent, 2 = good, 3 = moderate, 4 = low) and contrast-related streak artifacts were considered low (mean 2.9; 1 = severe, 2 = moderate, 3 = low, 4 = absent) by two radiologists. Conclusions: Our triphasic contrast injection provides excellent cardiovascular enhancement with minimal contrastrelated streak artifacts, particularly in the right cardiac chambers while adequately differentiating the right coronary artery.

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Right Heart: Split-Bolus Injection of Diluted Contrast Medium for Visualization at Coronary CT Angiography

Abstract: Split-bolus injection provides sufficient attenuation for visualization of the right heart, while streak artifacts from high-attenuation contrast material can generally be avoided and arterial attenuation is maintained.

Cited by 105 publications

References 20 publications

Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography

Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography

Can Contrast-Enhanced Multi-Detector Computed Tomography Replace Transesophageal Echocardiography for the Detection of Thrombogenic Milieu and Thrombi in the Left Atrial Appendage: A Prospective Study with 124 Patients

Triphasic Contrast Agent Injection in 64-MDCT Coronary Artery Angiography

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