Scientific Exhibit. Authors: D. Takenaka, Y. Ohno, Y. Onishi, K. Matsumoto, T.

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1 The feasibility of biphasic contrast-media-injection-protocol for chest imaging on 320-slice volume MDCT: Direct comparison of biphasic and bolus contrast-media injection protocols on 320-slice volume MDCT and 64-slice MDCT Poster No.: C-52 Congress: ECR 200 Type: Scientific Exhibit Topic: Contrast Media Authors: D. Takenaka, Y. Ohno, Y. Onishi, K. Matsumoto, T. 2 Yoshikawa, M. Konishi, H. Koyama, M. Nogami, K. Sugimura ; 2 Kobe/JP, Berlin/DE Keywords: 320-slice MDCT, contrast administration, contrast media DOI: 0.594/ecr200/C-52 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 of 7

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3 Purpose Introduction With the rapid development of multi-detector spiral computed tomography (MDCT), the contrast media injection protocol became more crucial. Recently, 320-detector row CT (i.e. area-detector CT) system has become clinically available. By using this CT system, the entire heart CT data can be obtained in a single rotation and within a single heartbeat. Thus, several investigators have reported the feasible contrast media injection protocols for computed tomography coronary angiography. As well as cardiac imaging, this CT system is also available for chest imaging by using non-spiral step and shoot scanning. In addition, no one discuss the feasible contrast media injection protocol for chest CT examination with this system. Purpose The purpose of this study was to determine the utility of the biphasic contrast media injection protocol on 320-detector row CT for chest CT examination, and reduction of total dose of contrast media on chest CT examination. Images for this section: Page 3 of 7

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6 Methods and Materials Materials and Methods Patient population 24 patients (3 male and female, mean age /- 4.2 years, mean body weight /- 5.8kg, mean body mass index /-.83) with chest disease were enrolled in this prospective study. They were diagnosed as having chest diseases as follows: lung cancers (n=7), thymic cysts (n=2), carcinoid (n=), thymoma (n=), sarcoidosis (n=), organizing pneumonia (n=), and chronic thromboembolic pulmonary hypertension (n=). All patients signed informed consent to participation. Exclusion criteria were general contraindication to iodinated contrast media. Materials and Methods CT 320-detector row CT All area-detector CT (Aquilion ONE, Toshiba Medical Systems, Ohtawara, Tochigi, Japan) examination was performed with non-ecg-gated step-and shoot scan protocol. Detail of scan protocol was as follows: detector collimation of mm, gantry rotation time 0.5 s, tube voltage 20 kv, tube current 270 ma, and 5 mm slice reconstruction). Scanning was performed in craniocaudal direction at end-inspiration 64-detector row CT All 64-slice MDCT (Aquilion 64, Toshiba Medical Systems, Ohtawara, Tochigi, Japan) examination was performed with non-ecg-gated helical scan protocol. Detail of scan protocol was as follows: detector collimation of mm, beam pitch 0.84, gantry rotation time 0.5 s, tube voltage 20 kvp, and tube current 300 ma. Scanning was performed in craniocaudal direction at end-inspiration. Contrast media injection protocol Dedicated biphasic-injection protocol Total 60 ml of Contrast media (Iopamiron370, Bayer Yakuhin, Osaka, Japan) was administered using a dual-head power injector (Daul Shot GX, Nemoto Kyorindo, Tokyo, Japan). At first phase, 40 ml of contrast material (370mgI/ml) was administered at constant flow rate of 2ml/s. Then, the concentration of contrast media was decreased for 20s from 2 to 0ml/s. At the same time period, the flow rate of saline was increased from 0 to 2 ml/s. Each scan was started with delay of 40 s. Bolus Injection Protocol Total 80 ml of Same contrast media was administered using a power injector (Auto Enhance A60, Nemoto Kyorindo, Tokyo, Japan) with bolus-injection protocol at a rate of 2ml/s. Each scan was also started with delay of 40 s. Page 6 of 7

7 Data analysis As quantitative analysis, the attenuation of following great vessels were measured in all patients using circular region of interest (ROI) positioned within the vessel lumen. Vena cava (Superior Vena Cava, Inferior Vena Cava) Right heart (right atrium, right ventricle) Pulmonary artery (pulmonary trunk, right main pulmonary artery, left main pulmonary artery) Left heart (left atrium, left ventricle) Aorta (ascending aorta, aortic arch, descending aorta). The attenuation were statistically compared each other between biphasic injection protocol on area-detector CT, bolus injection protocol on area-detector CT, and bolus injection protocol on 64-detector row CT by using Tukey-Kramer test. As qualitative analysis, image quality of each great vessel was also assessed by using five-point visual scale, and statistically compared with Fisher's PLSD test. Images for this section: Page 7 of 7

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12 Results Results Quantitative analysis of attenuation of great vessels Attenuation of great vessels on biphasic injection protocol on area-detector CT (24.8 +/ HU, mean +/- standard deviation) was significantly higher than those on bolus injection protocols on area-detector CT (88.8 +/ HU, p<0.05) and 64-detector row CT (50.6 +/ HU, p<0.05). Qualitative analysis of visualization of great vessels The visual score of biphasic injection protocol (4.88 +/- 0.32, mean +/-standard deviation) was significantly higher than that on bolus injection protocols on area-detector CT (4.29 +/- 0.7, p<0.05) and 64-detector row CT (4.56 +/- 0.64, p<0.05). Images for this section: Page 2 of 7

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16 Conclusion Conclusion Biphasic contrast-media-injection protocol on 320-detector row CT has the potential to provide higher contrast attenuation and better image quality than bolus injection protocols on 320- and 64-detector row CT. Contrast media dose reduction may be achieved by using this biphasic protocol in routine clinical practice. Images for this section: Fig. Page 6 of 7

17 References. 2. Hein PA, et al. Initial experience with a chest pain protocol using 320 slice volume MDCT. Eur Radiol Behrendt FF, et al. Intraindividual comparison of contrast media concentrations for combined abdominal and thoracic MDCT. AJR Am J Roentgenol Personal Information Page 7 of 7