Abstract
PurposeThe aim was to assess personalised contrast media (CM) protocols—based on patient’s blood volume (BV) and automated tube voltage selection (ATVS)—in coronary computed tomography angiography (CCTA).MethodsA total of 114 consecutive patients received an ECG-triggered or ECG-gated helical scan on a 3rd-generation dual-source CT with 70-120kV (ATVS) and 330mAsqual.ref. CM was adapted to BV, scan time (s) and kV. Image quality (IQ) was assessed in a 17-segment coronary model using attenuation values (HU), contrast-to-noise (CNR), signal-to-noise ratio (SNR) (objective IQ) and a Likert scale (subjective IQ: 1 = poor/2 = sufficient/3 = good/4 = excellent). igResultsPatient distribution was: n = 60 for 70kV, n = 37 80kV and n = 17 90kV. Mean BV was 5.4±0.6L for men and 4.1±0.6L for women. Mean CM volume (300 mg I/mL) and flow rate were: 30.9±6.4mL and 3.3±0.5mL/s (70kV); 40.8±7.1mL and 4.5±0.6mL/s (80kV); 53.6±8.6mL and 5.7±0.6mL/s (90kV). Overall mean HU was >300HU in 98.2% (112/114) of patients. Overall mean attenuation was below 300HU in two scans (70kV) due to late scan timing. Of 1.661 segments, 95.4% was assessable. Mean CNR was 14±4(70kV), 13±3(80kV) and 14±4(90kV); mean SNR was 10±2(both 70kV+80kV) and 9±2(90kV). Objective IQ was comparable between kV settings, protocols and sex. Subjective IQ was diagnostic in all scans and excellent-sufficient in 95.4% of segments.ConclusionsPersonalisation of CCTA CM injection protocols to BV and ATVS is a promising technique to tailor CM administration to the individual patient, while maintaining diagnostic IQ.
Highlights
Cardiac diseases are the leading cause of death in the western world [1]
Overall mean attenuation was below 300HU in two scans (70kV) due to late scan timing
Image quality (IQ) was comparable between kV settings, protocols and sex
Summary
Cardiac diseases are the leading cause of death in the western world [1]. Growing evidence shows that cardiac diseases, especially coronary artery disease (CAD), worsen the prognosis in a broad variety of non-cardiac pathologies (e.g. in patients with chronic obstructive pulmonary disease or diabetes mellitus) [2,3,4]. It would be beneficial to adapt and individualise CM injection protocols to a level where the patient only receives the minimum amount of CM required, in combination with an appropriate iodine delivery rate (IDR), to produce a CCTA with diagnostic image quality (sufficient intravascular attenuation and contrast-to-noise (CNR)). Previous studies have shown that adaptation of CM injection protocols to both tube voltage and body weight (BW) is feasible and results in lower CM volumes [11,12,13,14]. Another possibility is adjustment of CM injection protocols (flow rate and CM volume) to the patient’s estimated blood volume (BV). Using BV, the sex of the patient is taken into account, which could be the step in individualised diagnostic imaging
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