Dataset Information

Initial evidence of a 50% reduction of contrast media using digital variance angiography in endovascular carotid interventions.

ABSTRACT: Purpose: In previous clinical studies Digital Variance Angiography (DVA) provided higher signal-to-noise ratio (SNR) and better image quality than Digital Subtraction Angiography (DSA). Our aim was to investigate whether this quality reserve of DVA provides an opportunity for the reduction of iodinated contrast media (ICM) in carotid X-ray angiography (CXA).

Method: Our prospective study enrolled 26 patients (67.0?±?8.1 years) undergoing carotid percutaneous transluminal angioplasty. The SNR of DSA and DVA image pairs obtained by a standard (100 %, 6?mL ICM) or a low-dose (50 %, 3?mL ICM) protocol were compared. Visual evaluation of all images was performed by five specialists using a 5-grade rating scale. The quality of DSA₁₀₀ and DVA₅₀ videos was also compared.

Results: DVA provided more than two-fold SNR, the median SNR_DVA/SNR_DSA ratio was 2.06 (100 %) and 2.25 (50 %). In the visual evaluation, the DVA₁₀₀ score (3.73?±?0.06) was significantly higher than the DSA₁₀₀ score (3.52?±?0.07, Wilcoxon p?50 score (3.64?±?0.13) was also significantly higher than the DSA₅₀ score (3.01?±?0.17, Wilcoxon p?100 vs DSA₅₀), it had no effect on the DVA score (DVA₁₀₀ vs DVA₅₀). There was no statistical difference between the DSA₁₀₀ and DVA₅₀ scores. Evaluators preferred the diagnostic value of DVA₅₀ to DSA₁₀₀ videos in 61% of comparisons, the interrater agreement was 69 % (Fleiss' kappa 0.35, p?
Conclusions: Our data show that DVA allows a substantial (50 %) ICM reduction in CXA without affecting the quality and diagnostic value of angiograms.

SUBMITTER: Orias VI

PROVIDER: S-EPMC7683322 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Initial evidence of a 50% reduction of contrast media using digital variance angiography in endovascular carotid interventions.

Óriás Viktor I VI Szöllősi Dávid D Gyánó Marcell M Veres Dániel S DS Nardai Sándor S Csobay-Novák Csaba C Nemes Balázs B Kiss János P JP Szigeti Krisztián K Osváth Szabolcs S Sótonyi Péter P Ruzsa Zoltán Z

European journal of radiology open 20201117

<h4>Purpose</h4>In previous clinical studies Digital Variance Angiography (DVA) provided higher signal-to-noise ratio (SNR) and better image quality than Digital Subtraction Angiography (DSA). Our aim was to investigate whether this quality reserve of DVA provides an opportunity for the reduction of iodinated contrast media (ICM) in carotid X-ray angiography (CXA).<h4>Method</h4>Our prospective study enrolled 26 patients (67.0 ± 8.1 years) undergoing carotid percutaneous transluminal angioplasty ...[more]

PMID: 33294499

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Project description:ObjectivesThe objective was to retrospectively develop a protocol in swine for optimal contrast media timing in coronary CT angiography (CCTA).MethodsSeveral dynamic acquisitions were performed in 28 swine (55 ± 24 kg) with cardiac outputs between 1.5 and 5.5 L/min, for 80 total acquisitions. The contrast was injected (1mL/kg, 5mL/s, Isovue 370), followed by dynamic scanning of the entire aortic enhancement curve, from which the true peak time and aortic and coronary enhancements were recorded as the reference standard. Each dataset was then used to simulate two different CCTA protocols-a new optimal protocol and a standard clinical protocol. For the optimal protocol, the CCTA was acquired after bolus tracking-based trigging using a variable time delay of one-half the contrast injection time interval plus 1.5 s. For the standard protocol, the CCTA was acquired after bolus tracking-based triggering using a fixed time delay of 5 s. For both protocols, the CCTA time, aortic enhancement, coronary enhancement, and coronary contrast-to-noise ratio (CNR) were quantitatively compared to the reference standard measurements.ResultsFor the optimal protocol, the angiogram was acquired within -0.15 ± 0.75 s of the true peak time, for a mean coronary CNR within 7% of the peak coronary CNR. Conversely, for the standard CCTA protocol, the angiogram was acquired within -1.82 ± 1.71 s of the true peak time, for a mean coronary CNR that was 23% lower than the peak coronary CNR.ConclusionsThe optimal CCTA protocol improves contrast media timing and coronary CNR by acquiring the angiogram at the true aortic root peak time.Key points• This study in swine retrospectively developed the mathematical basis of an improved approach for optimal contrast media timing in CCTA. • By combining dynamic bolus tracking with a simple contrast injection timing relation, CCTA can be acquired at the peak of the aortic root enhancement. • CCTA acquisition at the peak of the aortic root enhancement should maximize the coronary enhancement and CNR, potentially improving the accuracy of CT-based assessment of coronary artery disease.

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:PurposeCurrent time-density curve analysis of digital subtraction angiography (DSA) provides intravascular flow information but requires manual vasculature selection. We developed an angiographic marker that represents cerebral perfusion by using automatic independent component analysis.Materials and methodsWe retrospectively analyzed the data of 44 patients with unilateral carotid stenosis higher than 70% according to North American Symptomatic Carotid Endarterectomy Trial criteria. For all patients, magnetic resonance perfusion (MRP) was performed one day before DSA. Fixed contrast injection protocols and DSA acquisition parameters were used before stenting. The cerebral circulation time (CCT) was defined as the difference in the time to peak between the parietal vein and cavernous internal carotid artery in a lateral angiogram. Both anterior-posterior and lateral DSA views were processed using independent component analysis, and the capillary angiogram was extracted automatically. The full width at half maximum of the time-density curve in the capillary phase in the anterior-posterior and lateral DSA views was defined as the angiographic mean transient time (aMTT; i.e., aMTTAP and aMTTLat). The correlations between the degree of stenosis, CCT, aMTTAP and aMTTLat, and MRP parameters were evaluated.ResultsThe degree of stenosis showed no correlation with CCT, aMTTAP, aMTTLat, or any MRP parameter. CCT showed a strong correlation with aMTTAP (r = 0.67) and aMTTLat (r = 0.72). Among the MRP parameters, CCT showed only a moderate correlation with MTT (r = 0.67) and Tmax (r = 0.40). aMTTAP showed a moderate correlation with Tmax (r = 0.42) and a strong correlation with MTT (r = 0.77). aMTTLat also showed similar correlations with Tmax (r = 0.59) and MTT (r = 0.73).ConclusionApart from vascular anatomy, aMTT estimates brain parenchyma hemodynamics from DSA and is concordant with MRP. This process is completely automatic and provides immediate measurement of quantitative peritherapeutic brain parenchyma changes during stenting.

Dataset Information

Initial evidence of a 50% reduction of contrast media using digital variance angiography in endovascular carotid interventions.

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Initial evidence of a 50% reduction of contrast media using digital variance angiography in endovascular carotid interventions.

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