Spectral computed tomography angiography using a gadolinium-based contrast agent for imaging of pathologies of the
Markus Graf1, Felix G Gassert2, Alexander W Marka2
1Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany. markus.m.graf@tum.de.
Insights
Gadolinium-based contrast agents offer a viable alternative for computed tomography angiography (CTA) in patients with aortic aneurysms who cannot use iodine-based agents. Spectral CT with monoenergetic reconstructions provides reliable aortic imaging in these cases.
Area of Science:
- Radiology
- Medical Imaging
- Cardiovascular Imaging
Background:
- Patients with aortic aneurysms often require multiple CTAs.
- Iodine-based contrast agents may be contraindicated due to medical conditions.
- Gadolinium-based contrast agents (Gd-CTA) present a potential alternative.
Purpose of the Study:
- To evaluate the feasibility of spectral computed tomography angiography (CTA) using a gadolinium-based contrast agent.
- To assess its utility in patients with aortic aneurysms who have contraindications for iodine-based contrast agents.
Main Methods:
- Spectral CT was performed on 15 patients (21 scans) with aortic aneurysms.
- Patients had contraindications for iodine-based contrast agents.
- Gd-based contrast agent was administered at routine doses (0.2 mmol/kg).
- Monoenergetic reconstructions were computed from spectral data.
Main Results:
- Significant increase in intravascular aortic attenuation with Gd-CTA (p < 0.001).
- Monoenergetic reconstructions (MonoE40) showed significantly higher contrast ratios compared to conventional imaging.
- Thoracic aorta: 6.5±4.5 (MonoE40) vs. 2.4±0.5 (conventional), p=0.003.
- Abdominal aorta: 4.1±1.8 (MonoE40) vs. 1.9±0.5 (conventional), p < 0.001.
Conclusions:
- Gd-CTA is a valid and reliable alternative for diagnostic aortic imaging.
- Monoenergetic reconstructions using Gd-CTA are useful for patients with aortic aneurysms and iodine contraindications.
Objectives:
Especially patients with aortic aneurysms and multiple computed tomography angiographies (CTA) might show medical conditions which oppose the use of iodine-based contrast agents. CTA using monoenergetic reconstructions from dual layer CT and gadolinium (Gd-)based contrast agents might be a feasible alternative in these patients. Therefore, the purpose of this study was to evaluate the feasibility of clinical spectral CTA with a Gd-based contrast agent in patients with aortic aneurysms.
Methods:
Twenty-one consecutive scans in 15 patients with and without endovascular aneurysm repair showing contraindications for iodine-based contrast agents were examined using clinical routine doses (0.2 mmol/kg) of Gd-based contrast agent with spectral CT. Monoenergetic reconstructions of the spectral data set were computed.
Results:
There was a significant increase in the intravascular attenuation of the aorta between pre- and post-contrast images for the MonoE40 images in the thoracic and the abdominal aorta (p < 0.001 for both). Additionally, the ratio between pre- and post-contrast images was significantly higher in the MonoE40 images as compared to the conventional images with a factor of 6.5 ± 4.5 vs. 2.4 ± 0.5 in the thoracic aorta (p = 0.003) and 4.1 ± 1.8 vs. 1.9 ± 0.5 in the abdominal aorta (p < 0.001).
Conclusions:
To conclude, our study showed that Gd-CTA is a valid and reliable alternative for diagnostic imaging of the aorta for clinical applications. Monoenergetic reconstructions of computed tomography angiographies using gadolinium based contrast agents may be a useful alternative in patients with aortic aneurysms and contraindications for iodine based contrast agents.
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