CardioVascular and Interventional Radiology

, Volume 37, Issue 2, pp 362–370 | Cite as

High-Pitch Carbon Dioxide Contrasted CT Angiography: Pilot Study

  • Tobias PenzkoferEmail author
  • Karin Slebocki
  • Jochen Grommes
  • Philipp Bruners
  • Peter Isfort
  • Thomas Schmitz-Rode
  • Stephan Langer
  • Christiane K. Kuhl
  • Andreas H. Mahnken
Clinical Investigation



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.


Carbon 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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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Tobias Penzkofer
    • 1
    • 2
    • 3
    Email author
  • Karin Slebocki
    • 1
  • Jochen Grommes
    • 4
    • 5
  • Philipp Bruners
    • 1
    • 3
  • Peter Isfort
    • 1
    • 3
  • Thomas Schmitz-Rode
    • 3
  • Stephan Langer
    • 4
    • 5
  • Christiane K. Kuhl
    • 1
  • Andreas H. Mahnken
    • 1
    • 3
    • 6
  1. 1.Department of Diagnostic and Interventional RadiologyRWTH Aachen University HospitalAachenGermany
  2. 2.Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Applied Medical EngineeringRWTH Aachen University HospitalAachenGermany
  4. 4.Department of Vascular Surgery, European Vascular Center Aachen-MaastrichtRWTH Aachen University HospitalAachenGermany
  5. 5.Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  6. 6.Department of Diagnostic and Interventional RadiologyUniversity of MarburgMarburgGermany

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