Personalized Test Bolus MSCT Protocol for Optimal Coronary Sinus Venous Visualization in Candidates for Cardiac...

Area of Science:

• Cardiovascular Imaging
• Medical Imaging Techniques
• Interventional Cardiology

Background:

• Accurate coronary sinus (CS) and tributary anatomy is vital for optimal left ventricular lead selection in cardiac resynchronization therapy (CRT).
• Current multislice computed tomography (MSCT) protocols lack personalization for visualizing CS veins across diverse patient populations.

Purpose of the Study:

• To develop and evaluate a personalized MSCT protocol for optimal visualization of coronary sinus veins.
• To assess the impact of a test bolus method on contrast enhancement and visualization quality for CRT planning.

Main Methods:

• A prospective, single-center study involving 74 adult patients undergoing CRT.
• Implementation of a personalized MSCT protocol featuring a test bolus for automated time-to-peak contrast calculation, followed by a fixed delay for CS vein imaging.
• Acquisition parameters included prospective gating, manual phase selection (200-400 ms), standard iodine concentration (300 mg I/mL), and controlled injection rate (≤4.5 mL/s).

Main Results:

• The personalized MSCT protocol successfully visualized all first-order CS branches in all patients.
• Heart rate and rhythm did not significantly affect venous visualization quality.
• The test bolus protocol, with a calculated delay, proved essential for optimal CS vein enhancement, as Hounsfield units explained only 28.9% of variability.

Conclusions:

• A personalized, detailed test bolus MSCT protocol offers superior visualization of coronary sinus veins.
• This protocol is crucial for precise anatomical assessment in patients undergoing cardiac resynchronization therapy.
• Further multi-center validation is recommended to confirm the generalizability of the proposed MSCT protocol.