An Optimised Patient-specific Approach to Administration of Contrast Agent for CT Pulmonary Angiography

Objectives: To investigate pulmonary vasculature opacification during CTPA using an optimised patient-specific protocol for administering contrast agent.

Methods: CTPA was performed on 200 patients with suspected PE. Patients were assigned to two protocol groups: protocol A, fixed 80 ml contrast agent; protocol B used a patient-specific approach. The mean cross-sectional opacification profile of 8 central and 11 peripheral pulmonary arteries and veins was measured and the arteriovenous contrast ratio (AVCR) calculated. Protocols were compared using Mann-Whitney U non-parametric statistics. Jack-knife alternative free-response receiver-operating characteristic (JAFROC) analyses assessed diagnostic efficacy. Interobserver variations were investigated using kappa methods.

Results: A number of pulmonary arteries demonstrated increases in opacification (P < 0.03) for protocol B compared to A, whilst opacification in the heart and veins was reduced in protocol B (P = 0.05). Increased AVCR in protocol B compared with A was observed at all anatomic locations (P < 0.0002). Increased JAFROC (P < 0.0002) and kappa variation were observed with protocol B (κ = 0.78) compared to A (κ = 0.25). Mean contrast volume was reduced in protocol B (33 ± 9 ml) compared to A (80 ± 1 ml).

Conclusions: Significant improvements in visualisation of the pulmonary vasculature can be achieved with a low volume of contrast agent using injection timing based on a patient-specific contrast formula.

Key Points: • Optimal opacification of the pulmonary arteries is essential for CT pulmonary angiography. • Matching timing with vessel dynamics significantly improves vessel opacification. • This leads to increased arterial opacification and reduced venous opacification. • This can also lead to a reduced volume of contrast agent.