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European Radiology
Published in: European Radiology 11/2019

01-11-2019 | CT Angiography | Cardiac

Impact of iodine concentration and iodine delivery rate on contrast enhancement in coronary CT angiography: a randomized multicenter trial (CT-CON)

Authors: Marco Rengo, Anoeshka Dharampal, Marisa Lubbers, Marc Kock, Joachim E. Wildberger, Marco Das, André Niezen, Fiek van Tilborg, Marcel Kofflard, Andrea Laghi, Gabriel Krestin, Koen Nieman

Published in: European Radiology | Issue 11/2019

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Abstract

Objective

To compare the effect of contrast medium iodine concentration on contrast enhancement, heart rate, and injection pressure when injected at a constant iodine delivery rate in coronary CT angiography (CTA).

Methods

One thousand twenty-four patients scheduled for coronary CTA were prospectively randomized to receive one of four contrast media: iopromide 300 mg I/ml, iohexol 350 mg I/ml, iopromide 370 mg I/ml, or iomeprol 400 mg I/ml. Contrast media were delivered at an equivalent iodine delivery rate of 2.0 g I/s. Intracoronary attenuation was measured and compared (per vessel and per segment). Heart rate before and after contrast media injection was documented. Injection pressure was recorded (n = 403) during contrast medium injection and compared between groups.

Results

Intracoronary attenuation values were similar for the different contrast groups. The mean attenuation over all segments ranged between 384 HU for 350 mg I/ml and 395 HU for 400 mg I/ml (p = 0.079). Dose-length product (p = 0.8424), signal-to-noise ratio (all p > 0.05), time to peak (p = 0.324), and changes in heart rate (p = 0.974) were comparable between groups. The peak pressures differed: 197.4 psi for 300 mg I/ml (viscosity 4.6 mPa s), 229.8 psi for 350 mg I/ml (10.4 mPa s), 216.1 psi for 370 mg I/ml (9.5 mPa s), and 243.7 psi for 400 mg I/ml (12.6 mPa s) (p < 0.0001).

Conclusion

Intravascular attenuation and changes in heart rate are independent of iodine concentration when contrast media are injected at the same iodine delivery rate. Differences in injection pressures are associated with the viscosity of the contrast media.

Key Points

• The contrast enhancement in coronary CT angiography is independent of the iodine concentration when contrast media are injected at body temperature (37 °C) with the same iodine delivery rate.
• Iodine concentration does not influence the change in heart rate when contrast media are injected at identical iodine delivery rates.
• For a fixed iodine delivery rate and contrast temperature, the viscosity of the contrast medium affects the injection pressure.
Literature
1.
Thomas DM, Divakaran S, Villines TC et al (2015) Management of coronary artery calcium and coronary CTA findings. Curr Cardiovasc Imaging Rep 8:18CrossRef
2.
Mihl C, Kok M, Wildberger JE et al (2015) Coronary CT angiography using low concentrated contrast media injected with high flow rates: feasible in clinical practice. Eur J Radiol 84:2155–2160CrossRef
3.
Park EA, Lee W, Park SJ, Kim YK, Hwang HY (2016) Influence of coronary artery diameter on intracoronary transluminal attenuation gradient during CT angiography. JACC Cardiovasc Imaging 9:1074–1083CrossRef
4.
Kok M, Mihl C, Seehofnerova A et al (2015) Automated tube voltage selection for radiation dose reduction in CT angiography using different contrast media concentrations and a constant iodine delivery rate. AJR Am J Roentgenol 205:1332–1338CrossRef
5.
Mihl C, Maas M, Turek J et al (2017) Contrast media administration in coronary computed tomography angiography - a systematic review. Rofo 189:312–325CrossRef
6.
Bae KT (2010) Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 256:32–61CrossRef
7.
Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40CrossRef
8.
Husmann L, Alkadhi H, Boehm T et al (2006) Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography. Eur Radiol 16:1111–1116CrossRef
9.
Cademartiri F, Mollet NR, Lemos PA et al (2006) Higher intracoronary attenuation improves diagnostic accuracy in MDCT coronary angiography. AJR Am J Roentgenol 187:W430–W433CrossRef
10.
Cademartiri F, de Monye C, Pugliese F et al (2006) High iodine concentration contrast material for noninvasive multislice computed tomography coronary angiography: iopromide 370 versus iomeprol 400. Invest Radiol 41:349–353CrossRef
11.
12.
13.
14.
Becker CR, Vanzulli A, Fink C et al (2011) Multicenter comparison of high concentration contrast agent iomeprol-400 with iso-osmolar iodixanol-320: contrast enhancement and heart rate variation in coronary dual-source computed tomographic angiography. Invest Radiol 46:457–464CrossRef
15.
Mihl C, Wildberger JE, Jurencak T et al (2013) Intravascular enhancement with identical iodine delivery rate using different iodine contrast media in a circulation phantom. Invest Radiol 48:813–818CrossRef
16.
Kok M, Mihl C, Hendriks BM et al (2016) Patient comfort during contrast media injection in coronary computed tomographic angiography using varying contrast media concentrations and flow rates: results from the EICAR trial. Invest Radiol 51:810–815CrossRef
17.
Lubbers MM, Kock M, Niezen A et al (2018) Iodixanol versus Iopromide at coronary CT angiography: lumen opacification and effect on heart rhythm-the randomized IsoCOR trial. Radiology 286:71–80CrossRef
18.
Zhang J, Fletcher JG, Harmsen WS et al (2008) Analysis of heart rate and heart rate variation during cardiac CT examinations. Acad Radiol 15:40–48CrossRef
19.
Chartrand-Lefebvre C, White CS, Bhalla S et al (2011) Comparison of the effect of low- and iso-osmolar contrast agents on heart rate during chest CT angiography: results of a prospective randomized multicenter study. Radiology 258:930–937CrossRef
20.
Svensson A, Ripsweden J, Ruck A, Aspelin P, Cederlund K, Brismar BT (2010) Heart rate variability and heat sensation during CT coronary angiography: low-osmolar versus iso-osmolar contrast media. Acta Radiol 51:722–726CrossRef
21.
Davenport MS, Wang CL, Bashir MR, Neville AM, Paulson EK (2012) Rate of contrast material extravasations and allergic-like reactions: effect of extrinsic warming of low-osmolality iodinated CT contrast material to 37 degrees C. Radiology 262:475–484CrossRef
22.
Rutten A, Meijs MF, de Vos AM, Seidensticker PR, Prokop M (2010) Biphasic contrast medium injection in cardiac CT: moderate versus high concentration contrast material at identical iodine flux and iodine dose. Eur Radiol 20:1917–1925CrossRef
23.
Jost G, Pietsch H, Sommer J et al (2009) Retention of iodine and expression of biomarkers for renal damage in the kidney after application of iodinated contrast media in rats. Invest Radiol 44:114–123CrossRef
24.
Kok M, Mihl C, Mingels AA et al (2014) Influence of contrast media viscosity and temperature on injection pressure in computed tomographic angiography: a phantom study. Invest Radiol 49:217–223CrossRef
25.
Metadata
Title
Impact of iodine concentration and iodine delivery rate on contrast enhancement in coronary CT angiography: a randomized multicenter trial (CT-CON)
Authors
Marco Rengo
Anoeshka Dharampal
Marisa Lubbers
Marc Kock
Joachim E. Wildberger
Marco Das
André Niezen
Fiek van Tilborg
Marcel Kofflard
Andrea Laghi
Gabriel Krestin
Koen Nieman
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Keyword
CT Angiography
Published in
European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06196-7

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