Purpose The aim of the study was to simultaneously optimize contrast media (CM) injection and scan parameters for the individual patient during computed tomography pulmonary angiography (CTPA). Methods In this study (NCT02611115), 235 consecutive patients suspected of having pulmonary embolism were prospectively enrolled. Automated kV selection software on a third-generation multidetector computed tomography adapted tube voltage to the individual patient, based on scout scans. The contrast injection protocol was adapted to both patient body weight and kV-setting selection via a predefined formula, based on previous research. Injection data were collected from a contrast media and radiation dose monitoring software. Attenuation was measured in Hounsfield units (HU) in the pulmonary trunk (PT); attenuation values 200 HU or greater were considered diagnostic. Subjective image quality was assessed by using a 4-point Likert scale at the level of the PT, lobar, segmental, and subsegmental arteries. Results between groups were reported as mean ± SD. Results Two hundred twenty-two patients (94%) were scanned at a kV setting below 100 kV: n = 108 for 70 kV, n = 82 for 80 kV, and n = 32 for 90 kV. Mean CM bolus volume (in milliliters) and total iodine load (in grams of iodine) for 70 to 90 kV were as follows: 24 ± 3 mL and 7 ± 1 g I, 29 ± 4 mL and 9 ± 2 g I, and 38 ± 4 mL and 11 ± 1 g I, respectively. Mean flow rates (in milliliters per second) and iodine delivery rates (in grams of iodine per second) were 3.0 ± 0.4 mL/s and 0.9 ± 0.1 g I/s (70 kV), 3.6 ± 0.4 mL/s and 1.0 ± 0.1 g I/s (80 kV), and 4.7 ± 0.5 mL/s and 1.3 ± 0.1 g I/s (90 kV). Mean radiation doses were 1.3 ± 0.3 mSv at 70 kV, 1.7 ± 0.4 mSv at 80 kV, and 2.2 ± 0.6 mSv at 90 kV. Mean vascular attenuation in the PT for each kV group was as follows: 397 ± 101 HU for 70 kV, 398 ± 96 HU for 80 kV, and 378 ± 100 HU for 90 kV, P = 0.59. Forty-six patients (21%) showed pulmonary embolism on the CTPA. One scan (90 kV) showed nondiagnostic segmental pulmonary arteries, and 5% of subsegmental arteries were of nondiagnostic image quality. All other segments were considered diagnostic-excellent subjective image quality. Conclusions Simultaneously optimizing both CM injections and kV settings to the individual patient in CTPA results in diagnostic attenuation with on average 24 to 38 mL of CM volume and a low radiation dose for most patients. This individualized protocol may help overcome attenuation-variation problems between patients and kV settings in CTPA. Received for publication September 22, 2017; and accepted for publication, after revision, November 19, 2017. Supported by institutional research grants from Bayer and Siemens. Conflicts of interest and sources of funding: M.D. receives institutional grants from Philips and personal fees (speakers' bureau) from Bayer, Siemens, and Cook. J.E.W. reports additional institutional research grants from Philips, AGFA, GE, and BRACCO and personal fees (speakers' bureau) from Siemens and Bayer, outside the submitted work. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2kq7jVD). Correspondence to: Babs M.F. Hendriks, MD, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail: babs.hendriks@mumc.nl. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2o6HzMn
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δημοφιλείς αναρτήσεις
-
Publication date: Available online 4 January 2018 Source: European Journal of Radiology Author(s): Peiyao Zhang, Jing Wang, Qin Xu, Zhen...
-
Publication date: March 2017 Source: Free Radical Biology and Medicine, Volume 104 from #AlexandrosSfakianakis via Alexandros G.Sfak...
-
Background Hyperthyroidism is associated with increased thrombotic risk. As contact system activation through formation of neutrophil extrac...
-
Dtsch med Wochenschr DOI: 10.1055/s-0043-100054 Hintergrund und Fragestellung Ein etablierter Weg, die optimale Behandlung von Tumorpatien...
-
Related Articles Anatomic parameters of the sacral lamina for osteosynthesis in transverse sacral fractures. Surg Radiol Anat....
-
Medicine by Alexandros G. Sfakianakis,Anapafseos 5... Medicine by Alexandros G. Sfakianakis,Anapafseos 5... Heralding change: The evolution ...
-
BACKGROUND AND PURPOSE: Dengue is a common arboviral disease, which uncommonly involves the brain. There has been a recent surge in dengu...
-
Abstract Limited memory size is considered as a major bottleneck in data centers for intelligent urban computing. It is shown that there e...
-
Abstract Objective Functional magnetic resonance imaging (fMRI) is one of the most advanced techniques to analyze the cerebral effects o...
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου