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Validation of a new contrast material protocol adapted to body surface area for optimized low-dose CT coronary angiography with prospective ECG-triggering


Pazhenkottil, A P; Husmann, L; Buechel, R R; Herzog, B A; Nkoulou, R; Burger, I A; Vetterli, A; Valenta, I; Ghadri, J R; von Schulthess, P; Kaufmann, P A (2010). Validation of a new contrast material protocol adapted to body surface area for optimized low-dose CT coronary angiography with prospective ECG-triggering. The International Journal of Cardiovascular Imaging, 26(5):591-597.

Abstract

In patients with large total blood volume contrast material (CM) dilution decreases coronary attenuation in CT coronary angiography (CTCA). As increased blood volume is well paralleled by body surface area (BSA) we assessed a BSA-adapted CM protocol to compensate for dilution effects. Low-dose CTCA with prospective ECG-triggering was performed in 80 patients with a BSA-adapted CM bolus ranging 40-105 ml and injection rate ranging 3.5-5.0 ml/s for a BSA of <1.70 to >or=2.5 m(2). Eighty control patients matched for BSA who had previously undergone routine CTCA with a fixed CM protocol of 80 ml at 5 ml/s served as reference group. The average vessel attenuation from the proximal right (RCA) and the left main coronary artery (LMA) was assessed. Correlation of BSA with vessel attenuation was assessed in both groups. BSA-matching of all patients was successful (BSA-adapted group 1.98 +/- 0.15 m(2), range 1.66-2.39 m(2) versus reference group 1.98 +/- 0.17 m(2), range 1.59-2.38 m(2); P = 0.74). Mean CM bolus was significantly smaller in the BSA-adapted versus the reference group (70.9 +/- 14.1 vs. 80.0 +/- 0 ml, P < 0.001). There was no correlation in the BSA-adapted group (r = -0.07, P = 0.53, SEE = 0.15), while coronary attenuation was inversely related to BSA in the reference group (r = -0.59, P < 0.001, SEE = 0.14). We have successfully validated a BSA-adapted contrast material protocol which results in a comparable coronary contrast enhancement independent of individual BSA. This was achieved despite a significant reduction in the overall contrast material amount.

Abstract

In patients with large total blood volume contrast material (CM) dilution decreases coronary attenuation in CT coronary angiography (CTCA). As increased blood volume is well paralleled by body surface area (BSA) we assessed a BSA-adapted CM protocol to compensate for dilution effects. Low-dose CTCA with prospective ECG-triggering was performed in 80 patients with a BSA-adapted CM bolus ranging 40-105 ml and injection rate ranging 3.5-5.0 ml/s for a BSA of <1.70 to >or=2.5 m(2). Eighty control patients matched for BSA who had previously undergone routine CTCA with a fixed CM protocol of 80 ml at 5 ml/s served as reference group. The average vessel attenuation from the proximal right (RCA) and the left main coronary artery (LMA) was assessed. Correlation of BSA with vessel attenuation was assessed in both groups. BSA-matching of all patients was successful (BSA-adapted group 1.98 +/- 0.15 m(2), range 1.66-2.39 m(2) versus reference group 1.98 +/- 0.17 m(2), range 1.59-2.38 m(2); P = 0.74). Mean CM bolus was significantly smaller in the BSA-adapted versus the reference group (70.9 +/- 14.1 vs. 80.0 +/- 0 ml, P < 0.001). There was no correlation in the BSA-adapted group (r = -0.07, P = 0.53, SEE = 0.15), while coronary attenuation was inversely related to BSA in the reference group (r = -0.59, P < 0.001, SEE = 0.14). We have successfully validated a BSA-adapted contrast material protocol which results in a comparable coronary contrast enhancement independent of individual BSA. This was achieved despite a significant reduction in the overall contrast material amount.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Center for Integrative Human Physiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Language:English
Date:June 2010
Deposited On:12 Nov 2010 15:23
Last Modified:05 Apr 2016 14:15
Publisher:Springer
ISSN:1569-5794
Additional Information:The original publication is available at www.springerlink.com
Publisher DOI:https://doi.org/10.1007/s10554-010-9594-3
PubMed ID:20131006

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