PDF herunterladen
Rofo 2013; 185(2): 128-135
DOI: 10.1055/s-0032-1325603
Experimentielle Radiologie
© Georg Thieme Verlag KG Stuttgart · New York

Carbon Dioxide-Contrasted Computed Tomography Angiography: High Pitch Protocols and Adapted Injection Parameters Improve Imaging Quality

Kohlendioxid-kontrastierte computertomografische Angiografie: Protokolle mit hohem Pitch und angepassten Injektionsparametern verbessern die Bildqualität
T. Penzkofer
1   Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
2   Surgical Planning Laboratory, Department of Radiology, Brigham and Women‘s Hospital, Harvard Medical School, Boston, USA
3   Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University Hospital, Aachen, Germany
,
K. Slebocki
1   Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
,
J. Grommes
4   European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
5   Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
,
P. Bruners
1   Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
3   Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University Hospital, Aachen, Germany
,
P. P. Isfort
1   Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
3   Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University Hospital, Aachen, Germany
,
N. Heussen
6   Department of Medical Statistics, Medical Faculty, RWTH Aachen University, Aachen, Germany
,
T. Schmitz-Rode
3   Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University Hospital, Aachen, Germany
,
C. K. Kuhl
1   Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
,
S. Langer
4   European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
5   Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
,
A. H. Mahnken
1   Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
3   Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University Hospital, Aachen, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

06. Juli 2012

28. September 2012

Publikationsdatum:
29. November 2012 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Purpose: To systematically investigate the impact of image acquisition and contrast injection parameters for CO2-enhanced CT angiography (CTA) of the aorto-iliac and peripheral arteries in a pig model using commercially available equipment. The aim was to establish an imaging protocol that is ready for use in human subjects.

Materials and Methods: Three domestic swine underwent CO2-CTA with varying injection parameters: pitch (1.0, 3.0), injection pressure (0.7 bar, 1.0 bar, 1.3 bar) and scan delay (2 s, 4 s, 6 s). Objective (vessel diameter) and subjective (image quality) parameters and applied radiation doses were systematically evaluated. To ensure clinical applicability of the setting, only approved catheters/injectors and standard injection parameters were evaluated.

Results: The image quality scores were superior and the vessel diameter was larger with high pitch in comparison to standard pitch (diameters: 4.7 ± 2.0 mm vs. 3.6 ± 2.1 mm, p = 0.0040, scores: 2.6 ± 1.1 vs. 2.0 ± 1.1, p = 0.0038). High injection pressure (1.3 bar) improved the image quality as assessed by subjective and objective ratings (diameters: 3.6 ± 2.0 mm, 4.0 ± 2.1 mm and 4.6 ± 2.1 mm, for 0.7, 1.0 and 1.3 bar, p-values ≤ 0.0052, scores: 1.9 ± 1.1, 2.3 ± 1.1 and 2.7 ± 1.2, p-values ≤ 0.0017), the same was observed for a shorter injection delay (diameters: 3.5 ± 2.0 mm, 4.2 ± 2.1 mm and 4.8 ± 2.1 mm, for 6 s, 4 s, and 2 s, p ≤ 0.0022, scores: 1.9 ± 1.1, 2.3 ± 1.1 and 2.7 ± 1.1, p-values ≤ 0.0013). The dose length products were 239 ± 47 mGycm (high pitch) and 565 ± 63 mGycm (standard pitch, p-values < 0.0001).

Conclusion: A higher pitch, shorter delay and higher injection pressure improve image quality in CO2-enhanced CTA. Since commercially available, clinically approved equipment was used. The protocol is now ready for use in human subjects.

Zusammenfassung

Ziel: Es sollen in einem klinisch zugelassenen Aufbau der Einfluss der Bildgebungs- und Injektionsparameter auf die computertomografische (CT) Kohlendioxid(CO2)-kontrastierte Becken-Bein-Angiografie (CO2-CTA) im Tiermodell untersucht werden. Ziel ist, ein Bildgebungsprotokoll zu etablieren, das für den Einsatz im Menschen geeignet ist.

Material und Methoden: In 3 Hausschweinen wurden CO2-CTAs durchgeführt, wobei der Pitch (1,0, 3,0), der Injektionsdruck (0,7 bar, 1,0 bar, 1,3 bar) und die Scanverzögerung (2 s, 4 s, 6 s) systematisch variiert wurden. Objektive (Gefäßdurchmesser) und subjektive (Bildqualität) Kriterien sowie die applizierte Strahlendosis wurden evaluiert. Um eine klinische Einsetzbarkeit der entwickelten Protokolle zu gewährleisten, wurden nur zugelassene Interventionsmaterialien und Injektionsparameter untersucht.

Ergebnisse: Die Bildqualität war besser und die Gefäßdurchmesser größer, wenn Untersuchungsprotokolle mit hohem Pitch verwendet wurden (Durchmesser: 4,7 ± 2,0 mm gegenüber 3,6 ± 2,1 mm, p = 0,0040, Bildqualität (Skala von 1 – 4): 2,6 ± 1,1 vs. 2,0 ± 1,1, p = 0,0038). Höherer Injektionsdruck (1,3 bar) verbesserte ebenfalls die subjektiven und objektiven Bewertungsparameter (Gefäßdurchmesser: 3,6 ± 2,0 mm, 4,0 ± 2,1 mm und 4,6 ± 2,1 mm, jeweils für 0,7, 1,0 und 1,3 bar, p-Werte ≤ 0,0052, Bildqualität: 1,9 ± 1,1, 2,3 ± 1,1 und 2,7 ± 1,2, p-Werte ≤ 0,0017), ähnliches war für eine kürzere Scanverzögerung feststellbar (Durchmesser: 3,5 ± 2,0 mm, 4,2 ± 2,1 mm und 4,8 ± 2,1 mm, für 6 s, 4 s, und 2 s, p ≤ 0,0022, Bildqualität: 1,9 ± 1,1, 2,3 ± 1,1 und 2,7 ± 1,1, p-Werte ≤ 0,0013).

Schlussfolgerung: Höherer Pitch, kürzere Scanverzögerung und höherer Injektionsdruck verbessern die Bildqualität in der CO2-CTA. Durch die Verwendung von zugelassenen Materialien ist das vorliegende Protokoll nun auf den Menschen übertragbar.

Key words

CT angiography - interventional procedures - vascular - experimental
 

  • References

  • 1 Fleischmann D. CT angiography: injection and acquisition technique. Radiologic clinics of North America 2010; 48: 237-247, vii
    CrossrefPubMedSuche in Google Scholar
  • 2 Ouwendijk R, de Vries M, Pattynama PMT et al. Imaging peripheral arterial disease: A randomized controlled trial comparing contrast-enhanced MR angiography and multi-detector row CT angiography. Radiology 2005; 236: 1094-1103
    CrossrefPubMedSuche in Google Scholar
  • 3 Sun ZH. Diagnostic accuracy of multislice CT angiography in peripheral arterial disease. J Vasc Interv Radiol 2006; 17: 1915-1921
    CrossrefPubMedSuche in Google Scholar
  • 4 Schroeder S, Kopp AF, Baumbach A et al. Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol 2001; 37: 1430-1435
    CrossrefPubMedSuche in Google Scholar
  • 5 Saam T, Ferguson MS, Yarnykh VL et al. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol 2005; 25: 234-239
    CrossrefPubMedSuche in Google Scholar
  • 6 Kessel DO, Robertson I, Patel JT et al. Carbon-dioxide-guided vascular interventions: technique and pitfalls. Cardiovascular and interventional radiology 2002; 25: 476-483
    CrossrefPubMedSuche in Google Scholar
  • 7 Hawkins IF, Caridi JG. Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol 1998; 8: 391-402
    CrossrefPubMedSuche in Google Scholar
  • 8 Cohnen M, Vogt C, Beck A et al. Feasibility of MDCT colonography in ultra-low-dose technique in the detection of colorectal lesions: Comparison with high-resolution video colonoscopy. Am J Roentgenol 2004; 183: 1355-1359
    CrossrefPubMedSuche in Google Scholar
  • 9 Akaeda T, Isaka K, Nakaji T et al. Clinical application of virtual hysteroscopy by CO2-multidetector-row computed tomography to submucosal myomas. J Mimim Invasive Gynecol 2005; 12: 261-266
    PubMedSuche in Google Scholar
  • 10 Seidelmann FE, Temes SP, Cohen WN et al. Computed tomography of gas-filled bladder: method of staging bladder neoplasms. Urology 1977; 9: 337-344
    CrossrefPubMedSuche in Google Scholar
  • 11 Bae KT, Hong C, Becker CR et al. CO2-enhanced CT imaging for the detection of pulmonary emboli: feasibility study in a porcine model. Academic radiology 2003; 10: 313-320
    CrossrefPubMedSuche in Google Scholar
  • 12 Mahnken AH, Penzkofer T, Grommes J et al. Carbon dioxide-enhanced CT-guided placement of aortic stent-grafts: feasibility in an animal model. Journal of endovascular therapy: an official journal of the International Society of Endovascular Specialists 2010; 17: 332-339
    CrossrefPubMedSuche in Google Scholar
  • 13 Mahnken AH, Bruners P, Mommertz G et al. Carbon dioxide contrast agent for CT arteriography: Results in a porcine model. J Vasc Interv Radiol 2008; 19: 1055-1064
    CrossrefPubMedSuche in Google Scholar
  • 14 Flohr TG, Leng S, Yu L et al. Dual-source spiral CT with pitch up to 3.2 and 75 ms temporal resolution: image reconstruction and assessment of image quality. Med Phys 2009; 36: 5641-5653
    CrossrefPubMedSuche in Google Scholar
  • 15 Schmitz-Rode T, Alzen G, Günther RW. Carbon dioxide digital subtraction angiography using a new gas management system. Fortschr Röntgenstr 1997; 167: 71-78
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Seeger JM, Self S, Harward TR et al. Carbon dioxide gas as an arterial contrast agent. Annals of surgery 1993; 217: 688-697
    CrossrefPubMedSuche in Google Scholar
  • 17 Lanzman RS, Blondin D, Schmitt P et al. Non-enhanced 3D MR angiography of the lower extremity using ECG-gated TSE imaging with non-selective refocusing pulses – initial experience. Fortschr Röntgenstr 2010; 182: 861-867
    Thieme ConnectPubMedSuche in Google Scholar
  • 18 Floery D, Fellner FA, Fellner C et al. Zeitaufgelöste MR-Angiografie der Becken-Bein-Etage: ein Lösungsansatz für das Problem der venösen Überlagerungen. Fortschr Röntgenstr 2011; 183: 136-143
    Thieme ConnectPubMedSuche in Google Scholar
  • 19 Meyer BC, Klein S, Krix M et al. Comparison of a Standard and a High-Concentration Contrast Medium Protocol for MDCT Angiography of the Lower Limb Arteries. Fortschr Röntgenstr 2012; 184: 527-534
    Thieme ConnectPubMedSuche in Google Scholar
  • 20 Werncke T, Albrecht T, Wolf KJ et al. Dual-Energy-CT der peripheren Arterien: eine Phantomstudie zur Bestimmung des Einflusses der automatischen Plaqueentfernung auf die Stenosegradbestimmung. Fortschr Röntgenstr 2010; 182: 682-689
    Thieme ConnectPubMedSuche in Google Scholar
  • 21 Dahm JB, Vogelgesang D, Hummel A et al. A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions 2002; 57: 172-176
    CrossrefPubMedSuche in Google Scholar
  • 22 Liss P, Eklof H, Hellberg O et al. Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study. Journal of vascular and interventional radiology: JVIR 2005; 16: 57-65
    CrossrefPubMedSuche in Google Scholar
  • 23 Sterner G, Nyman U, Valdes T. Low risk of contrast-medium-induced nephropathy with modern angiographic technique. Journal of internal medicine 2001; 250: 429-434
    CrossrefPubMedSuche in Google Scholar
  • 24 Silva AC, Lawder HJ, Hara A et al. Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. Am J Roentgenol 2010; 194: 191-199
    CrossrefPubMedSuche in Google Scholar