Protocol Coronary CTA to visualize left main stent
See corresponding case: Dual Source CT after left main coronary artery stenting in a patient with arrhythmias
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what the best recommandation contrast flow rate selection.
is there any different if we use high flow rate(6ml/s and above).
how about contrast flow at the distal of arteries?
It is wise to increase contrast flow rate in difficult patients (e.g. patients with stents or obese patients). Of course, it is important not to run out of contrast towards the end of the scan. Duratio nof contrast injection therefore also needs to be increased to compensate for the higher flow rate.
Our policy at our institution is to inject contrast for the same duration as data acquisition will take, nbut to inject at least 10 seconds.
So, if the scan will take 12 seconds, we will inject 60 cc at a flow rate of 6ml/s or 72 cc at a flow rate of 6 cc/s
If the scan taes only 8 seconds, we inject for 10 seconds. 50 cc at a rate of 5cc/s or 6 cc at a rate of 6 cc/s.
Dear Colleague,
Could you please inform us about the usage contrast media in coronary CTA for Philips Brilliance (64-slice)?
Sincerely,
Dr.Ersin Ozturk
Dear User
The injection protocols for contrast agent do not vary significantly between different scanners. We currently recommend the following:
Use a flow rate of 5 ml/s. In difficult patients, such as obese patients or patients with stents or known severe calcification, increase to 6 ml/s or even 7 ml/s.
Inject for the same duration as the scan. If the daza acquisition will last 12 seconds, inject for 12 seconds. If it lasts 16 seconds, inject for 16 seconds.
Always inject for at least 10 seconds. If your data acquisition is shorter than 10 seconds (i.e. 6 seconds), still inject for 10 seconds.
Add 4 seconds if you use a bolus tracking approach. Do not add anything is you use a test bolus approach. If you use a test bolus, start your scan with a delay that is 2 seconds longer than the contrast agent transit time that you measured.
Follow your contrast injection with 60 ml of saline or 60 ml of a mixture 20% contrast/80% saline, at a flow rate of 5 ml/s.
If you do a test bolus approach, us 10 ml of contrast agent at 5 ml/s and follow by 60 ml of saline at 5 ml/s.
I wish you success with your scanning
Stephan Achenbach
Dr. Stephan Achenbach, M.D.
I agree with the injections protocols you describe; at our insitution we have a GE equipment of 64 channels, and we use the amount of contrast and its flow depending the weight of the patient, for example : 70 kg we use 85 to 90 cc at 5.5 to 6 ml/sec of flow rate. We use two flows of contrast, the first flow is 5.5 ml/sec using 55 cc and the second flow is 6 ml/sec using 45 cc following of 30 ml of saline at 6 ml/s. The purpose of this technique is to visualize the distal arteries of the heart and we obtained very good results.
And we needed to know the limits of the flow of the contrast, and you described before we can use 6 or 7 ml/s in obese and stent cases.
Thank you for your instructions and recommendations.