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The Effect of Functional and Intra-Coronary Imaging Techniques on Fluoroscopy Time, Radiation Dose and Contrast Volume during Coronary Angiography.

ABSTRACT: The aim was to analyze the effect of fractional flow reserve (FFR), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) on fluoroscopy time (FT), radiation dose (RD) and contrast volume (CV) in patients undergoing coronary angiography. This case-control study included consecutive patients above the age of 18, who underwent coronary angiography. FT, RD, and CV after each procedure were retrospectively recorded. Multivariate models were used to demonstrate the effect of these complementary studies and other factors, on radiation and contrast exposure. A total of 1047 patients were included, 74.5% were men and the mean (SD) age was 62.4 (12.1) years. Complementary studies performed were: IVUS (n?=?237), FFR (n?=?56) and OCT (n?=?37). FFR and IVUS had a small effect on FT (??=?0.008 B?=?2.2, p?

SUBMITTER: De la Garza-Salazar F

PROVIDER: S-EPMC7181823 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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The Effect of Functional and Intra-Coronary Imaging Techniques on Fluoroscopy Time, Radiation Dose and Contrast Volume during Coronary Angiography.

De la Garza-Salazar Fernando F Lankenau-Vela Diana Lorena DL Cadena-Nuñez Bertha B González-Cantú Arnulfo A Romero-Ibarguengoitia Maria Elena ME

Scientific reports 20200424 1

The aim was to analyze the effect of fractional flow reserve (FFR), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) on fluoroscopy time (FT), radiation dose (RD) and contrast volume (CV) in patients undergoing coronary angiography. This case-control study included consecutive patients above the age of 18, who underwent coronary angiography. FT, RD, and CV after each procedure were retrospectively recorded. Multivariate models were used to demonstrate the effect of these co ...[more]

PMID: 32332840

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Project description:BackgroundThe excess volume of contrast media (CM) is a marker of a more severe coronary culprit lesion and longer intervention duration in patients undergoing cardiac procedures. However, it is unclear whether the contrast volume is directly correlated with worse clinical outcomes. The aim of this study was to investigate the association between contrast dose and the incidence of 1-year major adverse cardiac and cerebrovascular events (MACCE) and all-cause bleeding events in patients undergoing cardiac catheterization and coronary angiography (CAG).MethodsWe prospectively enrolled 10,961 consecutive patients diagnosed with coronary heart disease expecting CAG from 2012 to 2013. The study population was pursued with a follow-up duration of 1 year. The predictive value of contrast volume, divided into quartiles, for the risk of MACCE and all-cause bleeding events was assessed using logistic regression analysis.ResultsThe cumulative incidence of 1-year MACCE was 8.65%, which was directly associated with increasing contrast volume. In particular, MACCE was observed in 7.16%, 7.89%, 9.31%, and 11.73% of cases in the contrast volume quartile Q1 (≤100 ml), Q2 (101-140 ml), Q3 (141-200 ml), and Q4 (>200 ml), respectively (P < 0.001). Moreover, the incidence of 1-year all-cause bleeding events was noted in 4.70%, 5.93%, 7.28%, and 8.21% of patients in Q1, Q2, Q3, and Q4, respectively (P < 0.001). The survival analysis showed that the 1-year MACCE rate was higher in patients using greater CM volume during the CAG. CM volume used >140 ml was associated with the occurrence of 1-year MACCE, and the incidence was dramatically elevated in patients exceeding a contrast volume of 200 ml (P = 0.007).ConclusionOur data suggested that higher contrast volume was significantly correlated with an increased risk of MACCE and all-cause bleeding events in patients undergoing cardiac catheterization.Trial registrationClinicalTrials.gov, NCT01735305; https://clinicaltrials.gov/ct2/show/NCT01735305?id=NCT017353057rank=1.

Project description:ObjectivesDeep-learning image reconstruction (DLIR) offers unique opportunities for reducing image noise without degrading image quality or diagnostic accuracy in coronary CT angiography (CCTA). The present study aimed at exploiting the capabilities of DLIR to reduce radiation dose and assess its impact on stenosis severity, plaque composition analysis, and plaque volume quantification.MethodsThis prospective study includes 50 patients who underwent two sequential CCTA scans at normal-dose (ND) and lower-dose (LD). ND scans were reconstructed with Adaptive Statistical Iterative Reconstruction-Veo (ASiR-V) 100%, and LD scans with DLIR. Image noise (in Hounsfield units, HU) and quantitative plaque volumes (in mm3) were assessed quantitatively. Stenosis severity was visually categorized into no stenosis (0%), stenosis (< 20%, 20-50%, 51-70%, 71-90%, 91-99%), and occlusion (100%). Plaque composition was classified as calcified, non-calcified, or mixed.ResultsReduction of radiation dose from ND scans with ASiR-V 100% to LD scans with DLIR at the highest level (DLIR-H; 1.4 mSv vs. 0.8 mSv, p < 0.001) had no impact on image noise (28 vs. 27 HU, p = 0.598). Reliability of stenosis severity and plaque composition was excellent between ND scans with ASiR-V 100% and LD scans with DLIR-H (intraclass correlation coefficients of 0.995 and 0.974, respectively). Comparison of plaque volumes using Bland-Altman analysis revealed a mean difference of - 0.8 mm3 (± 2.5 mm3) and limits of agreement between - 5.8 and + 4.1 mm3.ConclusionDLIR enables a reduction in radiation dose from CCTA by 43% without significant impact on image noise, stenosis severity, plaque composition, and quantitative plaque volume.Key points•Deep-learning image reconstruction (DLIR) enables radiation dose reduction by over 40% for coronary computed tomography angiography (CCTA). •Image noise remains unchanged between a normal-dose CCTA reconstructed by ASiR-V and a lower-dose CCTA reconstructed by DLIR. •There is no impact on the assessment of stenosis severity, plaque composition, and quantitative plaque volume between the two scans.

Project description:PurposeTo demonstrate that highly accelerated (net acceleration factor [R(net)] ≥ 10) acquisition techniques can be used to generate three-dimensional (3D) subsecond timing images, as well as diagnostic-quality high-spatial-resolution contrast material-enhanced (CE) renal magnetic resonance (MR) angiograms with a single split dose of contrast material.Materials and methodsAll studies were approved by the institutional review board and were HIPAA compliant; written consent was obtained from all participants. Twenty-two studies were performed in 10 female volunteers (average age, 47 years; range, 27-62 years) and six patients with renovascular disease (three women; average age, 48 years; range, 37-68 years; three men; average age, 60 years; range, 50-67 years; composite average age, 54 years; range, 38-68 years). The two-part protocol consisted of a low-dose (2 mL contrast material) 3D timing image with approximate 1-second frame time, followed by a high-spatial-resolution (1.0-1.6-mm isotropic voxels) breath-hold 3D renal MR angiogram (18 mL) over the full abdominal field of view. Both acquisitions used two-dimensional (2D) sensitivity encoding acceleration factor (R) of eight and 2D homodyne (HD) acceleration (R(HD)) of 1.4-1.8 for R(net) = R · R(HD) of 10 or higher. Statistical analysis included determination of mean values and standard deviations of image quality scores performed by two experienced reviewers with use of eight evaluation criteria.ResultsThe 2-mL 3D time-resolved image successfully portrayed progressive arterial filling in all 22 studies and provided an anatomic overview of the vasculature. Successful timing was also demonstrated in that the renal MR angiogram showed adequate or excellent portrayal of the main renal arteries in 21 of 22 studies.ConclusionTwo-dimensional acceleration techniques with R(net) of 10 or higher can be used in CE MR angiography to acquire (a) a 3D image series with 1-second frame time, allowing accurate bolus timing, and (b) a high-spatial-resolution renal angiogram.Supplemental materialhttp://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110242/-/DC1.

Dataset Information

The Effect of Functional and Intra-Coronary Imaging Techniques on Fluoroscopy Time, Radiation Dose and Contrast Volume during Coronary Angiography.

Publications

The Effect of Functional and Intra-Coronary Imaging Techniques on Fluoroscopy Time, Radiation Dose and Contrast Volume during Coronary Angiography.

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