Abstract
Purpose. The study aimed at the comparison of computed tomography (СT) contrast enhancement (CE) protocols for optimal visualization of cardiac chambers, evaluation of their impact on results of non-invasive superficial cardiac mapping.Methods. The study included 93 patients with heart rhythm disorders in whom catheter ablation of arrhythmia was planned. Noninvasive cardiac mapping for arrhythmia localization was performed and included multichannel ECG-registration and CT with intravenous СE (1st group - monophasic (50 patients), 2nd group - split-bolus (18 patients), 3rd group - with pre-bolus (25 patients). Qualitative and quantitative (measurement of mean blood attenuation in four chambers, calculation of ventricular-myocardial [VM] contrast-to-noise ratio VM-LV и VM-RV for the left ventricle [LV] and right ventricle [RV], respectively) parameters were compared between the groups. Fusion of ECG and CT data was carried out a semi-automatic mode with a non-invasive imaging complex.Results. Regardless of CE technique, sufficient and homogeneous contrast attenuation was obtained for the left atrium (LA) and LV (mean blood attenuation in LA more than 278 HU, LV 250 HU, VM-LV 0,582). In most cases, the enhancement of the right heart was insufficient with the monophasic protocol; the average CT density was lower than 200 HU, VM-RV 0,256. The split-bolus protocol improved visualization of the right atrium (RA) and RV (blood density in RA 258HU, RV 227HU, VMRV 0,541); however, there was a heterogeneity of the RA cavity due to artifacts from the superior vena cava (VC) and unenhanced blood from the inferior VC. Pre-bolus administration increased the contrast ratio between RA myocardium and blood due to the improvement of blood CT density in the inferior VC (blood density 294 HU). The quality of RV CE was similar to 2nd group (blood density 264 HU, VM-RV 0,565).Conclusion. The split-bolus and with pre-bolus CE protocols improve visualization of the RV, supporting the high-level enhancement of the left heart. The protocol with a pre-bolus is preferable for exact differentiation of the right atrial endocardial contour.
Highlights
MethodsThe study included 93 patients with heart rhythm disorders in whom catheter ablation of arrhythmia was planned
The study aimed at the comparison of computed tomography (СT) contrast enhancement (CE) protocols for optimal visualization of cardiac chambers, evaluation of their impact on results of non-invasive superficial cardiac mapping
Regardless of CE technique, sufficient and homogeneous contrast attenuation was obtained for the left atrium (LA) and left ventricle (LV)
Summary
The study included 93 patients with heart rhythm disorders in whom catheter ablation of arrhythmia was planned. Qualitative and quantitative (measurement of mean blood attenuation in four chambers, calculation of ventricular-myocardial [VM] contrast-to-noise ratio VM-LV и VM-RV for the left ventricle [LV] and right ventricle [RV], respectively) parameters were compared between the groups. Most contrast ratio for the right and left ventricles using the forpatients had atrial arrhythmias - 73 patients (78.5%) and 20 mula: patients (21.5%) had ventricular arrhythmias. Preprocedural all patients under- derwent synchronous ECG recording in 6 standard leads went contrast-enhanced CT of the cardiac chambers and from the extremities and in 224 leads from the chest sur-. The patients were electrocardiographic and tomographic data were combined divided into 3 groups depending on the contrast enhance- semi‐automatically using the same diagnostic complex ment technique used.
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