Special aspects of intracardiac structures visualization with different contrast enhancement CT-protocols for planning arrhythmological operations

Kashtanova N.Yu., Kondratyev E.V., Artyukhina E.A., Karmazanovsky G.G.

Purpose. To assess the effect of СT-contrast enhancement (CE) techniques on the quality of cardiac imaging when planning intervention treatment of arrhythmias.

Materials and methods. The study included 100 patients with arrhythmias before operation. Cardiac CT with intravenous СE was performed for non-invasive imaging. Patients were divided into groups depending on CE technology: group I monophase, group II split-bolus, group III split-bolus with the preliminary bolus.

Results. Clear differentiation of endocardium and pathology in left chambers were determined in all CE technologies. With monophasic CE, the unenhanced blood from IVC reduced density of right chambers, obtaining diagnostic information was difficult in 83% cases. Split-bolus protocols (groups II and III) improved imaging of right chambers and increased CT-density in RV by 2.5 times compared to the monophasic protocol by prolonged administration of contrast agent, but increased frequency of artifacts in SVC. The heterogeneity of RA cavity in group II due to the mixing of high-density contrast agent from SVC and low-density blood from IVC reduced the accuracy of endocardial contour differentiation. Using of preliminary bolus in group III increased the homogeneity of RA and reduced the frequency of significant artifacts in SVC by 5.5 times.

Conclusion. Monophasic and split-bolus СE technologies provide optimal contrast in left cardiac chambers. Using of saline chaser minimise frequency of artifacts in SVC, but reduces contrast enhancement of right chambers. Technologies split-bolus and with preliminary bolus improve visualization of right chambers with similar frequency artifacts in SVC. CE technology with preliminary bolus is preferred when it is necessary to accurately differentiate RA structures.


1 -  A.V. Vishnevsky National Medical Research Center of Surgery.

2 - N.I. Pirogov Russian National Research Medical University. Moscow, Russia.

 

Keywords: computed tomography, contrast enchancement, radiofrequency ablation, heart, arrhythmia.

 


Corresponding author:  Kashtanova N.Yu., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Kashtanova N.Yu., Kondratyev E.V., Artyukhina E.A., Karmazanovsky G.G. Special aspects of intracardiac structures visualization with different contrast enhancement CT-protocols for planning arrhythmological operations. REJR 2021; 11(2):130-142. DOI: 10.21569/2222-7415-2021-11-2-130-142.

Received:       26.11.20 Accepted:     25.03.21