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Published on: February 20, 2017
[Observing the density increase curve after intravenous contrast medium administration using a bolus triggering
C A Stückle1, R Kickuth, E M Kirchner
1Klinik für Diagnostische Radiologie und Nuklearmedizin, Marienhospital Herne, Universitätsklinik.
Insights
Bolus tracking systems in CT scans can show atypical patterns in cardiac failure. However, this method is not reliable for screening overall cardiopulmonary function.
Area of Science:
- Radiology
- Cardiology
- Medical Imaging
Background:
- Bolus tracking systems enhance contrast media timing in helical CT.
- Assessing cardiac function parameters using these systems is an area of interest.
Purpose of the Study:
- To investigate the utility of bolus tracking systems as a parameter for cardiac function assessment.
- To correlate bolus tracking measurements with invasive cardiac investigations.
Main Methods:
- Retrospective analysis of 64 patients undergoing bolus-triggered contrast-enhanced helical CT and invasive cardiac evaluation.
- Utilized Siemens Somatom Plus 4 Volume Zoom with C.A.R.E. Bolus software for contrast tracking.
- Categorized Hounsfield attenuation patterns post-contrast injection into three types.
Main Results:
- A significant correlation was found between Hounsfield attenuation patterns and left ventricular systolic pressure.
- No significant correlation was observed with diastolic pressures, right ventricular pressures, or ejection fraction.
- The bolus tracking system demonstrated 70% accuracy in detecting left heart failure.
Conclusions:
- Atypical Hounsfield attenuation patterns are frequently observed in cardiac failure using the C.A.R.E.-bolus system.
- This system is not recommended as a primary screening tool for cardiopulmonary function.
Purpose:
Recently bolus tracking systems were developed to improve the timing of intravenous contrast media application in helical computed tomography. We investigated the benefit of this new method as a parameter of the cardiac function.
Material And Methods:
Retrospective analysis of 64 patients which incidentally underwent bolus triggered contrast enhanced helical CT and invasive investigation of the heart within one week. All examinations were performed on the CT scanner Somatom Plus 4 Volume Zoom (Siemens Corp., Forchheim, Germany) using the C.A.R.E. Bolus software. This performs repetitive low-dose test scans (e.g. for the abdomen: 140 kV, 20 mA, Tl 0.5 s) and measures the Hounsfield attenuation (increase over the baseline) in a preselected region of interest. The displayed increase of vascular density over the time after peripheral contrast media injection (75 ml lopromid (300 mg/ml), 2 ml/s) was categorised to three types: (a) rapid increase, (b) deceleration before a 100 HE threshold was reached and (c) one or more peaks. The findings of the invasive investigation of the heart were correlated to the findings of the bolus-tracking measurements.
Results:
The examinations were categorized as follows: 19 type A, 34 type B, 11 type C. We found a high significant correlation between the type of the Hounsfield attenuation and systolic pressure in the left ventricle. There was no correlation between the type of the Hounsfield attenuation and the diastolic pressure in the left ventricle, the pressures related to the right ventricle or the ejection fraction. The bolus-tacking system showed a sensitivity of 53, a specificity of 82, an accuracy of 70%, a positive predictive value of 70% and a negative predictive value of 70% in detection of left heart failure.
Conclusion:
The bolus tracking system C.A.R.E.-bolus often shows atypical Hounsfield attenuation in cases of cardiac failure but is not suitable as a screening method of the cardiopulmonary function.
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