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64-MDCT imaging of the coronary arteries and systemic arterial vascular tree in a single examination: optimisation of the scan protocol and contrast-agent administration

Imaging con TC spirale a 64 strati delle arterie coronarie e del circolo arterioso sistemico in un unico esame: ottimizzazione del protocollo di scansione e somministrazione del mezzo di contrasto

  • Cardiac Radiology/Cardioradiologia
  • Published:
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Abstract

Purpose

The aim of this study was to validate a 64-row multidetector computed tomography (64-MDCT) acquisition protocol with biphasic administration of contrast medium for comprehensive assessment of the coronary and systemic arterial tree in a single examination.

Materials and methods

The scanning protocol comprised two acquisitions: an electrocardiograph (ECG)-gated scan at the level of the heart, followed by a total-body, low-dose scan of the systemic arterial circulation. Twenty patients were evaluated using two different strategies for contrast administration. In ten patients, the delay between the two acquisitions was set at 40 s, whereas in the remaining patients, it varied between 45 s and 65 s. For both strategies, the degree of systemic arterial opacification and the attenuation gradient between arterial and venous structures were quantitatively assessed at six extracoronary locations. Two observers evaluated in consensus the presence or absence of atherosclerosis and the degree of stenosis of arterial segments.

Results

Three hundred coronary segments were analysed. Arterial-wall changes were depicted in 155 (51%) segments, and in 35 (23%), the degree of stenosis was >50%. Of the 640 extracoronary arterial segments, 250 (39%) presented atherosclerotic wall alterations, in 50 (20%), the degree of stenosis was >50% and five were affected by aneurysmal dilatation. The magnitude of arterial opacification values and attenuation gradients between arterial and venous structures were significantly higher in patients scanned with the 40-s fixed-delay strategy.

Conclusions

Whole-body CT angiography with biphasic administration of contrast agent and fixed scan delay has been shown to be a feasible and reproducible technique. Comprehensive data on the global atherosclerotic burden potentially offer important therapeutic options for subclinical, high-risk segments.

Riassunto

Obiettivo

Ottimizzare un protocollo di scansione con somministrazione bifasica del mezzo di contrasto (MdC) per la valutazione angio-TC con scanner a 64 detettori delle arterie coronarie e del circolo arterioso sistemico in un unico esame.

Materiali e metodi

Il protocollo di scansione ha previsto una prima acquisizione con gating cardiaco per lo studio delle coronarie seguita da una scansione total-body a bassa dose per la vascolarizzazione sistemica, utilizzando due iniezioni di MdC. Sono stati esaminati 20 pazienti utilizzando due differenti strategie di ritardo (fisso: 40 s, o variabile: 45–65 s) tra prima e seconda somministrazione del MdC. Per entrambi i protocolli lo studio extracoronarico è stato valutato quantitativamente misurando il grado di opacizzazione arteriosa ed il gradiente di attenuazione delle strutture arteriose e venose a 6 differenti livelli. Due osservatori hanno valutato in consenso la presenza o assenza di patologia aterosclerotica ed il grado di stenosi dei segmenti arteriosi esaminati.

Risultati

Sono stati analizzati 300 segmenti coronarici, di cui 155 (51%) con alterazioni di parete; in 35 (23%) era presente una stenosi >50%. Dei 640 segmenti del circolo arterioso sistemico, 250 (39%) sono risultati patologici. In 50 (20%) era presente una stenosi compresa tra il 50% ed il 99%, in 5 era presente una dilatazione aneurismatica. I valori assoluti di opacizzazione arteriosa ed i gradienti di attenuazione tra struttture arteriose e venose del circolo extra-coronarico sono risultati significativamente più alti nei pazienti studiati con strategia di somministrazione a ritardo fisso rispetto a quelli evidenziati nei pazienti studiati con ritardo variabile.

Conclusioni

La tecnica angio-TC per lo studio del sistema arterioso di tutto il corpo con protocollo bifasico di somministrazione del MdC a ritardo fisso appare fattibile e riproducibile. Le numerose informazioni ottenibili sullo stato globale della patologia aterosclerotica offrono potenzialmente opzioni terapeutiche importanti soprattutto in distretti ad alto rischio, non ancora sintomatici.

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Authors and Affiliations

  1. Department of Radiological Sciences, University of Rome “La Sapienza”, V.le R. Elena 324, 00161, Rome, Italy

    A. Napoli, M. Anzidei, M. Francone, B. Cavallo Marincola, I. Carbone, D. Geiger, F. Zaccagna, P. L. Di Paolo, C. Zini, C. Catalano & R. Passariello

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  1. A. Napoli
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  2. M. Anzidei
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  3. M. Francone
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Correspondence to A. Napoli.

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Napoli, A., Anzidei, M., Francone, M. et al. 64-MDCT imaging of the coronary arteries and systemic arterial vascular tree in a single examination: optimisation of the scan protocol and contrast-agent administration. Radiol med 113, 799–816 (2008). https://doi.org/10.1007/s11547-008-0304-3

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