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Review of Factors Contributing to the Imaging of the Coronary Arteries in Coronary Computed Tomography Angiography and Implications for Imaging Practice

Yıl 2023, Cilt: 45 Sayı: 1, 88 - 93, 23.01.2023
https://doi.org/10.20515/otd.1107186

Öz

We aimed to review factors affecting the opacification of the coronary arteries in coronary computed tomography angiography (CTA) and evaluate their reflections on imaging practices. Coronary CTA images were retrospectively evaluated. The measurements performed from the central part of the left main coronary artery (LMCA) were divided into two groups optimal CTA (in the range of 300-400 Hounsfield units) and non-optimal CTA. Weight, heart rate, tube current, amount of contrast agent, region of interest (ROI), the short axis diameter of the left ventricle at the midventricular line in the end-diastolic phase, the field of view (FOV), and contrast + saline injection time were compared between the two groups. P<0.05 was accepted as the statistical significance limit. Eighty-three patients were included in the study, and their mean age and standard deviation were 58±18.56 years. In the study, 35 patients (42.3%) had non-optimal CTA and 48 (57.8%) had optimal CTA according to LMCA density. Patient weight (p<0.05), amount of contrast (p<0.01), FOV (p<0.05), and contrast + saline injection time (p<0.01) were significantly higher and tube current was significantly lower (p < 0.05) in the optimal CTA group compared to the non-optimal CTA group. As a result of the logistic model established with independent variables that affected the non-optimal CTA scan, tube current and amount of contrast agent were found to be significant. To bring coronary CTA to a more optimal level, radiologists should work on a patient basis, revising contrast agent protocols and adapting them to each patient.

Destekleyen Kurum

The author received no financial support for the research, authorship, and/or publication of this article.

Kaynakça

  • 1. Becker CR. Cardiac CT: a one-stop-shop procedure? Eur Radiol. 2006;7:M65-M70.
  • 2. Budoff MJ, Rasouli ML, Shavelle DM, et al. Cardiac CT angiography (CTA) and nuclear myocardial perfusion imaging (MPI)-a comparison in detecting significant coronary artery disease. Acad Radiol. 2007;14:252-7.
  • 3. Raff GL, Gallagher MJ, O'Neill WW, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005;46:552-7.
  • 4. Leber AW, Knez A, Becker A, et al. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol. 2004;43:1241-7.
  • 5. Cademartiri F, Mollet NR, Lemos PA, et al. Higher intracoronary attenuation improves diagnostic accuracy in MDCT coronary angiography. Am J Roentgenol. 2006;187:W430-3.
  • 6. Cademartiri F, Maffei E, Palumbo AA, et al. Influence of intracoronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography. Eur Radiol. 2008;18:576-83.
  • 7. Fei X, Du X, Yang Q, et al. 64-MDCT coronary angiography: Phantom study of effects of vascular attenuation on detection of coronary stenosis. Am J Roentgenol. 2008;191:43-9.
  • 8. Tatsugami F, Kanamoto T, Nakai G, et al. Reduction of the total injection volume of contrast material with a short injection duration in 64-detector row CT coronary angiography. Br J Radiol. 2010;83:35-39.
  • 9. Higaki T, Nakaura T, Kidoh M, et al. Effect of contrast material injection duration on arterial enhancement at CT in patients with various cardiac indices: Analysis using computer simulation. PLoS One. 2018;13:e0191347.
  • 10. Budoff MJ, Shinbane JS, Child J, et al. Multiphase contrast medium injection for optimization of computed tomographic coronary angiography. Acad Radiol. 2006;13:159-65.
  • 11. Hausleiter J, Meyer T, Hadamitzky M, et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation. 2006;113:1305-10.
  • 12. Kim DJ, Kim TH, Kim SJ, et al. Saline flush effect for enhancement of aorta and coronary arteries at multidetector CT coronary angiography. Radiology. 2008;246:110-5.
  • 13. Becker CR, Hong C, Knez A et al. Optimal contrast application for cardiac 4-detector-row computed tomography. Invest Radiol. 2003;38:690-4.
  • 14. Mihl C, Kok M, Altintas S, et al. Evaluation of individually body weight adapted contrast media injection in coronary CT-angiography. Eur J Radiol. 2016;85:830-6.
  • 15. Wang C, Asch D, Joseph Cavallo J. ACR Manual on Contrast Media [Internet]. Contrast Manual |American College of Radiology. American College of Radiology; 2021 [cited 2022Apr22]. Available from: https://www.acr.org/Clinical-Resources/Contrast-Manual.
  • 16. Muenzel D, Noel PB, Dorn F, et al. Coronary CT angiography in step-and-shoot technique with 256-slice CT: impact of the field of view on image quality, craniocaudal coverage, and radiation exposure. Eur J Radiol. 2012;81:1562-8.
  • 17. Frauenfelder T, Appenzeller P, Karlo C, et al. Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings. Eur Radiol. 2009;19:789-99.
  • 18. Oda S, Utsunomiya D, Funama Y, et al. A hybrid iterative reconstruction algorithm that improves the image quality of low-tube-voltage coronary CT angiography. AJR Am J Roentgenol. 2012;198:1126-31.
  • 19. Nakaura T, Awai K, Yauaga Y, et al. Contrast injection protocols for coronary computed tomography angiography using a 64-detector scanner: comparison between patient weight-adjusted- and fixed iodine-dose protocols. Invest Radiol. 2008;43:512-9.

Koroner Bilgisayarlı Tomografik Anjiografide Koroner Damarların Görüntülenmesine Katkı Sağlayan Faktörlerin Gözden Geçirilmesi ve Bunların Çekim Pratiğine Yansıması

Yıl 2023, Cilt: 45 Sayı: 1, 88 - 93, 23.01.2023
https://doi.org/10.20515/otd.1107186

Öz

Koroner bilgisayarlı tomografik anjiografide (BTA) koroner damarların opasifikasyonuna etki eden faktörlerin gözden geçirilmesi ve bunların çekim pratiğine yansımalarını değerlendirmeyi amaçladık. Retrospektif olarak koroner BTA çekimleri değerlendirilmiş olup sol ana koroner arter (LMCA) santral kesiminden yapılan ölçümlere göre 300-400 Hounsfield Unit aralığında yapılan ölçümler optimum kabul edilip, bunun dışındakiler optimum olmayan grup olarak kabul edildi. İki grup kilo, kalp atımı, tüp akımı, kontrast miktarı, region of interest (ROI), end diastolik fazda midventriküler hatta sol ventrikül kısa aks çapı, Field of View (FOV), kontrast+ serum fizyolojik (SF) verilme süresi kıyaslandı. İstatistiksel anlamlılık sınırı olarak p<0,05 kabul edildi. Çalışmaya 83 hasta dahil edilmiş olup hastaların yaş ortalamaları ve standart sapması 58 ± 18.56 yıl olarak saptandı. Çalışmada LMCA dansitesine göre 35 hasta (42.3%) optimum olmayan grupta olup, 48 hasta (57.8%) optimum olan gruptaydı. Çalışmada LMCA dansitesine göre 48 hasta (57.8%) optimum olan grupta olup, 35 hasta (42.3%) optimum olmayan gruptaydı. Koroner BTA çekimi optimum olan hastalarda optimum olmayan hastalara göre kilo değerleri (p<0.05), kontrast madde miktarı (p<0.01), FOV değerleri (p<0.05), kontrast+SF verilme süresi değerleri (p<0.01) anlamlı düzeyde yüksek, tüp akımı (p<0.05) anlamlı düzeyde düşük olarak saptandı. Optimum olmayan BTA tetkikine etkili bağımsız değişkenlerle oluşturulan logistik regresyon modeli sonucunda; tüp akımı ve kontrast madde miktarı anlamlı bulunmuştur. Koroner BTA çekimlerini daha optimal düzeye taşıyabilmek için hasta bazlı çalışılmalı, kontrast protokollerini değiştirerek hastaya uyarlamalıyız.

Kaynakça

  • 1. Becker CR. Cardiac CT: a one-stop-shop procedure? Eur Radiol. 2006;7:M65-M70.
  • 2. Budoff MJ, Rasouli ML, Shavelle DM, et al. Cardiac CT angiography (CTA) and nuclear myocardial perfusion imaging (MPI)-a comparison in detecting significant coronary artery disease. Acad Radiol. 2007;14:252-7.
  • 3. Raff GL, Gallagher MJ, O'Neill WW, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005;46:552-7.
  • 4. Leber AW, Knez A, Becker A, et al. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol. 2004;43:1241-7.
  • 5. Cademartiri F, Mollet NR, Lemos PA, et al. Higher intracoronary attenuation improves diagnostic accuracy in MDCT coronary angiography. Am J Roentgenol. 2006;187:W430-3.
  • 6. Cademartiri F, Maffei E, Palumbo AA, et al. Influence of intracoronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography. Eur Radiol. 2008;18:576-83.
  • 7. Fei X, Du X, Yang Q, et al. 64-MDCT coronary angiography: Phantom study of effects of vascular attenuation on detection of coronary stenosis. Am J Roentgenol. 2008;191:43-9.
  • 8. Tatsugami F, Kanamoto T, Nakai G, et al. Reduction of the total injection volume of contrast material with a short injection duration in 64-detector row CT coronary angiography. Br J Radiol. 2010;83:35-39.
  • 9. Higaki T, Nakaura T, Kidoh M, et al. Effect of contrast material injection duration on arterial enhancement at CT in patients with various cardiac indices: Analysis using computer simulation. PLoS One. 2018;13:e0191347.
  • 10. Budoff MJ, Shinbane JS, Child J, et al. Multiphase contrast medium injection for optimization of computed tomographic coronary angiography. Acad Radiol. 2006;13:159-65.
  • 11. Hausleiter J, Meyer T, Hadamitzky M, et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation. 2006;113:1305-10.
  • 12. Kim DJ, Kim TH, Kim SJ, et al. Saline flush effect for enhancement of aorta and coronary arteries at multidetector CT coronary angiography. Radiology. 2008;246:110-5.
  • 13. Becker CR, Hong C, Knez A et al. Optimal contrast application for cardiac 4-detector-row computed tomography. Invest Radiol. 2003;38:690-4.
  • 14. Mihl C, Kok M, Altintas S, et al. Evaluation of individually body weight adapted contrast media injection in coronary CT-angiography. Eur J Radiol. 2016;85:830-6.
  • 15. Wang C, Asch D, Joseph Cavallo J. ACR Manual on Contrast Media [Internet]. Contrast Manual |American College of Radiology. American College of Radiology; 2021 [cited 2022Apr22]. Available from: https://www.acr.org/Clinical-Resources/Contrast-Manual.
  • 16. Muenzel D, Noel PB, Dorn F, et al. Coronary CT angiography in step-and-shoot technique with 256-slice CT: impact of the field of view on image quality, craniocaudal coverage, and radiation exposure. Eur J Radiol. 2012;81:1562-8.
  • 17. Frauenfelder T, Appenzeller P, Karlo C, et al. Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings. Eur Radiol. 2009;19:789-99.
  • 18. Oda S, Utsunomiya D, Funama Y, et al. A hybrid iterative reconstruction algorithm that improves the image quality of low-tube-voltage coronary CT angiography. AJR Am J Roentgenol. 2012;198:1126-31.
  • 19. Nakaura T, Awai K, Yauaga Y, et al. Contrast injection protocols for coronary computed tomography angiography using a 64-detector scanner: comparison between patient weight-adjusted- and fixed iodine-dose protocols. Invest Radiol. 2008;43:512-9.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Nevin Aydın 0000-0002-7765-4323

Yayımlanma Tarihi 23 Ocak 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 45 Sayı: 1

Kaynak Göster

Vancouver Aydın N. Review of Factors Contributing to the Imaging of the Coronary Arteries in Coronary Computed Tomography Angiography and Implications for Imaging Practice. Osmangazi Tıp Dergisi. 2023;45(1):88-93.


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