Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration

Hwang, Jae-Yeon; Choo, Ki Seok; Choi, Yoon Young; Kim, Jihun; Ryu, Hwaseong; Han, Junhee; Kim, Yong-Woo; Jeon, Ung Bae; Nam, Kyung Jin

doi:10.1007/s00247-017-3795-z

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…In our study, the average injection flow rate was adjusted for the infants, taking into consideration the IV gauge and IV site [5,10] in order to limit the volume of CA injected into the recommended CA volume used in pediatric CTA of 1-2 mL/kg [4,5,10]. The flow ranged overall from 0.5 to 1.6 mL/s, being highest in the Iodixanol group (1.08 mL/s) but being similar to flows reported in the literature [2,3,26].…”

Section: Discussionmentioning

confidence: 84%

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Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation—Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320

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2021

Children

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Background: Computed tomography angiography (CTA) in infants is considered one of the most challenging radiological examinations due to difficulties in balancing start delay, contrast agent (CA) volume and flow in order to achieve optimal opacification of the large vessels. This study aimed to compare the contrast enhancement achieved by four CAs when taking into consideration CA injection parameters and patient characteristics. Methods: We performed a retrospective assessment of forty-eight consecutive cardiothoracic CTAs performed for aortic arch evaluation on children aged 0–1 year. All examinations were performed using the same 64-slice scanner and power injector using the bolus tracking technique. Axial 0.6 mm slices were used to measure large vessel enhancement using regions of interest at the level of the main pulmonary artery, ascending and descending aorta. The recorded variables included anthropometric measurements, CA type, flow rate, volume, and the average Hounsfield unit (HU) values of the blood pool. Descriptive statistics are presented as averages and standard deviations (SD) for normal distributed data or otherwise as medians and interquartile ranges (IQRs). Results: We found no statistically significant differences between age and anthropometric parameters when looking at different CAs. The median CA volume was 7 (IQR, 7–9) mL with the average flow rate of 0.94 (SD, 0.23) mL/s. Ascending aorta average HU values were 605.9 (SD, 177.23) for Iomeprol 350, 626 (SD, 183.83) for Ioversol 350, 530.83 (SD, 175.56) for Iopromide 370 and 354.91 (SD, 115.81) for Iodixanol 320. The difference in HU value for Iodixanol 320 compared to the other CAs was statistically significant. Similar differences were found for the other vascular structures. Conclusion: In CTA of infants suspected of aortic arch hypoplasia/coarctation, Iodixanol 320 provided up to 40% less enhancement of the great vessels when compared to Iomeprol 350, Ioversol 350 and Iopromide 370.

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Section: Discussionmentioning

confidence: 84%

“…With regard to pediatric patients, Hwang [26] compared Iodixanol 270 with Ioptomide 370 and found no statistically significant difference between Iodixanol 270 and Iopromide 370. While they used a faster dual-source machine and heated CA, it must be noted that Iodixanol 270 has half the viscosity of Iodixanol 320 [32].…”

Section: Discussionmentioning

confidence: 99%

Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation—Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320

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2021

Children

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“…As mentioned previously, the recommendations regarding CA application protocols in this patient population are heterogeneous, but 2 ml/kg body weight CA volume is commonly advised 15–17,26–34 . Literature data also suggest several alternatives regarding contrast injection protocols.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, to reach an appropriate enhancement in all of the major thoracic vessels, a triphasic protocol can be applied, in which undiluted contrast agent is followed by the admission of 50–60% diluted CA and by a 5–10% diluted CA afterwards 13 . Split bolus techniques to achieve an appropriate enhancement of parenchymal and vascular structures can be cosidered as well 26 , whereas fixed CA delays are not commonly used for angiographies. Dilution of CA was already advised by some authors to reduce streak artifacts particularly in case of an antecubital injection site 13,30,32 .…”

Section: Discussionmentioning

confidence: 99%

Chest CTA in children younger than two years – a retrospective comparison of three contrast injection protocols

Nagy

Tschauner

Marterer

et al. 2019

Sci Rep

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To obtain the highest diagnostic information with least side effects when performing thoracic CT angiography (CTA) is challenging in young children. The current study aims to compare three contrast agent (CA) injection protocols regarding image quality and CA characteristic: a standard CTA, a fixed-bolus delay protocol, and the “microbolus technique (MBT)” developed in our institution. Seventy chest CTA scans of patients (<2 years) were divided into three groups. MBT was applied in group I, the standard protocol in group II and a fixed bolus delay in group III. Objective image quality was assessed by measuring peak enhancement, image noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Two observers scored subjective image quality and artifacts. Significantly lower amounts of CA (mean ± SD) were used in the MBT group compared to Group II (9.0 ± 3.7 ml vs. 12.9 ± 4.5 ml). A lower, but still diagnostic (>400 HU) enhancement was registered in all major thoracic vessels in group I without significant differences regarding SNR and CNR in most regions (p < 0.05). The best scores for image quality and artifacts were reached in group I. All three chest CTA contrast injection protocols offered diagnostic vessel enhancement in young patients. MBT was associated with reduced image artifacts and less injected CA.

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“…Clinical interpretation of radiological images is predominantly subjective. While it is vital to make progress in objective models, it is equally important to keep on making advancement towards enhancing the utility of observer models or scoring criteria to fully utilize human potential [28–30]. We believe that IQSC can aid in radiation dose optimization in children.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study

et al. 2019

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Objective To develop and assess the value and limitations of an image quality scoring criteria (IQSC) for pediatric CT exams. Methods IQSC was developed for subjective assessment of image quality using the scoring scale from 0 to 4, with 0 indicating desired anatomy or features not seen, 3 for adequate image quality, and 4 depicting higher than needed image quality. Pediatric CT examinations from 30 separate patients were selected, five each for routine chest, routine abdomen, kidney stone, appendicitis, craniosynostosis, and ventriculoperitoneal (VP) shunt. Five board-certified pediatric radiologists independently performed image quality evaluation using the proposed IQSC. The kappa statistics were used to assess the interobserver variability. Results All five radiologists gave a score of 3 to two-third (67%) of all CT exams, followed by a score of 4 for 29% of CT exams, and 2 for 4% exams. The median image quality scores for all exams were 3 and the interobserver agreement among five readers (acceptable image quality [scores 3 or 4] vs sub-optimal image quality ([scores 1 and 2]) was moderate to very good (kappa 0.4–1). For all five radiologists, the lesion detection was adequate for all CT exams. Conclusions The image quality scoring criteria covering routine and some clinical indication-based imaging scenarios for pediatric CT examinations has potential to offer a simple and practical tool for assessing image quality with a reasonable degree of interobserver agreement. A more extensive and multi-centric study is recommended to establish wider usefulness of these criteria.

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Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration

Cited by 6 publications

References 37 publications

Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation—Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320

Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation—Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320

Chest CTA in children younger than two years – a retrospective comparison of three contrast injection protocols

Development and validation of image quality scoring criteria (IQSC) for pediatric CT: a preliminary study

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