A Non Invasive Tool To Evaluate Coronary Arteries

1894 words - 8 pages

With the development of CT equipment and technology, coronary CT angiography (CCTA) is widely recognized by clinicians as a non-invasive tool to evaluate coronary arteries [1]. Although the improvement of CT technology is followed by a higher diagnostic accuracy of CCTA [2], the contrast medium (CM) injection protocol is relatively simple during CCTA. In the clinical practice, the CM injection protocol with a constant speed and volume is conventionally used, and the body weight tailored CM injection protocol has been reported in only a few literatures [3-5]. As different concentrations of contrast media, especially a low concentration of contrast media, are widely used in clinic [6、7], there is an issue to be solved during CCTA, i.e., how to use the individualized injection protocols for different concentrations of contrast media so as to reduce the difference of enhancement effect caused by the difference of contrast medium concentration and thus acquire the coronary artery images with a similar enhancement effect. This study aimed to achieve a similar enhancement effect of coronary arteries by the weight-adjusted use of different concentrations of contrast media and thus optimize the use of contrast media and improve the image quality. In the present study, we compared the weight-adjusted iodine-dose protocol for different concentrations of contrast media (the content of iodine in 1kg contrast media was identical) and the fixed iodine-dose protocol.

Coronary arteries have a small diameter and are routing tortuous, and CCTA image quality is critical for diagnostic accuracy, while the reasonable use of CM is one of major factors that influence imaging. An appropriate CM enhancement level is beneficial for the visualization of coronary arteries, while a too high enhancement level may affect the visualization of calcification plaques [9]; however, the underestimation of non-calcification plaque area and then lumen stenosis may occur because of partial volume effect [10].At a very low CM enhancement level, coronary arteries have no sufficient contrast to adjacent tissues, which will affect the diagnosis. During CCTA, the CM injection protocol with a constant speed and volume is conventionally used in clinic, and under such a protocol the individual variation among subjects using different concentrations of contrast media, at different ages, and with different body types and different heart functions is ignored, which may result in a differential enhancement effect. This is not beneficial to visualize coronary arteries and coronary atheromatous plaques and thus reduces image quality and diagnosis quality [11].
The enhancement degree of coronary arteries is positively correlated with the content of iodine in the CM [7]. The content of iodine in coronary arteries can be achieved by increasing the flow rate of CM or using a higher concentration of CM [12]. With the purpose of standardizing the use of CM during CCTA and achieving the similar enhancement...

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