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Homogeneous Enhancement in Pediatric Thoracic CT Aortography Using a Novel and Reproducible Method: Contrast-Covering Time

¹ Department of Radiology, Taichung Veterans General Hospital, No. 160, Sec. 3, Taichung Harbor Rd., Taichung 407, Taiwan, R.O.C.
² Faculty of Medicine, Medical College of Chung Shan Medical University, Taiwan, R.O.C.
³ Department of Radiology, Fong-Yuan Hospital, Department of Health, Executive Yuan, Taiwan, R.O.C.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Transverse CT sections acquired at different levels during pediatric thoracic CT aortography in 7-year-old girl with swallowing difficulty who was referred for suspected vascular ring. In first image of data set, left common carotid artery is easily identified. Region of interest (ROI) is drawn for measurement.

View larger version (51K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Transverse CT sections acquired at different levels during pediatric thoracic CT aortography in 7-year-old girl with swallowing difficulty who was referred for suspected vascular ring. On image acquired at level of aortic arch, ROI is also drawn.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Transverse CT sections acquired at different levels during pediatric thoracic CT aortography in 7-year-old girl with swallowing difficulty who was referred for suspected vascular ring. Scrolling down, ROI goes into descending aorta.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Transverse CT sections acquired at different levels during pediatric thoracic CT aortography in 7-year-old girl with swallowing difficulty who was referred for suspected vascular ring. On image acquired during last part of examination, ROI is drawn in descending aorta at diaphragm level.

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig.2A —Representative cases of different age groups using contrast-covering time (CCT) concept to set flow rate of thoracic CT aortography (window level, 100 H; window width, 800 H). In our study, in all age groups, CCT provided consistently high and homogeneous enhancement. CCT concept in 4-year-old girl undergoing thoracic CT aortography. Multiplanar reformation image from left common carotid artery to descending aorta shows high and homogeneous enhancement. Average enhancement in region of interest (ROI) was 395.4 ± 20.3 H with slope of 3.7 H/s.

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig.2B —Representative cases of different age groups using contrast-covering time (CCT) concept to set flow rate of thoracic CT aortography (window level, 100 H; window width, 800 H). In our study, in all age groups, CCT provided consistently high and homogeneous enhancement. CCT concept in 8-year-old girl undergoing thoracic CT aortography. Multiplanar reformation image from left common carotid artery to descending aorta shows high and homogeneous enhancement. Average enhancement in ROI was 418.3 ± 25.1 H with slope of 5.1 H/s.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig.2C —Representative cases of different age groups using contrast-covering time (CCT) concept to set flow rate of thoracic CT aortography (window level, 100 H; window width, 800 H). In our study, in all age groups, CCT provided consistently high and homogeneous enhancement. CCT concept in 13-year-old girl undergoing thoracic CT aortography. Multiplanar reformation image from left common carotid artery to descending aorta shows high and homogeneous enhancement. Average enhancement in ROI was 406.3 ± 20.8 H with slope of 6.1 H/s.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Representative cases of group 2B using empiric experience to set flow rate of thoracic CT aortography (window level, 100 H; window width, 800 H). In our study, empiric setting resulted in similar average enhancement but slopes varied considerably, which means enhancement was not homogeneous during examination. Empiric setting in 7-year-old girl undergoing thoracic CT aortography. Multiplanar reformation image from left common carotid artery to descending aorta shows ascending-type bolus geometry, which indicates early timing. Average enhancement in region of interest (ROI) was 429.4 ± 59.4 H with slope of 38.5 H/s. Note that attenuation in descending aorta is higher than that in left common carotid artery.

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Representative cases of group 2B using empiric experience to set flow rate of thoracic CT aortography (window level, 100 H; window width, 800 H). In our study, empiric setting resulted in similar average enhancement but slopes varied considerably, which means enhancement was not homogeneous during examination. Empiric setting in 8-year-old girl undergoing thoracic CT aortography. Multiplanar reformation image from left common carotid artery to descending aorta shows descendingtype bolus geometry, which indicates late timing. Average enhancement in ROI was 393.4 ± 52.2 H with slope of -28.3 H/s. Note that attenuation in left common carotid artery is higher than that in descending aorta.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Time-attenuation curves of each group. Time-attenuation curves of each group are displayed: group 1 (1-5 years old, contrast-covering time [CCT]) (A), group 2A (6-10 years old, CCT) (B), group 2B (6-10 years old, empiric setting) (C), and group 3 (11-15 years old, CCT) (D). Comparing groups 2A (B) and 2B (C), CCT and empiric setting both provided high enhancement with no significant difference. However, average SD of enhancement of group 2B (C) was larger than that of group 2A (B) with statistical significance, which means CCT concept provided more homogeneous enhancement than empiric setting. Furthermore, comparing three different age groups set by CCT (groups 1, 2A, and 3; A, B, and D, respectively), high and homogeneous enhancement was routinely obtained. No significant difference was found in average enhancement, slopes, or SD among the CCT groups.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Time-attenuation curves of each group. Time-attenuation curves of each group are displayed: group 1 (1-5 years old, contrast-covering time [CCT]) (A), group 2A (6-10 years old, CCT) (B), group 2B (6-10 years old, empiric setting) (C), and group 3 (11-15 years old, CCT) (D). Comparing groups 2A (B) and 2B (C), CCT and empiric setting both provided high enhancement with no significant difference. However, average SD of enhancement of group 2B (C) was larger than that of group 2A (B) with statistical significance, which means CCT concept provided more homogeneous enhancement than empiric setting. Furthermore, comparing three different age groups set by CCT (groups 1, 2A, and 3; A, B, and D, respectively), high and homogeneous enhancement was routinely obtained. No significant difference was found in average enhancement, slopes, or SD among the CCT groups.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Time-attenuation curves of each group. Time-attenuation curves of each group are displayed: group 1 (1-5 years old, contrast-covering time [CCT]) (A), group 2A (6-10 years old, CCT) (B), group 2B (6-10 years old, empiric setting) (C), and group 3 (11-15 years old, CCT) (D). Comparing groups 2A (B) and 2B (C), CCT and empiric setting both provided high enhancement with no significant difference. However, average SD of enhancement of group 2B (C) was larger than that of group 2A (B) with statistical significance, which means CCT concept provided more homogeneous enhancement than empiric setting. Furthermore, comparing three different age groups set by CCT (groups 1, 2A, and 3; A, B, and D, respectively), high and homogeneous enhancement was routinely obtained. No significant difference was found in average enhancement, slopes, or SD among the CCT groups.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Time-attenuation curves of each group. Time-attenuation curves of each group are displayed: group 1 (1-5 years old, contrast-covering time [CCT]) (A), group 2A (6-10 years old, CCT) (B), group 2B (6-10 years old, empiric setting) (C), and group 3 (11-15 years old, CCT) (D). Comparing groups 2A (B) and 2B (C), CCT and empiric setting both provided high enhancement with no significant difference. However, average SD of enhancement of group 2B (C) was larger than that of group 2A (B) with statistical significance, which means CCT concept provided more homogeneous enhancement than empiric setting. Furthermore, comparing three different age groups set by CCT (groups 1, 2A, and 3; A, B, and D, respectively), high and homogeneous enhancement was routinely obtained. No significant difference was found in average enhancement, slopes, or SD among the CCT groups.

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