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Contrast Volume Reduction with Superior Vena Cava Catheter-Directed Coronary CT Angiography: Comparison with Peripheral IV Contrast Enhancement in a Swine Model

¹ Department of Diagnostic Radiology, William Beaumont Hospital, 3601 W 13 Mile Rd., Royal Oak, MI 48073.
² Division of Cardiovascular Disease, William Beaumont Hospital, Royal Oak, MI.
³ Research Institute-Biostatistics, William Beaumont Hospital, Royal Oak, MI.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Photograph shows 5-French Vanguard diffusion catheter (Medrad) with 640 laser-drilled side holes (arrows) and distal tip constrictor (white end).

View larger version (19K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Bar graphs of proximal (blue), mid (red), and distal (yellow) coronary attenuation values. Bar graphs show coronary attenuation values for right coronary artery (RCA) (A), left anterior descending coronary artery (LAD) (B), and left circumflex coronary artery (LCX) (C) on superior vena cava (SVC) (25-mL and 50-mL studies) and IV (100-mL) studies. Significance of grouped segments (proximal, mid, and distal) for each injection is compared with threshold value of 250 H.

View larger version (18K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Bar graphs of proximal (blue), mid (red), and distal (yellow) coronary attenuation values. Bar graphs show coronary attenuation values for right coronary artery (RCA) (A), left anterior descending coronary artery (LAD) (B), and left circumflex coronary artery (LCX) (C) on superior vena cava (SVC) (25-mL and 50-mL studies) and IV (100-mL) studies. Significance of grouped segments (proximal, mid, and distal) for each injection is compared with threshold value of 250 H.

View larger version (18K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Bar graphs of proximal (blue), mid (red), and distal (yellow) coronary attenuation values. Bar graphs show coronary attenuation values for right coronary artery (RCA) (A), left anterior descending coronary artery (LAD) (B), and left circumflex coronary artery (LCX) (C) on superior vena cava (SVC) (25-mL and 50-mL studies) and IV (100-mL) studies. Significance of grouped segments (proximal, mid, and distal) for each injection is compared with threshold value of 250 H.

View larger version (20K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Bar graph shows pooled mean coronary attenuation values compared for each vessel on superior vena cava (SVC) (25-mL and 50-mL studies) and IV (100-mL) studies. In comparison of 25 mL SVC and 100-mL IV studies, for left anterior descending coronary artery (LAD), p = 0.0055; for left circumflex coronary artery (LCX), p = 0.0113; and for right coronary artery (RCA), p = 0.0017. Also, in comparison between SVC 50-mL and IV 100-mL studies, for LAD, p = 0.7664; for LCX, p = 0.5724; and for RCA, p = 0.9797. Blue = RCA, Red = LAD, Yellow = LCX. Note: Although some of pairwise comparisons are statistically significant, there is no significant difference in overall full-width at half-maximum (FWHM) because of interactive (i.e., combined) effect of segment x concentration (p value of type 3 test of fixed effects = 0.9102).

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Coronary artery CT angiography with superior vena cava (SVC) (50 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using central SVC injection of 50 mL of contrast material at 10 mL/s. Coronary arteries are displayed with similar attenuation as in Figures 5A, 5B, 5C, and 5D (peripheral IV injection) but with much lower enhancement of right heart structures.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Coronary artery CT angiography with superior vena cava (SVC) (50 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using central SVC injection of 50 mL of contrast material at 10 mL/s. Coronary arteries are displayed with similar attenuation as in Figures 5A, 5B, 5C, and 5D (peripheral IV injection) but with much lower enhancement of right heart structures.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Coronary artery CT angiography with superior vena cava (SVC) (50 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using central SVC injection of 50 mL of contrast material at 10 mL/s. Coronary arteries are displayed with similar attenuation as in Figures 5A, 5B, 5C, and 5D (peripheral IV injection) but with much lower enhancement of right heart structures.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Coronary artery CT angiography with superior vena cava (SVC) (50 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using central SVC injection of 50 mL of contrast material at 10 mL/s. Coronary arteries are displayed with similar attenuation as in Figures 5A, 5B, 5C, and 5D (peripheral IV injection) but with much lower enhancement of right heart structures.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Coronary artery CT angiography with peripheral IV (100 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using peripheral IV injection of 100 mL of contrast material at 5 mL/s.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Coronary artery CT angiography with peripheral IV (100 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using peripheral IV injection of 100 mL of contrast material at 5 mL/s.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Coronary artery CT angiography with peripheral IV (100 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using peripheral IV injection of 100 mL of contrast material at 5 mL/s.

View larger version (41K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —Coronary artery CT angiography with peripheral IV (100 mL) injection. RA = right atrium, RVOT = right ventricular outflow tract. 10-mm maximum-intensity-projection images of left main bifurcation (A), left anterior descending coronary artery (LAD) (B), proximal and middle right coronary artery (RCA) (C), and distal RCA (D) are shown using peripheral IV injection of 100 mL of contrast material at 5 mL/s.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Comparison between maximum-intensity-projection (MIP) and multiplanar reformatted (MPR) images for IV contrast-enhanced (100-mL) and superior vena cava (SVC) (50-mL) studies. MIP image (2 mm) for 100-mL IV contrast-enhanced study (A) and corresponding image from MPR (0.6 mm) (B) of same data set.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Comparison between maximum-intensity-projection (MIP) and multiplanar reformatted (MPR) images for IV contrast-enhanced (100-mL) and superior vena cava (SVC) (50-mL) studies. MIP image (2 mm) for 100-mL IV contrast-enhanced study (A) and corresponding image from MPR (0.6 mm) (B) of same data set.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Comparison between maximum-intensity-projection (MIP) and multiplanar reformatted (MPR) images for IV contrast-enhanced (100-mL) and superior vena cava (SVC) (50-mL) studies. MIP (2 mm) for 50-mL SVC study (C) and corresponding image from MPR (0.6 mm) (D) of same data set.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —Comparison between maximum-intensity-projection (MIP) and multiplanar reformatted (MPR) images for IV contrast-enhanced (100-mL) and superior vena cava (SVC) (50-mL) studies. MIP (2 mm) for 50-mL SVC study (C) and corresponding image from MPR (0.6 mm) (D) of same data set.

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