Optimal contrast medium injection protocols for the depiction of the Adamkiewicz artery using 64-detector CT angiography

Nakayama, Y.; Awai, K.; Yanaga, Y.; Nakaura, T.; Funama, Y.; Hirai, T.; Yamashita, Y.

doi:10.1016/j.crad.2008.01.009

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Volume 63, Issue 8 , Pages 880-887, August 2008

Optimal contrast medium injection protocols for the depiction of the Adamkiewicz artery using 64-detector CT angiography

Y. Nakayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
K. Awai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Guarantor and correspondent: K. Awai, Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. Tel.: +81 96 373 5261; fax: +81 96 362 4330.
Y. Yanaga
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
T. Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Y. Funama
- Department of Radiological Sciences, School of Health Sciences, Kumamoto University, Kumamoto, Japan
T. Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Y. Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

Received 23 July 2007; received in revised form 11 January 2008; accepted 22 January 2008.

Aim

To determine the optimal contrast medium injection protocol for demonstrating the Adamkiewicz artery (AKA) using 64-detector CT angiography (CTA).

Materials and methods

CTA was performed using 64-detector CT. The study population consisted of 80 patients (mean age 67.2 years) with aortoiliac diseases. In the first 60 patients 540mgI/kg body weight was administered over 25s. The patients were randomly assigned to three protocols with imaging started at 15 (protocol A-1), 18 (A-2), or 21s (A-3) after triggering (threshold 150HU). The other 20 received 720mgI/kg body weight with an imaging delay of 18s (protocol B). Two radiologists evaluated the presence of the AKA and measured the attenuation of the aorta and AKA.

Results

Aortic enhancement was 360.4, 348, 279.3, and 372HU for protocols A-1, A-2, A-3, and B, respectively. There was no significant difference between the A-1 and A-2 protocols (Tukey-Kramer test, p=0.73); however, aortic enhancement was significantly lower in A-3 than A-1 and A-2 (p<0.01). There was no significant difference between A-2 and B (p=0.40). AKA attenuation was 69.3, 91.9, 94.6, and 105.4HU for protocols A-1, A-2, A-3, and B, respectively. There was no significant difference between the A-2 and A-3 protocols (p=0.91); however, AKA attenuation was significantly lower with A-1 than A-2 or A-3 (p=0.01). AKA attenuation was significantly lower with A-2 than B (p=0.03) and there was a significant difference between A-2 (50%) and B (95%) in the depiction of the hairpin configuration of the AKA (p=0.02).

Conclusion

For the demonstration of the AKA at CTA, the optimal protocol used an imaging delay of 18s after triggering and an iodine dose of 720mgI/kg body weight.