Abstract
ABSTRACTPurpose This hybrid retrospective and prospective study performed on 200 consecutive patients undergoing renal CTA, investigates the opacification of renal vasculature, radiation dose, and reader confidence.Materials and Methods 100 patients were assigned retrospectively to protocol A and the other 100 were allocated prospectively to protocol B. Both protocols implemented a contrast material and saline flow rate of 4.5 mL/sec. Protocol A utilized a 100 mL of low-osmolar nonionic IV contrast material (Ioversol 350 mg I/mL) while protocol B employed a patient-tailored contrast media formula using iso-osmolar non-ionic (Iodixanol 320 mg I/mL).Results Arterial opacification in the abdominal aorta and in the bilateral main proximal renal arteries demonstrated no statistical significance (p>0.05). Only the main distal renal artery of the left kidney in protocol B was statistically significant (p<0.046). In the venous circulation, the IVC demonstrated a significant reduction in opacification in protocol B (59.39 HU ± 19.39) compared to A (87.74 HU ± 34.06) (p<0.001). Mean CNR for protocol A (22.68 HU ± 13.72) was significantly higher than that of protocol B (14.75 HU ± 5.76 p< 0.0001). Effective dose was significantly reduced in protocol B (2.46 ± 0.74 mSv) compared to A (3.07 ± 0.68 mSv) (p<0.001). Mean contrast media volume was reduced in protocol B (44.56 ± 14.32 mL) with lower iodine concentration. ROC analysis demonstrated significantly higher area under the ROC curve for protocol B (p< 0.0001), with inter-reader agreement increasing from moderate to excellent in renal arterial visualization.Conclusion Employing a patient-tailored contrast media injection protocol shows a significant refinement in the visualization of renal vasculature and reader confidence during renal CTA.
Highlights
CT Angiography (CTA) is established as one of the noninvasive imaging modalities for the evaluation of vascular diseases
Protocol B demonstrated a significant reduction in venous opacification of the proximal and distal segments of bilateral renal veins comparing to protocol A (p
We examined a patient-tailored contrast media protocol compared to the conventional contrast media injection protocol
Summary
CT Angiography (CTA) is established as one of the noninvasive imaging modalities for the evaluation of vascular diseases. Renal CTA (rCTA) has emerged as a reliable tool for the diagnosis of renal artery stenosis. The sensitivity and specificity of rCTA for the diagnosis of greater than 50% renal artery stenosis range from 67%-100% and 77%-98%, respectively [1]. Renal magnetic resonance angiography (MRA) has sensitivity and specificity of 88%–100%. Improvements in CTA to evaluate renal artery stenosis have resulted from optimization of acquisition [4, 5], image presentation with various rendering algorithms, as well as contrast media administration protocols. Recent studies have reported attenuation values of the renal arteries being as high as 435±48 HU, while those of the renal veins have reached 277±29 HU [6], whilst employing large contrast media volumes (60-125 mL) [5,6,7,8]
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