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Feasibility of Selective Catheter-Directed Coronary Computed Tomography Angiography Using Ultralow-Dose Intracoronary Contrast Injection in a Swine Model

 Hong, Youngtaek  ;  Shin, Sanghoon  ;  Park, Hyung-Bok  ;  Lee, Byoung Kwon  ;  Arsanjani, Reza  ;  Hartaigh, Bríain ó  ;  Ha, Seongmin  ;  Jang, Yeonggul  ;  Jeon, Byunghwan  ;  Jung, Sunghee  ;  Park, Se-Il  ;  Sung, Ji Min  ;  Shim, Hackjoon  ;  Chang, Hyuk-Jae 
 INVESTIGATIVE RADIOLOGY, Vol.50(7) : 449-455, 2015 
Journal Title
Issue Date
Animals ; Cardiac Catheterization/methods* ; Contrast Media/administration & dosage ; Coronary Angiography/methods* ; Dose-Response Relationship, Drug ; Feasibility Studies ; Female ; Image Enhancement/methods* ; Image Interpretation, Computer-Assisted/methods ; Iopamidol/administration & dosage ; Iopamidol/analogs & derivatives* ; Radiation Protection/methods* ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods* ; Wine
computed tomography ; catheter ; coronary angiography ; contrast media
OBJECTIVE: Selective catheter-directed intracoronary contrast injected coronary computed tomography angiography (selective CCTA) has recently been introduced for on-site evaluation of coronary artery disease during coronary artery catheterization. In this study, we aimed to develop a feasible protocol for selective CCTA using ultralow-dose contrast medium as compared with conventional intravenous CCTA (IV CCTA).

MATERIALS AND METHODS: A novel combined system incorporating coronary angiography and a 320-detector row computed tomographic scanner was used to study 4 swine (35-40 kg) under animal institutional review board approval. A selective CCTA scan was simultaneously performed with an injection of 13.13 mgI/mL of modulated contrast medium at multiple different injection rates including 2, 3, and 4 mL/s and different total injection volumes of either 20 or 30 mL. Intravenous CCTA was performed with 60 mL of contrast medium, followed by 30 mL of saline chaser at 5 mL/s. Coronary mean and peak intensity, transluminal attenuation gradient, as well as 3-dimensional maximum intensity projections were obtained.

RESULTS: Attenuation values (mean ± standard error, in Hounsfield units [HUs]) of selective CCTA for the left anterior descending (LAD) and right coronary artery (RCA) using the various combinations of injection rates and total injection volumes were as follows: 20 mL at 2 mL/s (LAD, 270.3 ± 20.4 HU; RCA, 322.6 ± 7.4 HU), 20 mL at 3 mL/s (LAD, 262.9 ± 20.4 HU; RCA, 264.7 ± 7.4 HU), 30 mL at 3 mL/s (LAD, 276.8 ± 20.4 HU; RCA, 274.0 ± 7.4 HU), 20 mL at 4 mL/s (LAD, 268.0 ± 20.4 HU; RCA, 277.7 ± 7.4 HU), and 30 mL at 4 mL/s (LAD, 251.3 ± 20.4 HU; RCA, 334.7 ± 7.4 HU). The representative protocol of the selective CCTA studies produced results within the optimal enhancement range (approximately 250-350 HU) for all segments, and comparison of transluminal attenuation gradient data with selective CCTA and IV CCTA studies demonstrated that the former method was more homogenous (-1.5245 and -1.7558 for LAD as well as 0.0459 and 0.0799 for RCA, respectively). Notably, the volume of iodine contrast medium used for selective CCTA was reported to be 1.09% (0.2 g) of IV CCTA (24 g).

CONCLUSIONS: The current findings demonstrate the feasibility of selective CCTA using ultralow-dose intracoronary contrast injection. This technique may provide additional means of coronary evaluation in patients who may require strategic planning before a procedure using a combined modality system.
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1. College of Medicine (의과대학) > Research Institute (부설연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Park, Se Il(박세일) ORCID logo https://orcid.org/0000-0002-4949-8976
Shim, Hack Joon(심학준)
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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