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Impaired left ventricular function has a detrimental effect on image quality in multi-detector row CT coronary
N E Manghat1, G J Morgan-Hughes, S R Shaw
1Department of Clinical Radiology, Derriford Hospital, Plymouth, Devon, UK. docnatman@msn.com
Insights
Left ventricular (LV) function impacts contrast opacification in computed tomography (CT) coronary angiography. This can reduce image quality, especially in cardiomyopathy patients, necessitating protocol adjustments.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Imaging Physics
Background:
- Computed tomography (CT) coronary angiography is vital for diagnosing coronary artery disease.
- Image quality in CT coronary angiography can be affected by patient-specific hemodynamic factors.
- Understanding these factors is crucial for accurate diagnosis and effective imaging protocols.
Purpose of the Study:
- To investigate the relationship between left ventricular (LV) hemodynamic parameters, circulation times, and arterial contrast opacification.
- To determine the impact of these factors on the image quality of CT coronary angiography.
- To identify potential pitfalls in imaging patients with impaired LV function.
Main Methods:
- A study cohort of 36 patients, including 18 with cardiomyopathy (CM) and LV dilatation and 18 controls, was analyzed.
- Coronary artery image quality was assessed using a three-point visual scale.
- Contrast medium circulation times, aortic root contrast attenuation, and LV functional parameters were measured.
Main Results:
- Reduced contrast opacification impaired image quality more frequently in the CM group (27.4%) compared to controls (5.1%).
- A significant portion of CM patients (55.6%) exhibited contrast transit times between 30-75 seconds.
- Increasing transit times correlated with a higher number of unassessable coronary segments (R²=0.74), and LV ejection fraction related to contrast attenuation (R²=0.71).
Conclusions:
- Left ventricular (LV) hemodynamics significantly influence coronary artery opacification during cardiac CT.
- Clinicians should be aware of potential imaging pitfalls in patients with impaired LV function.
- Further research into optimized CT protocols for this specific patient subgroup is warranted.
Aim:
To determine whether there is a relationship between left ventricular (LV) haemodynamic parameters, circulation times, and arterial contrast opacification that might affect the image quality of computed tomography (CT) coronary angiography.
Methods:
Thirty-six patients were included in the study: 18 with cardiomyopathy (CM) and LV dilatation of suspected ischaemic aetiology [age 57.9+/-13.7 years, range 30-77 years; 14 male, four female; body mass index (BMI)=27.7+/-4.5, range 25.5-31.8] and 18 controls (age 62.3+/-9.4 years, range 47-89 years; 10 male, eight female; BMI 27.8+/-6.6; range 19.2-33.6). Coronary artery image quality was assessed using a three-point visual scale; contrast medium circulation times, aortic root contrast attenuation, and LV functional parameters were studied.
Results:
Visually reduced contrast opacification impaired image quality more often in the CM group than the control group (27.4 versus 5.1%). A total of 55.6% CM patients had a contrast transit time ranging from 30-75 s; the number of "unassessable" segments increased with increasing transit time conforming to a fitted quadratic model (R2=0.74). The relationship between LV ejection fraction and contrast attenuation may also conform to a quadratic model (R2=0.71).
Conclusion:
LV haemodynamics influence coronary artery opacification using cardiac CT, and users imaging this subgroup must do so with the knowledge of this potential pitfall. The results indicate the need for further studies examining CT protocols in this clinical subgroup.
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