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. 2019 Apr;9(4):552-564.
doi: 10.21037/qims.2019.03.13.

Personalized administration of contrast medium with high delivery rate in low tube voltage coronary computed tomography angiography

Sock Keow Tan  1   2 , Kwan Hoong Ng  1   2 , Chai Hong Yeong  3 , Raja Rizal Azman Raja Aman  1   2 , Fadhli Mohamed Sani  1   2 , Yang Faridah Abdul Aziz  1   2 , Zhonghua Sun  4
Affiliations

Personalized administration of contrast medium with high delivery rate in low tube voltage coronary computed tomography angiography

Sock Keow Tan et al. Quant Imaging Med Surg. 2019 Apr.

Abstract

Background: High delivery rate is an important factor in optimizing contrast medium administration in coronary computed tomography angiography (CCTA). A personalized contrast volume calculation algorithm incorporating high iodine delivery rate (IDR) can reduce total iodine dose (TID) and produce optimal vessel contrast enhancement (VCE) in low tube voltage CCTA. In this study, we developed and validated an algorithm for calculating the volume of contrast medium delivered at a high rate for patients undergoing retrospectively ECG-gated CCTA with low tube voltage protocol.

Methods: The algorithm for an IDR of 2.22 gI·s-1 was developed based on the relationship between VCE and contrast volume in 141 patients; test bolus parameters and characteristics in 75 patients; and, tube voltage in a phantom study. The algorithm was retrospectively tested in 45 patients who underwent retrospectively ECG-gated CCTA with a 100 kVp protocol. Image quality, TID and radiation dose exposure were compared with those produced using the 120 kVp and routine contrast protocols.

Results: Age, sex, body surface area (BSA) and peak contrast enhancement (PCE) were significant predictors for VCE (P<0.05). A strong linear correlation was observed between VCE and contrast volume (r=0.97, P<0.05). The 100-to-120 kVp contrast enhancement conversion factor (Ec) was calculated at 0.81. Optimal VCE (250 to 450 HU) and diagnostic image quality were obtained with significant reductions in TID (32.1%) and radiation dose (38.5%) when using 100 kVp and personalized contrast volume calculation algorithm compared with 120 kVp and routine contrast protocols (P<0.05).

Conclusions: The proposed algorithm could significantly reduce TID and radiation exposure while maintaining optimal VCE and image quality in CCTA with 100 kVp protocol.

Keywords: Coronary computed tomography angiography (CCTA); contrast medium; image quality; radiation dose; total iodine dose (TID).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of patient assignment for development of a personalized contrast volume calculation algorithm, its clinical validation and retrospective comparison of TID, image quality and radiation dose. TID, total iodine dose.
Figure 2
Figure 2
The development of personalized contrast volume calculation algorithm. BSA, body surface area; PCE, peak contrast enhancement; TTP, time-to-peak.
Figure 3
Figure 3
Curved MPR images of LM coronary artery to LAD artery and their corresponding axial images (inset). The images represent VCE scores of (A) Grade 3—acceptable opacification, sufficient for diagnosis; (B) Grade 4—good opacification of proximal and distal segments; and, (C) Grade 5—excellent opacification of proximal and distal segments. All images were displayed at a same window width of 800 and level of 300. MPR, multiplanar reformation; LM, left main; LAD, left anterior descending; VCE, vessel contrast enhancement.
Figure 4
Figure 4
The relationship between VCE and contrast volume. VCE, vessel contrast enhancement.
Figure 5
Figure 5
Iodine attenuation curves for tube voltages of 100 and 120 kVp.
Figure S1
Figure S1
(A) Six polyethylene vials of 2 mL in volume that has been filled with saline and different concentrations of iodinated contrast medium: 5, 10, 15, 20 and 25 mg/mL; (B) placement of polyethylene vial in female adult anthropomorphic phantom; (C) ROI for contrast enhancement measurement. ROI, region of interest.
See this image and copyright information in PMC

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