Improved image-quality consistency in coronary CT angiography using a test-bolus-based individually tailored contrast...

Area of Science:

• Cardiovascular Imaging
• Medical Physics
• Radiology

Background:

• Coronary CT angiography (CCTA) requires precise contrast delivery for optimal image quality.
• Patient-to-patient variability in aortic enhancement is a common challenge in CCTA.
• Traditional contrast injection protocols may not account for individual hemodynamic variations.

Purpose of the Study:

• To develop and validate a quantitative model using test bolus (TB) data.
• To create an individualized contrast medium injection protocol for CCTA.
• To enhance patient-to-patient uniformity of intracoronary attenuation.

Main Methods:

• Model development using 175 patients with traditional CCTA protocols.
• Personalized injection equation derived from TB-based hemodynamic parameters and aortic enhancement.
• Validation in 215 patients with a target aortic enhancement of 350 HU.

Main Results:

• High correlation found between aortic enhancement and TB-derived hemodynamic parameters.
• Personalized injection equation determined via linear regression.
• Reduced inter-individual variability in aortic enhancement (71.8 vs. 38.9 HU, p<0.001) and lower contrast flow rates at 100 kVp (4.1 to 3.2 ml/s, p<0.001).

Conclusions:

• The TB-based injection protocol effectively achieves preset and stable aortic enhancement.
• Individualized contrast protocols improve consistency in CCTA.
• This method offers a promising approach for optimizing CCTA image quality.