PURPOSE: To investigate enhancement of head and neck arteries during carotid computed tomography angiography using a reduced volume contrast regimen and craniocaudal scan acquisition. MATERIALS AND METHODS: Two hundred and two patients underwentcarotid angiography using a 64 channel computed tomography scanner. Patients were allocated to one of two acquisition/contrast regimens: regimen A, the department's standard protocol, consisting of a caudocranial scan direction with 100mL of contrast intravenously; regimen B, involving a craniocaudal scan direction and approximately 50 mL of contrast using a timing dictated by patient hemodynamics. Attenuation profiles of cranial arteries and veins in 6 anatomical segments were assessed and arteriovenous contrast ratios (AVCR) calculated. Receiver operating characteristic (ROC) analysis was performed using DBM methodology. RESULTS:Arterial attenuation was up to 54% (p<0.01) higher following regimen B compared with A. Attenuation in the veins were significantly lower in regimen B than in regimen A with a maximum reduction of up to 93% (p<0.0001). With regimen B, there were significant (p<0.0001) improvements in AVCR at a variety of anatomical sites. The ROC analysis demonstrated a significantly higher Az score for the novel regimen compared with regimen A (p<0.002) with inter-neuroradiologist agreement increasing from poor to moderate. CONCLUSION: Significant improvements in visualisation of head and neck arterial vasculature can be achieved with a CT acquisition regimen using low contrast volume and injection timing based on patient specific contrast formula and craniocaudal scan direction.
RCT Entities:
PURPOSE: To investigate enhancement of head and neck arteries during carotid computed tomography angiography using a reduced volume contrast regimen and craniocaudal scan acquisition. MATERIALS AND METHODS: Two hundred and two patients underwent carotid angiography using a 64 channel computed tomography scanner. Patients were allocated to one of two acquisition/contrast regimens: regimen A, the department's standard protocol, consisting of a caudocranial scan direction with 100mL of contrast intravenously; regimen B, involving a craniocaudal scan direction and approximately 50 mL of contrast using a timing dictated by patient hemodynamics. Attenuation profiles of cranial arteries and veins in 6 anatomical segments were assessed and arteriovenous contrast ratios (AVCR) calculated. Receiver operating characteristic (ROC) analysis was performed using DBM methodology. RESULTS: Arterial attenuation was up to 54% (p<0.01) higher following regimen B compared with A. Attenuation in the veins were significantly lower in regimen B than in regimen A with a maximum reduction of up to 93% (p<0.0001). With regimen B, there were significant (p<0.0001) improvements in AVCR at a variety of anatomical sites. The ROC analysis demonstrated a significantly higher Az score for the novel regimen compared with regimen A (p<0.002) with inter-neuroradiologist agreement increasing from poor to moderate. CONCLUSION: Significant improvements in visualisation of head and neck arterial vasculature can be achieved with a CT acquisition regimen using low contrast volume and injection timing based on patient specific contrast formula and craniocaudal scan direction.
Authors: Thaworn Dendumrongsup; Andrew A Plumb; Steve Halligan; Thomas R Fanshawe; Douglas G Altman; Susan Mallett Journal: PLoS One Date: 2014-12-26 Impact factor: 3.240