Improved image-quality consistency in coronary CT angiography using a test-bolus-based individually tailored contrast medium injection protocol. Issue 11 (November 2016)

• Record Type: Journal Article
• Authors: Zhu, X.; Zhu, Y.; Liu, W.; Yang, G.; Su, Z.; Tang, L.; Xu, Y.
• Is Part Of: Clinical radiology. Volume 71:Issue 11(2016)
• Page Start: 1113
• Page End: 1119
• Publication Date: 2016-11
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2016.04.001
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : Aim: To develop and validate a test bolus (TB)-based quantitative model to create an individualised contrast medium injection protocol for use at coronary computed tomography angiography (CCTA) to improve patient-to-patient uniformity of intracoronary attenuation. Materials and methods: In the model-building phase, 175 patients who underwent CCTA using a traditional contrast medium injection protocol were recruited. A personalised injection equation was proposed according to the relationship between aortic enhancement and the haemodynamic parameters obtained from the TB. In the model-validation phase, a target aortic enhancement of 350 HU was set. Two hundred and fifteen additional CCTA examinations were performed using the proposed personalised injection model. Comparisons of inter-individual variability between the traditional and the proposed personalised injection protocol were performed. Results: In the model-building phase, a high positive correlation between aortic enhancement and the haemodynamic parameters obtained from the TB was found. As a result, a personalised injection equation was determined using linear regression. In the model-validation phase, the average aortic enhancement was 350.5 HU, without significant differences from the preset level. Using the TB-based personalised injection protocol, inter-individual variability of aortic enhancement was significantly reduced (71.8 versus 38.9 HU, p <0.001) and patients who were scanned at 100 kVp had a reduction in the average contrast medium flow rate from 4.1 to 3.2 ml/s ( p <0.001). Conclusions: The proposed TB-based injection protocol can achieve a desired preset and stable aortic enhancement. Highlights: Aortic enhacement is highly related to hemodynamic parameters from the test bolus. Test bolus based contrast protocols achieve target aortic attenuation with improved uniformity. Patients scanned at 100 kVp has a reduction in the mean contrast flow rate close to 3 ml/s.