Feasibility of contrast agent volume reduction on 640-slice CT coronary angiography in patients with low heart rate

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1 Feasibility of contrast agent volume reduction on 640-slice CT coronary angiography in patients with low heart rate Poster No.: B-0742 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Paper Z. Ding, Z. Wang; Hangzhou/CN Cardiac, Cardiovascular system, Contrast agents, CT- Angiography, Contrast agent-intravenous, Cost-effectiveness, Technology assessment, Hemodynamics / Flow dynamics /ecr2013/B-0742 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Purpose 640-slice dynamic volume CT (DVCT) allows for whole-heart acquisition within 0.35s in a single heart beat, which provides the possibility to reduce the amount of contrast agent because the scan time is reduced. This study aimed to optimize the contrast injection protocol for coronary CT angiography (CTA) to achieve more efficient utilization of contrast agent by investigating the impact of reducing the volume of contrast agent on the attenuation of coronary arteries and coronary sinus. Methods and Materials A total of 105 subjects with low heart rate (# 65 beats/min) and suspected coronary artery disease were randomly divided into three groups with 35 subjects in each group. The patients in Groups A, B and C were injected with a volume of 0.8, 0.7, and 0.6 ml/kg of contrast agent, respectively. In all cases, injection rate was 5.0ml/s, followed by 30ml saline flush at the same rate. CT values within the ascending and descending aorta, left main and right coronary artery orifices and coronary sinus were measured and the differences of contrast enhancement among the three groups were evaluated. Images for this section: Page 2 of 8

Fig. 2: Curved planar reconstruction (CPR) of the coronary sinus shows that the degree of contrast enhancement within the coronary sinus is affected by

3 Fig. 2: Curved planar reconstruction (CPR) of the coronary sinus shows that the degree of contrast enhancement within the coronary sinus is affected by the reflux of contrast material into the right atrium (long arrow) and the reflux of the contrast material into the coronary veins (short arrow). Page 3 of 8

Fig. 3: Tracking the contrast material shows that the contrast moves from right atrium to right ventricle, to left atrium (not shown), to left ventricle, and

4 Fig. 3: Tracking the contrast material shows that the contrast moves from right atrium to right ventricle, to left atrium (not shown), to left ventricle, and then to the coronary artery. Reflux of contrast material from right artium into the coronary sinus can be observed in different phases of enhancement. Page 4 of 8

5 Fig. 4: Volumetric imaging shows that imaging of the coronary vein is accompanied by (or intersected by) braches of the left coronary artery (LAD and LCX), which interfere with the image quality of the coronary arteries. Page 5 of 8

Results The mean injection volume of contrast agent in Groups A, B and C was 54.1, 47.9 and 41.1 ml respectively (P < 0.001), and the scan delay time was 23.7, 23.4 and 22.2 s, respectively (P < 0.

6 Results The mean injection volume of contrast agent in Groups A, B and C was 54.1, 47.9 and 41.1 ml respectively (P < 0.001), and the scan delay time was 23.7, 23.4 and 22.2 s, respectively (P < 0.05). The CT values within the coronary sinus were 112.7, 93.7 and 81.2 HU for Groups A, B, and C respectively (P < 0.001), and CT values within the ascending and descending aorta, and the coronary artery were higher than 300 Hounsfield units in all 3 groups. Images for this section: Fig. 1: The results of the analysis with respect to attenuation in the evaluated coronary artery segments, aorta and coronary sinus are illustrated. Page 6 of 8

7 Conclusion Application of the 0.6 ml/kg protocol in coronary CTA, a steady contrast enhancement in coronary artery, can be achieved using 640-slice volume CT. The utilization of contrast agent can be optimized with shorten the duration of contrast agent injection. References [1] Hara T, Yamada S, Hayashi T, et al. Accuracy of nonstenotic coronary atherosclerosis assessment by multi-detector computed tomography. Circ J, 2007, 71(6): [2] Stein PD, Yaekoub AY, Matta F, et al. 64-slice CT for diagnosis of coronary artery disease: a systematic review.am J Med, 2008, 121(8): [3] Yamamuro M, Tadamura E, Kanao S, et al. Coronary angiography by 64-detector row computed tomography using low dose of contrast material with saline chaser: influence of total injection volume on vessel attenuation. J Comput Assist Tomogr, 2007, 31(2): [4] MorcosSK, Thomsen HS. Adverse reactions to iodinated contrast media. Eur Radiol, 2001, 11(7): [5] Wang CL, Cohan RH, Ellis JH, et al. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in intravenous injections. Radiology, 2007, 243(1): [6] Nakaura T, Awai K, Yauaga Y, et al. Contrast Injection Protocols for Coronary Computed Tomography Angiography Using a 64-Detector Scanner: Comparison Between Patient Weight-Adjusted and Fixed Iodine-Dose Protocols. Invest Radiol, 2008, 43(7): [7] Tatsugami F, Husmann L, Herzog BA, et al. Evaluation of a Body Mass Index- Adapted Protocol for Low-Dose 64-MDCT Coronary Angiography with Prospective ECG Triggering. AJR 2009, 192(3): [8] Tatsugami F, Kanamoto T, Nakai G, et al. Reduction of the total injection volume of contrast material with a short injection duration in 64-detector row CT coronary angiography. Br J Radiol, 2010, 83(985): [9] Cademartiri F, Mollet NR, van der Lugt A, et al. Intravenous contrast material administration at helical 16-detector row CT coronary angiography: effect of iodine concentration on vascular attenuation. Radiology, 2005, 236(2): Page 7 of 8

8 [10] Rybicki FJ, Otero HJ, Steigner ML, et al. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovase Imaging, 2008, 24(5): [11] de Graaf FR, Schuijf JD, van Velzen JE, et al. Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. Eur Heart J, 2010, 31(15): [12] Tatsugami T, Matsuki M, Inada Y, et al. Feasibility of Low-volume Injections of Contrast Material with a Body Weight-Adapted Iodine-Dose Protocol in 320-Detector Row Coronary CT Angiography. Acad Radiol, 2010, 17(2): [13] Cademartiri F, Mollet NR, Lemos PA, et al. Higher intracoronary attenuation improves diagnostic accuracy in MDCT coronary angiography. AJR, 2006, 187(4): [14] Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology, 2010, 256(1): [15] Hoffmann E, Assennato P, Donatelli M, et al. Plasma endothelin-1 levels in patients with angina pectoris and normal coronary angiograms. Am Heart J, 1998, 135(4): Personal Information Page 8 of 8

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