Contrast enhancement of the right ventricle during coronary CTA: is it necessary?

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1 Contrast enhancement of the right ventricle during coronary CTA: is it necessary? Poster No.: C-1545 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit M. Kok, C. Mihl, B. Kietselaer, J. E. Wildberger, M. Das; Maastricht/NL Contrast agents, Cardiovascular system, Cardiac, CT- Angiography, Contrast agent-intravenous /ecr2014/C-1545 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 6

2 Aims and objectives Assessment of the right side of the heart in particular can give additional information about the size and dysfunction of the right ventricle (RV). Both are important in detecting rightsided heart diseases who can cause death, such as acute pulmonary embolism (PE), pulmonary artery hypertension (PAH) and congenital heart defects (CDH) involving the RV such as pulmonary valve stenosis, tetralogy of Fallot (TOF) and Ebstein malformation. In a clinical routine coronary CT angiography (CCTA), image quality is not emphasized at the RV as RV pathology is not often expected in patients who receive a screening CCTA, because patients are referred because of cardiac symptoms suspected for coronary artery disease (CAD). Thus the purpose was to evaluate right ventricle enhancement and detection of pathology of the right ventricle in a screening population during coronary CTA. Methods and materials 472 consecutive patients who were referred for screening CTA of the coronary arteries were retrospectively evaluated. Every patient underwent MDCT of the coronary arteries (SOMATOM Definition Flash, Siemens) either in a high pitch mode (heart rate #65bmp), dual step prospective triggering mode (>65-90 bpm) or helical scan mode (#90 bpm) and received an individualized (P3T, Bayer) contrast bolus injection of iodinated CM (300 mg I/ml). Patient data was analyzed with regard to right ventricular enhancement and right ventricular pathology. Images for this section: Page 2 of 6

3 Fig. 1: Coronary CTA; Non-enhanced CT (left) and contrast enhanced CT (right). Page 3 of 6

4 Fig. 2: Contrast enhancement of the RV (260 HU) in coronary CTA. Page 4 of 6

5 Results 472 patients (52% male) with a mean age of 58y. Patients received an average bolus of 108 ml and an average peak flow rate of 6.1 ml/s. In only three of the 472 patients (0,63%) pathology of the right ventricle was found: dilatation of the right ventricle. No other right ventricular pathology was seen. Images for this section: Table 1: Mean bolus [ml], mean peak flow [ml/s] and mean ventricle enhancement [HU ±SD] in both diagnostic images and dilatation, with all p-values > Page 5 of 6

6 Conclusion As right ventricular pathology was only seen in three patients (dilatation), which might have been picked up with contrast enhancement of the left ventricle only, right ventricular enhancement can be omitted during screening CTA of the coronary arteries. Thus contrast volume might potentially be reduced and tailored to the enhancement of the coronary arteries only. Personal information References 1. Dupont MV, Dragean CA, Coche EE. Right ventricle function assessment by MDCT. AJR American journal of roentgenology. 2011;196: doi: /ajr Bleasdale RA, Frenneaux MP. Prognostic importance of right ventricular dysfunction. Heart. 2002;88: Kutty S, Deatsman SL, Russell D, et al. Pulmonary valve replacement improves but does not normalize right ventricular mechanics in repaired congenital heart disease: a comparative assessment using velocity vector imaging. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2008;21: doi: /j.echo Weidemann F, Eyskens B, Mertens L, et al. Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indexes after surgical repair of tetralogy of Fallot. The American journal of cardiology. 2002;90: Valsangiacomo Buechel ER, Mertens LL. Imaging the right heart: the use of integrated multimodality imaging. European heart journal. 2012;33: doi: /eurheartj/ehr490. Page 6 of 6

AFib is the most common cardiac arrhythmia and its prevalence and incidence increases with age (Fuster V. et al. Circulation 2006).

AFib is the most common cardiac arrhythmia and its prevalence and incidence increases with age (Fuster V. et al. Circulation 2006). Feasibility, image quality and radiation dose of coronary CT angiography (CCTA) in patients with atrial fibrillation using a new generation 256 multi-detector CT (MDCT) Poster No.: C-2378 Congress: ECR