Single injection protocol for coronary and lower extremity CT angiographies in patients suspected for peripheral arterial disease

Ashish Khandelwal, Takeshi Kondo, Makoto Amanuma, Akitsugu Oida, Tomonari Sano, Saboo S. Sachin, Shinichi Takase, Frank J. Rybicki, Kanako K. Kumamaru

Research output: Contribution to journalArticle

Abstract

To evaluate the feasibility of a single injection protocol for coronary CT angiography (CTA) and lower extremity CTA in patients suspected for peripheral arterial disease (PAD). This prospective observational study included a total of 103 patients who showed an ankle brachial index <0.9 and underwent the single injection protocol for coronary and lower extremity CTA. All CTAs used iodinated contrast (weight × 0.06mL/s × 20 seconds). A prospective Electrocardiogram (ECG)-gated coronary CTA was performed, followed by helical lower extremity CTA beginning 9 seconds after coronary CTA. Using catheter angiography as reference standard, diagnostic ability of CTA was evaluated. The mean total volume of iodinated contrast used was 70±14mL. Contrast opacification in the superficial femoral artery was adequate (408±97 Hounsfield Units [HU]) and PAD was detected in 72.8% (75/103). The estimated radiation doses for lower extremity and coronary CTA were 3.6±1.2 and 5.5±4.5mSv. A significant coronary stenosis was detected in 47 patients (45.6%). Coronary CT image quality was recorded as excellent in 86.4%, acceptable in 11.7%, and unacceptable for 1.9%. Contrast opacification within the superficial femoral artery was adequate in all cases while 27.2% needed an additional scan below the calf to capture the contrast bolus arrival in the smaller lower extremity vessels. Segment based sensitivity, specificity, positive, and negative predictive values were 57.9%, 97.9%, 73.8%, and 95.9% for the coronary CTA, and 63.4%, 91.5%, 76.3%, and 85.3% for peripheral CTA. A single injection protocol for coronary CTA and lower extremity CTA is feasible with a relatively small volume of iodinated contrast.

Original languageEnglish (US)
Article numbere5410
JournalMedicine (United States)
Volume95
Issue number46
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Peripheral Arterial Disease
Lower Extremity
Injections
Coronary Angiography
Femoral Artery
Computed Tomography Angiography
Ankle Brachial Index
Coronary Stenosis
Observational Studies
Angiography
Electrocardiography
Catheters
Prospective Studies
Radiation

Keywords

  • Coronary CT angiography
  • Iodinated contrast media
  • Lower extremity CT angiography
  • Radiation exposure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Single injection protocol for coronary and lower extremity CT angiographies in patients suspected for peripheral arterial disease. / Khandelwal, Ashish; Kondo, Takeshi; Amanuma, Makoto; Oida, Akitsugu; Sano, Tomonari; Sachin, Saboo S.; Takase, Shinichi; Rybicki, Frank J.; Kumamaru, Kanako K.

In: Medicine (United States), Vol. 95, No. 46, e5410, 01.01.2016.

Research output: Contribution to journalArticle

Khandelwal, Ashish ; Kondo, Takeshi ; Amanuma, Makoto ; Oida, Akitsugu ; Sano, Tomonari ; Sachin, Saboo S. ; Takase, Shinichi ; Rybicki, Frank J. ; Kumamaru, Kanako K. / Single injection protocol for coronary and lower extremity CT angiographies in patients suspected for peripheral arterial disease. In: Medicine (United States). 2016 ; Vol. 95, No. 46.
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abstract = "To evaluate the feasibility of a single injection protocol for coronary CT angiography (CTA) and lower extremity CTA in patients suspected for peripheral arterial disease (PAD). This prospective observational study included a total of 103 patients who showed an ankle brachial index <0.9 and underwent the single injection protocol for coronary and lower extremity CTA. All CTAs used iodinated contrast (weight × 0.06mL/s × 20 seconds). A prospective Electrocardiogram (ECG)-gated coronary CTA was performed, followed by helical lower extremity CTA beginning 9 seconds after coronary CTA. Using catheter angiography as reference standard, diagnostic ability of CTA was evaluated. The mean total volume of iodinated contrast used was 70±14mL. Contrast opacification in the superficial femoral artery was adequate (408±97 Hounsfield Units [HU]) and PAD was detected in 72.8{\%} (75/103). The estimated radiation doses for lower extremity and coronary CTA were 3.6±1.2 and 5.5±4.5mSv. A significant coronary stenosis was detected in 47 patients (45.6{\%}). Coronary CT image quality was recorded as excellent in 86.4{\%}, acceptable in 11.7{\%}, and unacceptable for 1.9{\%}. Contrast opacification within the superficial femoral artery was adequate in all cases while 27.2{\%} needed an additional scan below the calf to capture the contrast bolus arrival in the smaller lower extremity vessels. Segment based sensitivity, specificity, positive, and negative predictive values were 57.9{\%}, 97.9{\%}, 73.8{\%}, and 95.9{\%} for the coronary CTA, and 63.4{\%}, 91.5{\%}, 76.3{\%}, and 85.3{\%} for peripheral CTA. A single injection protocol for coronary CTA and lower extremity CTA is feasible with a relatively small volume of iodinated contrast.",
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AU - Sano, Tomonari

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AU - Takase, Shinichi

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AB - To evaluate the feasibility of a single injection protocol for coronary CT angiography (CTA) and lower extremity CTA in patients suspected for peripheral arterial disease (PAD). This prospective observational study included a total of 103 patients who showed an ankle brachial index <0.9 and underwent the single injection protocol for coronary and lower extremity CTA. All CTAs used iodinated contrast (weight × 0.06mL/s × 20 seconds). A prospective Electrocardiogram (ECG)-gated coronary CTA was performed, followed by helical lower extremity CTA beginning 9 seconds after coronary CTA. Using catheter angiography as reference standard, diagnostic ability of CTA was evaluated. The mean total volume of iodinated contrast used was 70±14mL. Contrast opacification in the superficial femoral artery was adequate (408±97 Hounsfield Units [HU]) and PAD was detected in 72.8% (75/103). The estimated radiation doses for lower extremity and coronary CTA were 3.6±1.2 and 5.5±4.5mSv. A significant coronary stenosis was detected in 47 patients (45.6%). Coronary CT image quality was recorded as excellent in 86.4%, acceptable in 11.7%, and unacceptable for 1.9%. Contrast opacification within the superficial femoral artery was adequate in all cases while 27.2% needed an additional scan below the calf to capture the contrast bolus arrival in the smaller lower extremity vessels. Segment based sensitivity, specificity, positive, and negative predictive values were 57.9%, 97.9%, 73.8%, and 95.9% for the coronary CTA, and 63.4%, 91.5%, 76.3%, and 85.3% for peripheral CTA. A single injection protocol for coronary CTA and lower extremity CTA is feasible with a relatively small volume of iodinated contrast.

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KW - Lower extremity CT angiography

KW - Radiation exposure

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