High-Pitch Carbon Dioxide Contrasted CT Angiography: Pilot Study
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This study was designed to evaluate CO2 computed tomography angiography (CO2-CTA) of the iliac and lower limb arteries in patients with contraindications for iodinated contrast agent (ICA).
Five patients with contraindications for ICA were examined using CO2-fluoroscopic enhanced angiography (CO2-FLA) and CO2-CTA using a high-pitch examination protocol. Objective (vessel diameter) and subjective (visual score) image quality parameters were evaluated. Pathological findings in both modalities were compared.
CO2-CTA was feasible in all patients without adverse side effects, except for CO2 injection-associated pain. Objective vessel analysis revealed no significant difference in diameters as determined by CO2-CTA and CO2-FLA (0.44 ± 0.4 and 0.46 ± 0.41 mm, p = 0.93). CO2-CTA had on average a higher image-quality score (2.6 ± 1.0 vs. 2.3 ± 1.0, p = 0.009). While for pelvic and upper leg CO2-CTA advantageous (3.1 ± 0.74 vs. 2.7 ± 0.9, p = 0.0014) at good quality scores, for calf vessels no significant improvement was visible (1.9 ± 1.0 vs. 1.7 ± 0.9, p = 0.49) and scores were poorer.
CO2-CTA with high-pitch CT was feasible in a limited number of patients. Image-quality scores were on average higher for CO2-CTA than for CO2-FLA, while limited imaging quality in the vessels below the knee needs further work on the CT protocol. An added value of cross-sectional imaging was apparent but needs further quantification.
KeywordsCarbon dioxide angiography Computed tomography angiography Peripheral vascular disease Alternative contrast agents Contrast agent contraindications
The study was supported within the RWTH Aachen University Hospital START Program and the German Society of Vascular Surgery and Vascular Medicine (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin DGG).
Conflict of interest
Tobias Penzkofer reports travel support from Siemens Healthcare and Philips Healthcare, outside the submitted work. The Department of Diagnostic and Interventional Radiology, RWTH University Hospital Aachen has a research agreement with Siemens Healthcare, Germany. Karin Slebocki, Jochen Grommes, Philipp Bruners, Peter Isfort, Stephane Langer, Christiane K. Kuhl and Andreas H. Mahnken have nothing to disclose. Thomas Schmitz-Rode is inventor of the CO2 injection device used in the study.
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