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Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography

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Abstract

The aim of this study was to determine whether individually tailored protocols for the injection of contrast medium (CM) result in higher and more homogeneous vascular attenuation throughout the coronary arteries at coronary CT angiography compared with conventional injection protocols using fixed injection parameters. Of 120 patients included in the study, 80 patients were randomized into two groups. Group 1 received 80 mL of CM at 6 mL/s. For group 2 injection parameters were individually adjusted to patient weight, the duration of CT data acquisition, and attenuation parameters following a test bolus. In the control group (group 3) the volume of CM was adjusted to the duration of CT data acquisition and injected at 5 mL/s. Attenuation was measured in the proximal, middle, and distal right coronary artery (RCA), in the proximal and middle left anterior descending artery (LAD), and in cranial and caudal sections of both ventricles. Patient parameters, scan delay, and scan duration did not differ significantly between the groups. Mean CM volume was 82.5 mL (flow rate 5.1 mL/s) in group 2 and 73.5 mL in group 3. Attenuation in both RCA and LAD was significantly higher for group 2 vs. group 3 (RCA: 414.9(±49.9)–396.1(±52.1) HU vs. 366.0(±64.3)–341.6(±72.5) HU; LAD: 398.9(±48.6)–364.6(±44.6) HU vs. 356.3(±69.5)–323.0(±67.2) HU). For group 1 vs. group 2 only attenuation in the distal RCA differed significantly: 396.1(±52.1) vs. 370.7(±70.5) HU. Individually tailored CM injection protocols yield higher attenuation, especially in the distal segments of the coronary vessels, compared with injection protocols using fixed injection parameters.

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References

  1. Achenbach S, Ropers D, Kuettner A, Flohr T, Ohnesorge B, Bruder H, Theessen H, Karakaya M, Daniel WG, Bautz W, Kalender WA, Anders K (2006) Contrast-enhanced coronary artery visualization by dual-source computed tomography—initial experience. Eur J Radiol. 57:331–335

    Article  PubMed  Google Scholar 

  2. Herzog C, Zwerner PL, Doll JR, Nielsen CD, Nguyen SA, Savino G, Vogl TJ, Costello P, Schoepf UJ (2007) Significant coronary artery stenosis: comparison on per-patient and per-vessel or per-segment basis at 64-section CT angiography. Radiology 244:112–120

    Article  PubMed  Google Scholar 

  3. Heuschmid M, Burgstahler C, Reimann A, Brodoefel H, Mysal I, Haeberle E, Tsiflikas I, Claussen CD, Kopp AF, Schroeder S (2007) Usefulness of noninvasive cardiac imaging using dual-source computed tomography in an unselected population with high prevalence of coronary artery disease. Am J Cardiol 100:587–592

    Article  PubMed  Google Scholar 

  4. Leschka S, Wildermuth S, Boehm T, Desbiolles L, Husmann L, Plass A, Koepfli P, Schepis T, Marincek B, Kaufmann PA, Alkadhi H (2006) Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality. Radiology 241:378–385

    Article  PubMed  Google Scholar 

  5. Meijboom WB, Weustink AC, Pugliese F, van Mieghem CA, Mollet NR, van Pelt N, Cademartiri F, Nieman K, Vourvouri E, Regar E, Krestin GP, de Feyter PJ (2007) Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in women versus men with angina pectoris. Am J Cardiol 100:1532–1537

    Article  PubMed  Google Scholar 

  6. Raff GL, Gallagher MJ, O’Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552–557

    Article  PubMed  Google Scholar 

  7. Schoepf UJ, Zwerner PL, Savino G, Herzog C, Kerl JM, Costello P (2007) Coronary CT angiography. Radiology 244:48–63

    Article  PubMed  Google Scholar 

  8. Seifarth H, Wienbeck S, Püsken M, Juergens KU, Maintz D, Vahlhaus C, Heindel W, Fischbach R (2007) Optimal systolic and diastolic reconstruction windows for coronary CT angiography using dual-source CT. AJR 189:1317–1323

    Article  PubMed  Google Scholar 

  9. Weustink AC, Meijboom WB, Mollet NR, Otsuka M, Pugliese F, van Mieghem C, Malago R, van Pelt N, Dijkshoorn ML, Cademartiri F, Krestin GP, de Feyter PJ (2007) Reliable high-speed coronary computed tomography in symptomatic patients. J Am Coll Cardiol 50:786–794

    Article  PubMed  Google Scholar 

  10. Dewey M, Hoffmann H, Hamm B (2007) CT coronary angiography using 16 and 64 simultaneous detector rows: intraindividual comparison. RoFo 179:581–586

    PubMed  CAS  Google Scholar 

  11. Leber AW, Johnson T, Becker A, von Ziegler F, Tittus J, Nikolaou K, Reiser M, Steinbeck G, Becker CR, Knez A (2007) Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 28:2354–2360

    Article  PubMed  Google Scholar 

  12. Nakaura T, Awai K, Yauaga Y, Nakayama Y, Oda S, Hatemura M, Nagayoshi Y, Ogawa H, Yamashita Y (2008) 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 43:512–519

    Article  PubMed  Google Scholar 

  13. Fleischmann D, Hittmair K (1999) Mathematical analysis of arterial enhancement and optimization of bolus geometry for CT angiography using the discrete Fourier transform. J Comput Assist Tomogr 23:474–484

    Article  PubMed  CAS  Google Scholar 

  14. Hittmair K, Fleischmann D (2001) Accuracy of predicting and controlling time-dependent aortic enhancement from a test bolus injection. J Comput Assist Tomogr 25:287–294

    Article  PubMed  CAS  Google Scholar 

  15. Mahnken AH, Rauscher A, Klotz E, Mühlenbruch G, Das M, Günther RW, Wildberger JE (2007) Quantitative prediction of contrast enhancement from test bolus data in cardiac MSCT. Eur Radiol 17:1310–1319

    Article  PubMed  Google Scholar 

  16. Rist C, Becker CR, Kirchin MA, Johnson TR, Busch S, Bae KT, Leber AW, Reiser MF, Nikolaou K (2008) Optimization of cardiac MSCT contrast injection protocols: dependency of the main bolus contrast density on test bolus parameters and patients’ body weight. Acad Radiol 15:49–57

    Article  PubMed  Google Scholar 

  17. Brodoefel H, Burgstahler C, Tsiflikas I, Reimann A, Schroeder S, Claussen CD, Heuschmid M, Kopp AF (2008) Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy. Radiology 247:346–355

    Article  PubMed  Google Scholar 

  18. Rixe J, Rolf A, Conradi G, Elsaesser A, Moellmann H, Nef H, Bachmann G, Hamm C, Dill T (2008) Image quality on dual-source computed-tomographic coronary angiography. Eur Radiol 18:1857–1862

    Article  PubMed  Google Scholar 

  19. Kerl JM, Ravenel JG, Nguyen SA, Suranyi P, Thilo C, Costello P, Bautz W, Schoepf UJ (2008) Right heart: split-bolus injection of diluted contrast medium for visualization at coronary CT angiography. Radiology 247:356–364

    Article  PubMed  Google Scholar 

  20. Bae KT, Heiken JP, Brink JA (1998) Aortic and hepatic contrast medium enhancement at CT. Part I. Prediction with a computer model. Radiology 207:647–655

    CAS  Google Scholar 

  21. Flohr TG, McCollough CH, Bruder H, Petersilka M, Gruber K, Suss C, Grasruck M, Stierstorfer K, Krauss B, Raupach R, Primak AN, Kuttner A, Achenbach S, Becker C, Kopp A, Ohnesorge BM (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268

    Article  PubMed  Google Scholar 

  22. Achenbach S, Anders K, Kalender WA (2008) Dual-source cardiac computed tomography: image quality and dose considerations. Eur Radiol 18:1188–1198

    Article  PubMed  Google Scholar 

  23. Cademartiri F, Maffei E, Palumbo AA, Malagò R, La Grutta L, Meiijboom WB, Aldrovandi A, Fusaro M, Vignali L, Menozzi A, Brambilla V, Coruzzi P, Midiri M, Kirchin MA, Mollet NR, Krestin GP (2008) Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography. Eur Radiol 18:576–583

    Article  PubMed  Google Scholar 

  24. Leber A (2003) Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. Am J Cardiol 91:714–718

    Article  PubMed  Google Scholar 

  25. Schroeder S, Kuettner A, Leitritz M, Janzen J, Kopp AF, Herdeg C, Heuschmid M, Burgstahler C, Baumbach A, Wehrmann M, Claussen CD (2004) Reliability of differentiating human coronary plaque morphology using contrast-enhanced multislice spiral computed tomography: a comparison with histology. J Comput Assist Tomogr 28:449–454

    Article  PubMed  Google Scholar 

  26. Cademartiri F, La Grutta L, Runza G, Palumbo A, Maffei E, Mollet NR, Bartolotta TV, Somers P, Knaapen M, Verheye S, Midiri M, Hamers R, Bruining N (2007) Influence of convolution filtering on coronary plaque attenuation values: observations in an ex vivo model of multislice computed tomography coronary angiography. Eur Radiol 17:1842–1849

    Article  PubMed  Google Scholar 

  27. Awai K, Hiraishi K, Hori S (2004) Effect of contrast material injection duration and rate on aortic peak time and peak enhancement at dynamic CT involving injection protocol with dose tailored to patient weight. Radiology 230:142–150

    Article  PubMed  Google Scholar 

  28. Bae K, Seeck B, Hildebolt C, Tao C, Zhu F, Kanematsu M, Woodard P (2008) Contrast enhancement in cardiovascular MDCT: effect of body weight, height, body surface area, body mass index, and obesity. AJR 190:777–784

    Article  PubMed  Google Scholar 

  29. Husmann L, Leschka S, Boehm T, Desbiolles L, Schepis T, Koepfli P, Gaemperli O, Marincek B, Kaufmann P, Alkadhi H (2006) Influence of body mass index on coronary artery opacification in 64-slice CT angiography. RoFo 178:1007–1013

    PubMed  CAS  Google Scholar 

  30. Husmann L, Alkadhi H, Boehm T, Leschka S, Schepis T, Koepfli P, Desbiolles L, Marincek B, Kaufmann PA, Wildermuth S (2006) Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography. Eur Radiol 16:1111–1116

    Article  PubMed  Google Scholar 

  31. Platt JF, Reige KA, Ellis JH (1999) Aortic enhancement during abdominal CT angiography: correlation with test injections, flow rates, and patient demographics. AJR 172:53–56

    PubMed  CAS  Google Scholar 

  32. Bae KT, Tao C, Gürel S, Hong C, Zhu F, Gebke TA, Milite M, Hildebolt CF (2007) Effect of patient weight and scanning duration on contrast enhancement during pulmonary multidetector CT angiography. Radiology 242:582–589

    Article  PubMed  Google Scholar 

  33. Heiken JP, Brink JA, McClennan BL, Sagel SS, Crowe TM, Gaines MV (1995) Dynamic incremental CT: effect of volume and concentration of contrast material and patient weight on hepatic enhancement. Radiology 195:353–357

    PubMed  CAS  Google Scholar 

  34. Yamashita Y, Komohara Y, Takahashi M, Uchida M, Hayabuchi N, Shimizu T, Narabayashi I (2000) Abdominal helical CT: evaluation of optimal doses of intravenous contrast material—a prospective randomized study. Radiology 216:718–723

    PubMed  CAS  Google Scholar 

  35. Johnson TR, Nikolaou K, Wintersperger BJ, Fink C, Rist C, Leber AW, Knez A, Reiser MF, Becker CR (2007) Optimization of contrast material administration for electrocardiogram-gated computed tomographic angiography of the chest. J Comput Assist Tomogr 31:265–271

    Article  PubMed  Google Scholar 

  36. Rist C, Nikolaou K, Kirchin MA, van Gessel R, Bae KT, von Ziegler F, Knez A, Wintersperger BJ, Reiser MF, Becker CR (2006) Contrast bolus optimization for cardiac 16-slice computed tomography: comparison of contrast medium formulations containing 300 and 400 milligrams of iodine per milliliter. Invest Radiol 41:460–467

    Article  PubMed  Google Scholar 

  37. Cademartiri F, de Monye C, Pugliese F, Mollet NR, Runza G, van der Lugt A, Midiri M, de Feyter PJ, Lagalla R, Krestin GP (2006) High iodine concentration contrast material for noninvasive multislice computed tomography coronary angiography: iopromide 370 versus iomeprol 400. Invest Radiol 41:349–353

    Article  PubMed  Google Scholar 

  38. Cademartiri F, van der Lugt A, Luccichenti G, Pavone P, Krestin GP (2002) Parameters affecting bolus geometry in CTA: a review. J Comput Assist Tomogr 26:598–607

    Article  PubMed  Google Scholar 

  39. Awai K, Hatcho A, Nakayama Y, Kusunoki S, Liu D, Hatemura M, Funama Y, Denbo M, Sato N, Yamashita Y (2006) Simulation of aortic peak enhancement on MDCT using a contrast material flow phantom: feasibility study. AJR 186:379–385

    Article  PubMed  Google Scholar 

  40. Johnson TR, Nikolaou K, Busch S, Leber AW, Becker A, Wintersperger BJ, Rist C, Knez A, Reiser MF, Becker CR (2007) Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease. Invest Radiol 42:684–691

    Article  PubMed  Google Scholar 

  41. Becker CR, Hong C, Knez A, Leber A, Bruening R, Schoepf UJ, Reiser MF (2003) Optimal contrast application for cardiac 4-detector-row computed tomography. Invest Radiol 38:690–694

    Article  PubMed  Google Scholar 

  42. Bae KT (2003) Peak contrast enhancement in CT and MR angiography: when does it occur and why? Pharmacokinetic study in a porcine model. Radiology 227:809–816

    Article  PubMed  Google Scholar 

  43. Kim DJ, Kim TH, Kim SJ, Kim DP, Oh CS, Ryu YH, Kim YJ, Choi BW (2008) Saline flush effect for enhancement of aorta and coronary arteries at multidetector CT coronary angiography. Radiology 246:110–115

    PubMed  Google Scholar 

  44. Cademartiri F, Nieman K, van der Lugt A, Raaijmakers RH, Mollet N, Pattynama PM, de Feyter PJ, Krestin GP (2004) Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology 233:817–823

    Article  PubMed  Google Scholar 

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Conflict of interest

J.F. Kalafut is an employee of MEDRAD, Inc.

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Authors and Affiliations

  1. Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, 48149, Muenster, Germany

    Harald Seifarth, Michael Puesken, Susanne Wienbeck, Johannes Wessling, David Maintz, Walter Heindel & Kai-Uwe Juergens

  2. MEDRAD, Inc., Corporate Development and Innovations, 100 Global View Drive, Warrendale, PA, 15086, USA

    John F. Kalafut

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  1. Harald Seifarth
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Seifarth, H., Puesken, M., Kalafut, J.F. et al. Introduction of an individually optimized protocol for the injection of contrast medium for coronary CT angiography. Eur Radiol 19, 2373–2382 (2009). https://doi.org/10.1007/s00330-009-1421-7

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