Contrast Media Administration in Coronary Computed Tomography Angiography – A Systematic Review

Abstract

Background Various different injection parameters influence enhancement of the coronary arteries. There is no consensus in the literature regarding the optimal contrast media (CM) injection protocol. The aim of this study is to provide an update on the effect of different CM injection parameters on the coronary attenuation in coronary computed tomographic angiography (CCTA).

Method Studies published between January 2001 and May 2014 identified by Pubmed, Embase and MEDLINE were evaluated. Using predefined inclusion criteria and a data extraction form, the content of each eligible study was assessed. Initially, 2551 potential studies were identified. After applying our criteria, 36 studies were found to be eligible. Studies were systematically assessed for quality based on the validated Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-II checklist.

Results Extracted data proved to be heterogeneous and often incomplete. The injection protocol and outcome of the included publications were very diverse and results are difficult to compare. Based on the extracted data, it remains unclear which of the injection parameters is the most important determinant for adequate attenuation. It is likely that one parameter which combines multiple parameters (e. g. IDR) will be the most suitable determinant of coronary attenuation in CCTA protocols.

Conclusion Research should be directed towards determining the influence of different injection parameters and defining individualized optimal IDRs tailored to patient-related factors (ideally in large randomized trials).

Key points 

• This systematic review provides insight into decisive factors on coronary attenuation.

• Different and contradicting outcomes are reported on coronary attenuation in CCTA.

• One parameter combining multiple parameters (IDR) is likely decisive in coronary attenuation.

• Research should aim at defining individualized optimal IDRs tailored to individual factors.

• Future directions should be tailored towards the influence of different injection parameters.

Citation Format

• Mihl C, Maas M, Turek J et al. Contrast Media Administration in Coronary Computed Tomography Angiography – A Systematic Review. Fortschr Röntgenstr 2017; 189: 312 – 325

Zusammenfassung

Hintergrund Die Kontrastierung der Koronararterien in der CT wird durch verschiedene Parameter der Kontrastmittelinjektion beeinflusst. Bislang existiert in der Literatur kein allgemeingültiger Konsens zu einem optimalen Kontrastmittelinjektionsprotokoll. Das Ziel dieser Übersichtsarbeit war es, die vorhandene wissenschaftliche Literatur systematisch zu analysieren, um den Einfluss der verschiedenen Injektionsparameter zu bestimmen.

Methode Hierzu wurden peer-reviewed Studien analysiert, welche in Pubmed, Embase und MEDLINE zwischen Januar 2001 und Mai 2014 publiziert wurden. Mithilfe bestimmter vorher festgelegter Kriterien wurden in Frage kommende Studien evaluiert. Zu Beginn wurden 2551 mögliche Studien ausgewählt. Nach Analyse der Kriterien wurden letztendlich 36 Studien herausgefiltert, welche systematisch bezüglich ihrer Qualität mittels eines standardisiertem Bewertungsverfahren (Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-II checklist) beurteilt wurden.

Ergebnisse Innerhalb dieser Studien zeigte sich eine sehr heterogene und teils inkomplette Datenlage, was eine exakte Vergleichbarkeit sehr schwierig macht. Es bleibt weiterhin nicht in letzter Konsequenz zu beantworten, welcher Parameter entscheidend für eine optimale Kontrastierung der Koronararterien ist. Wahrscheinlich ist daher ein Parameter wie die Jodapplikationsrate (Iodine Delivery Rate) optimal, da dieser mehrere Faktoren (Kontrastkonzentration und Flussrate) miteinander verbindet.

Schlussfolgerung Da zukünftige Kontrastforschung sich auf eine verstärkt individualisierte Kontrastgabe richtet, sollten weitere (möglichst große randomisierte) Studien durchgeführt werden, welche die offenen Fragen bezüglich des Einflusses der einzelnen Parameter beantworten können.

Kernaussagen:

• Die vorliegende Arbeit gibt eine systematische Übersicht der entscheidenden Einflussfaktoren auf die optimale Kontrastierung der Koronarien.

• Verschiedene teils widersprüchliche Resultate wurden bislang in der Literatur bezüglich der Kontrastierung der Koronarien beschrieben.

• Die Jodapplikationsrate ist wahrscheinlich entscheidend, da dieser Parameter die zwei wichtigsten Faktoren miteinander kombiniert.

• Weitere Forschung ist notwendig, um die Jodapplikationsrate für den individuellen Patienten zu optimieren.

• Weitere Forschung ist notwendig, um den genauen Einfluss von verschiedenen Einzelfaktoren zu untersuchen.

Key words

cardiac - contrast agents - technical aspects - CT angiography

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