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Contrast Agent Application and Protocols

  • Markus S. Juchems
Part of the Medical Radiology book series (MEDRAD)

Abstract

Contrast enhanced MDCT is a powerful and continuously evolving technology for non-invasive imaging of the abdomen. As for contrast media application in general, there is a variety of patient-related and injection-related factors that can affect the magnitude and timing of intravenous contrast agent attenuation for abdominal CT scans. MDCT, with its dramatically shorter image acquisition times, permits images with a much better utilization of the peak contrast attenuation. High iodine flux rates—e.g. required by modern angiographic applications—can be achieved with newly developed high concentration iodine contrast agents. In contrast low concentration iodine agents need to be injected at very high flow rates resulting in high volumes administered to meet these requirements. Sporadic failure, though, is unpreventable at the current stage of development. This is due to the fact that the patient’s cardiac output is not known prior to scan initiation in most cases. Contrast media administration is an integral part of the ongoing evolution of MDCT and needs to be continuously adopted and optimized to take full advantage of this technology. The purpose of this chapter is to give a basic understanding of physiologic and pharmacokinetic principles, as well as an understanding of the effects of injection parameters on vascular and parenchymal enhancement. This will enable the development of optimized contrast agent delivery protocols for current and future MDCT abdominal scans.

Keywords

Inferior Vena Cava Superior Vena Cava Injection Duration Parenchymal Enhancement Early Arterial Phase 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Awai K, Takada K, Onishi H, Hori S (2002) Aortic and hepatic enhancement and tumor-to-liver contrast: analysis of the effect of different concentrations of contrast material at multi-detector row helical CT. Radiology 224:757–763PubMedCrossRefGoogle Scholar
  2. Awai K, Hiraishi K, Hori S (2004) Effect of contrast material injection duration and rate on aortic peak time and peak enhancement at dynamic CT involving injection protocol with dose tailored to patient weight. Radiology 230:142–150PubMedCrossRefGoogle Scholar
  3. Bae KT (2003) Peak contrast enhancement in CT and MR angiography: when does it occur and why? Pharmacokinetic study in a porcine model. Radiology 227:809–816PubMedCrossRefGoogle Scholar
  4. Bae KT (2005) Test-bolus versus bolus-tracking techniques for CT angiographic timing. Radiology 236:369–370, author reply 70.Google Scholar
  5. Bae KT, Heiken JP (2000) Computer modeling approach to contrast medium administration and scan timing for multislice CT. In: Marincek B, Ros PR, Reiser M, Baker ME (eds) Multislice CT: A Practical Guide Springer, Berlin, pp 28–36Google Scholar
  6. Bae KT, Heiken JP, Brink JA (1998a) Aortic and hepatic contrast medium enhancement at CT. Part I. Prediction with a computer model. Radiology 207:647–655PubMedGoogle Scholar
  7. Bae KT, Heiken JP, Brink JA (1998b) Aortic and hepatic contrast medium enhancement at CT. Part II. Effect of reduced cardiac output in a porcine model. Radiology 207:657–662PubMedGoogle Scholar
  8. Bae KT, Heiken JP, Brink JA (1998c) Aortic and hepatic peak enhancement at CT: effect of contrast medium injection rate–pharmacokinetic analysis and experimental porcine model. Radiology 206:455–464PubMedGoogle Scholar
  9. Bae KT, Tran HQ, Heiken JP (2000) Multiphasic injection method for uniform prolonged vascular enhancement at CT angiography: pharmacokinetic analysis and experimental porcine model. Radiology 216:872–880PubMedGoogle Scholar
  10. Bae KT, Tran HQ, Heiken JP (2004) Uniform vascular contrast enhancement and reduced contrast medium volume achieved by using exponentially decelerated contrast material injection method. Radiology 231:732–736PubMedCrossRefGoogle Scholar
  11. Becker CR, Hong C, Knez A, Leber A, Bruening R, Schoepf UJ, Reiser MF (2003) Optimal contrast application for cardiac 4-detector-row computed tomography. Invest Radiol 38:690–694PubMedCrossRefGoogle Scholar
  12. Cademartiri F, Luccichenti G, Marano R, Gualerzi M, Brambilla L, Coruzzi P (2004a) Comparison of monophasic versus biphasic administration of contrast material in non-invasive coronary angiography using a 16-row multislice Computed Tomography. Radiol Med 107:489–496PubMedGoogle Scholar
  13. Cademartiri F, Nieman K, van der Lugt A, Raaijmakers RH, Mollet N, Pattynama PM, de Feyter PJ, Krestin GP (2004b) Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology 233:817–823PubMedCrossRefGoogle Scholar
  14. Cheng CP, Herfkens RJ, Lightner AL, Taylor CA, Feinstein JA (2004) Blood flow conditions in the proximal pulmonary arteries and vena cavae: healthy children during upright cycling exercise. Am J Physiol Heart Circ Physiol 287:H921–926PubMedCrossRefGoogle Scholar
  15. Coursey CA, Nelson RC, Weber PW, Howle LE, Nichols EB, Marin D, DeLong D (2009) Contrast material administration protocols for 64-MDCT angiography: altering volume and rate and use of a saline chaser to better match the imaging window–physiologic phantom study. Am J Roentgenol 193:1568–1575CrossRefGoogle Scholar
  16. Fenchel S, Fleiter TR, Aschoff AJ, van Gessel R, Brambs HJ, Merkle EM (2004) Effect of iodine concentration of contrast media on contrast enhancement in multislice CT of the pancreas. Br J Radiol 77:821–830PubMedCrossRefGoogle Scholar
  17. Fleischmann D (2003a) Use of high-concentration contrast media in multiple-detector-row CT: principles and rationale. Eur Radiol 13:M14–20PubMedCrossRefGoogle Scholar
  18. Fleischmann D (2003b) Use of high concentration contrast media: principles and rationale-vascular district. Eur J Radiol 45:S88–S93PubMedCrossRefGoogle Scholar
  19. Fleischmann D, Rubin GD, Bankier AA, Hittmair K (2000) Improved uniformity of aortic enhancement with customized contrast medium injection protocols at CT angiography. Radiology 214:363–371PubMedGoogle Scholar
  20. Gosselin MV, Rassner UA, Thieszen SL, Phillips J, Oki A (2004) Contrast dynamics during CT pulmonary angiogram: analysis of an inspiration associated artifact. J Thorac Imaging 19:1–7PubMedCrossRefGoogle Scholar
  21. Haage P, Schmitz-Rode T, Hubner D, Piroth W, Gunther RW (2000) Reduction of contrast material dose and artifacts by a saline flush using a double power injector in helical CT of the thorax. Am J Roentgenol 174:1049–1053Google Scholar
  22. Heiken JP, Brink JA, McClennan BL, Sagel SS, Crowe TM, Gaines MV (1995) Dynamic incremental CT: effect of volume and concentration of contrast material and patient weight on hepatic enhancement. Radiology 195:353–357PubMedGoogle Scholar
  23. Kirchner J, Kickuth R, Laufer U, Noack M, Liermann D (2000) Optimized enhancement in helical CT: experiences with a real-time bolus tracking system in 628 patients. Clin Radiol 55:368–373PubMedCrossRefGoogle Scholar
  24. Kormano M, Partanen K, Soimakallio S, Kivimaki T (1983) Dynamic contrast enhancement of the upper abdomen: effect of contrast medium and body weight. Invest Radiol 18:364–367PubMedCrossRefGoogle Scholar
  25. Laghi A (2007) Multidetector CT (64 Slices) of the liver: examination techniques. Eur Radiol 17:675–683PubMedCrossRefGoogle Scholar
  26. Megibow AJ, Jacob G, Heiken JP, Paulson EK, Hopper KD, Sica G, Saini S, Birnbaum BA, Redvanley R, Fishman EK (2001) Quantitative and qualitative evaluation of volume of low osmolality contrast medium needed for routine helical abdominal CT. Am J Roentgenol 176:583–589Google Scholar
  27. Roos JE, Desbiolles LM, Weishaupt D, Wildermuth S, Hilfiker PR, Marincek B, Boehm T (2004) Multi-detector row CT: effect of iodine dose reduction on hepatic and vascular enhancement. Rofo 176:556–563PubMedCrossRefGoogle Scholar
  28. Schueller G, Schima W, Schueller-Weidekamm C, Weber M, Stift A, Gnant M, Prokesch R (2006) Multidetector CT of pancreas: effects of contrast material flow rate and individualized scan delay on enhancement of pancreas and tumor contrast. Radiology 241:441–448PubMedCrossRefGoogle Scholar
  29. Suzuki H, Oshima H, Shiraki N, Ikeya C, Shibamoto Y (2004) Comparison of two contrast materials with different iodine concentrations in enhancing the density of the the aorta, portal vein and liver at multi-detector row CT: a randomized study. Eur Radiol 14:2099–2104PubMedCrossRefGoogle Scholar
  30. Tatsugami F, Matsuki M, Inada Y, Nakai G, Tanikake M, Yoshikawa S, Narabayashi I (2007) Usefulness of saline pushing in reduction of contrast material dose in abdominal CT: evaluation of time-density curve for the aorta, portal vein and liver. Br J Radiol 80:231–234PubMedCrossRefGoogle Scholar
  31. Vrachliotis TG, Bis KG, Haidary A, Kosuri R, Balasubramaniam M, Gallagher M, Raff G, Ross M, O’Neil B, O’Neill W (2007) Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography. Radiology 243:368–276PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Diagnostic and Interventional RadiologyUniversity Hospitals UlmUlmGermany

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