Contrast material injection protocol with the flow rate adjusted to the heart rate for dual source CT coronary angiography

Abstract

To investigate the effect on coronary arterial attenuations of contrast material flow rate adjusted to a patient's heart rate during dual source CT coronary angiography (DSCT-CCTA). A total of 296 consecutive patients (mean age: 58.7 years) undergoing DSCT-CCTA without previous coronary stent placement, bypass surgery, congenital or valvular heart disease were included. The image acquisition protocol was standardized (120 kV, 380 mAs) and retrospective electrocardiograph (ECG) gating was used. Patients were randomly assigned to one of three groups [flow rate: G1: dosage/16, G2: dosage/(scan time +8), G3: fixed flow rate]. The groups were compared with respect to the attenuations of the ascending aorta (AA) above coronary ostia, the left main coronary artery (LM), the proximal right coronary artery (RCA), the left anterior descending artery (LAD), the left circumflex artery (LCX), and the contrast to noise ratio of the LM (LM(CNR)) and the proximal RCA (RCA(CNR)). Correlations between heart rate and attenuation of the coronary arteries were evaluated in three groups with linear regression. There was no significant difference in the three groups among the mean attenuations of AA (P = 0.141), LM (P = 0.068), RCA (P = 0.284), LM(CNR) (P = 0.598) and RCA(CNR) (P = 0.546). The attenuations of the LAD and the LCX in group 1 were slightly higher than those in group 2 and 3 (P < 0.05). In group 1, the attenuations of the AA (P < 0.01), LM (P < 0.01), RCA (P < 0.01), LAD (P = 0.02) and LCX (P < 0.01) decreased, respectively, with an increasing heart rate. A similar finding was detected in group 3 (AA: P < 0.01, LM: P < 0.01, RCA: P < 0.01, LAD: P < 0.01 and LCX: P < 0.01). In contrast, the attenuations of the AA (P = 0.55), LM (P = 0.27), RCA (P = 0.77), LAD (P = 0.22) and LCX (P = 0.74) had no significant correlation with heart rate in group 2. In all three groups, LM(CNR) (P = 0.77, 0.69 and 0.73 respectively) and RCA(CNR) (P = 0.75, 0.39 and 0.61 respectively) had no significant correlation with heart rate. Contrast material flow rate adjusted to heart rate can diminish the influence of heart rate on attenuations of the coronary arteries in DSCT-CCTA.