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Impact of Contrast Media Concentration on Low-Kilovolt Computed Tomography Angiography: A Systematic Preclinical Approach

Fleischmann, Ulrike, Cand med*; Pietsch, Hubertus, PhD; Korporaal, Johannes, G., PhD; Flohr, Thomas, G., PhD; Uder, Michael, MD; Jost, Gregor, PhD; Lell, Michael, M., MD

doi: 10.1097/RLI.0000000000000437
Original Articles
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Objectives Low peak kilovoltage (kVp) protocols in computed tomography angiography (CTA) demand a review of contrast media (CM) administration practices. The aim of this study was to systematically evaluate different iodine concentrations of CM in a porcine model.

Materials and Methods Dynamic 70 kVp CTA was performed on 7 pigs using a third-generation dual-source CT system. Three CM injection protocols (A-C) with an identical total iodine dose and iodine delivery rate (150 mg I/kg, 12 s, 0.75 g I/s) differed in iodine concentration and flow rate (protocol A: 400 mg I/mL, 1.9 mL/s; B: 300 mg I/mL, 2.5 mL/s; C: 150 mg I/mL, 5 mL/s). All protocols were applied in a randomized order and compared intraindividually. Arterial enhancement at different locations in the pulmonary artery, the aorta, and aortic branches was measured over time. Time attenuation curves, peak enhancement, time to peak, and bolus tracking delay times needed for static CTA were calculated. The reproducibility of optimal parameters was tested in single-phase CTA.

Results The heart rates of the pigs were comparable for all protocols (P > 0.7). The injection pressure was significantly higher for protocol A (64 ± 5 psi) and protocol C (55 ± 3 psi) compared with protocol B (39 ± 2 psi) (P < 0.001). Average arterial peak enhancement in the dynamic scans was 359 ± 51 HU (protocol A), 382 ± 36 HU (B), and 382 ± 60 HU (C) (A compared with B and C: P < 0.01; B compared with C: P = 0.995). Time to peak enhancement decreased with increasing injection rate. The delay time for bolus tracking depended on the injection rate as well and was highest for protocol A (4.7 seconds) and lowest for protocol C (3.9 seconds) (P = 0.038). The peak enhancement values of the dynamic scans highly correlated with those of the single-phase CTA scans.

Conclusions In 70 kVp CTA, 300 mg I/mL iodine concentrations showed to be superior to high-concentration CM when keeping the iodine delivery rate constant. Besides, iodine concentrations as low as 150 mg I/mL can be administered without compromising vascular enhancement. This opens up new possibilities in CM administration.

From the *Department of Radiology, Friedrich-Alexander-University Erlangen-Nuernberg (FAU); †MR and CT Contrast Media Research, Bayer AG, Berlin; ‡Siemens Healthcare, Forchheim; §Imaging Science Institute (ISI), Erlangen; and ∥Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuernberg, Germany.

Received for publication September 7, 2017; and accepted for publication, after revision, October 29, 2017.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Ulrike Fleischmann, Cand med, Henkestrasse 76, 91052 Erlangen, Germany. E-mail: ul.fleischmann@googlemail.com.

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