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Right heart: split-bolus injection of diluted contrast medium for visualization at coronary CT angiography
J Matthias Kerl1, James G Ravenel, Shaun A Nguyen
1Department of Radiology, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425, USA.
Insights
Split-bolus contrast injection in coronary CT angiography improves right heart visualization and reduces streak artifacts. This method maintains arterial attenuation, offering a better balance for cardiac imaging.
Area of Science:
- Radiology
- Medical Imaging
- Cardiovascular Imaging
Background:
- Coronary computed tomographic (CT) angiography is crucial for diagnosing coronary artery disease.
- Optimizing contrast medium injection protocols is essential for enhancing image quality and diagnostic accuracy.
- Different injection protocols, including monophasic, biphasic, and split-bolus, aim to balance contrast enhancement, artifact reduction, and patient safety.
Purpose of the Study:
- To compare the effectiveness of a split-bolus contrast medium injection protocol against biphasic and monophasic protocols.
- To evaluate visualization of right and left heart structures, contrast medium-related streak artifacts, and attenuation levels in cardiac chambers and coronary arteries.
- To determine the optimal contrast injection strategy for coronary CT angiography.
Main Methods:
- Retrospective analysis of 75 patients undergoing 64-section coronary CT angiography.
- Categorization into three groups: monophasic (n=25), biphasic (n=25), and split-bolus (n=25) contrast injection protocols.
- Radiological assessment of heart structure visualization, streak artifacts, and quantitative attenuation measurements of cardiac chambers and coronary arteries.
Main Results:
- The split-bolus group showed significantly higher contrast attenuation in the right heart compared to the biphasic group (P < .001).
- Streak artifacts were significantly less frequent in the biphasic and split-bolus groups compared to the monophasic group (P < .001).
- Visualization of right heart structures was significantly better in the split-bolus group (P < .05), with no significant differences in left heart or coronary artery visualization or attenuation among groups.
Conclusions:
- Split-bolus injection provides adequate contrast attenuation for optimal right heart visualization in coronary CT angiography.
- This protocol effectively minimizes streak artifacts associated with high-attenuation contrast material.
- Arterial attenuation is successfully maintained, making split-bolus a favorable protocol for cardiac imaging.
Purpose:
To retrospectively compare a split-bolus contrast medium injection protocol with a biphasic and a monophasic protocol in terms of visualization of the right and left heart, contrast medium-related streak artifacts, and level of attenuation in the cardiac chambers and coronary arteries at coronary computed tomographic (CT) angiography.
Materials And Methods:
The human research committee approved this HIPAA-compliant study and waived informed consent. Seventy-five patients had undergone 64-section coronary CT angiography: 25 were injected by using a monophasic, contrast-medium-only protocol with a single-syringe injector; 25 were injected by using a biphasic protocol with a dual-syringe injector; and 25 were injected by using a split-bolus protocol with a dual-syringe injector and an initial bolus of contrast medium followed by 50 mL of a 70%:30% saline-to-contrast medium mixture and a 30-mL saline chaser. Two radiologists rated the visualization of right and left heart structures and the degree of streak artifacts. One observer performed attenuation measurements of the cardiac chambers and of the coronary arteries. Data were analyzed with one-way analysis of variance and Duncan post-hoc multiple comparison procedures.
Results:
Data for 27 women and 48 men (mean age, 62 years) were included. Mean contrast medium attenuation in the right heart was significantly (P < .001) higher in the split-bolus group than in the biphasic injection group but was significantly (P < .001) lower than in the monophasic injection group. For the left heart and the coronary arteries, there were no significant differences among the three groups. Artifacts occurred less frequently (P < .001) in the biphasic and split-bolus groups than in the monophasic group. Visualization of right heart structures was rated significantly (P < .05) better in the split-bolus group than in the two other groups, while there was no difference for visualization of left heart structures.
Conclusion:
Split-bolus injection provides sufficient attenuation for visualization of the right heart, while streak artifacts from high-attenuation contrast material can generally be avoided and arterial attenuation is maintained.
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