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

Abstract

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.

Image Quality of Prospectively ECG-Triggered Coronary CT Angiography in Heart Transplant Recipients

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Effect of vessel wall segmentation on volumetric and radiomic parameters of coronary plaques with adverse characteristics

“…Four-phasic injection protocol with 90-100 ml of Iomeprol contrast agent was used (Iomeron 400, Bracco Ltd, Milan, Italy) for the coronary CTA examinations. 15 Coronary CTA examinations were performed using 128 × 0.625 mm detector collimation, 270 ms gantry rotation time and mAs 250-300 depending on patient's body mass index and chest size. All images were reconstructed to a 512 × 512 matrix with a slice thickness of 0.8 mm and 0.4 mm spacing between slices.…”

Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation

“…In total 85-95 ml contrast material (Iomeron 400, Bracco Ltd, Milan, Italy) was injected with a flow rate of 4.5-5.5 ml/sec via antecubital vein access using a four-phasic injection protocol. 20 Bolus tracking in the LA was used to obtain proper scan timing. All patients received 0.8 mg sublingual nitroglycerin between the native CT and CTA examinations.…”