Feasibility of selective catheter-directed coronary computed tomography angiography using ultralow-dose intracoronary contrast injection in a swine model

Youngtaek Hong, Sanghoon Shin, Hyung Bok Park, Byoung Kwon Lee, Reza Arsanjani, Bríain O. Hartaigh, Seongmin Ha, Yeonggul Jang, Byunghwan Jeon, Sunghee Jung, Se Il Park, Ji Min Sung, Hackjoon Shim, Hyuk Jae Chang

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Abstract

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.

Original languageEnglish
Pages (from-to)449-455
Number of pages7
JournalInvestigative Radiology
Volume50
Issue number7
DOIs
Publication statusPublished - 2015 Jul 22

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

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    Hong, Y., Shin, S., Park, H. B., Lee, B. K., Arsanjani, R., Hartaigh, B. O., Ha, S., Jang, Y., Jeon, B., Jung, S., Park, S. I., Sung, J. M., Shim, H., & Chang, H. J. (2015). Feasibility of selective catheter-directed coronary computed tomography angiography using ultralow-dose intracoronary contrast injection in a swine model. Investigative Radiology, 50(7), 449-455. https://doi.org/10.1097/RLI.0000000000000150