High-pitch CT pulmonary angiography (CTPA) with ultra-low contrast medium volume for the detection of pulmonary embolism: a comparison with standard CTPA - Report - MDSpire
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High-pitch CT pulmonary angiography (CTPA) with ultra-low contrast medium volume for the detection of pulmonary embolism: a comparison with standard CTPA
High-Pitch CT Pulmonary Angiography with Minimal Contrast for PE Detection
Overview
This study evaluated a high-pitch CT pulmonary angiography (CTPA) protocol using ultra-low contrast volume (20 mL) and compared it to a standard CTPA protocol with 50 mL contrast in normal weight patients. The high-pitch protocol demonstrated feasibility with reduced scan time and contrast volume while maintaining diagnostic image quality for pulmonary embolism (PE) detection.
Background
Pulmonary embolism is a common acute cardiovascular condition requiring rapid and accurate diagnosis to improve patient outcomes. Computed tomography pulmonary angiography (CTPA) is the preferred imaging modality due to its high sensitivity and specificity. However, concerns about radiation exposure and contrast-induced nephropathy necessitate optimization of scan protocols. High-pitch dual-source CT scanning combined with low contrast volume may reduce radiation dose, contrast load, and motion artifacts, particularly in patients with limited breath-holding capacity.
Data Highlights
Parameter
High-Pitch CTPA
Standard CTPA
Contrast Volume (mL)
20
50
Pitch
3.2
1.2
Scan Time (s)
<1
~2
Tube Voltage and Current
Adapted
Standard
Breathing Instructions
Free breathing
Breath hold
Key Findings
The high-pitch CTPA protocol used a significantly lower contrast volume (20 mL) compared to the standard protocol (50 mL).
Scan acquisition time was reduced to less than 1 second with high-pitch mode versus approximately 2 seconds in the standard protocol.
High-pitch scanning allowed free breathing during image acquisition, potentially reducing motion artifacts in patients unable to hold their breath.
Image quality was maintained at a diagnostic level despite the lower contrast volume and faster scan time.
The dual-source CT scanner enabled high-pitch scanning without gaps or image artifacts, unlike single-source scanners.
The study included normal weight patients without severe nephropathy or contraindications to iodinated contrast.
Clinical Implications
The high-pitch CTPA protocol with ultra-low contrast volume offers a feasible alternative to standard CTPA, particularly in emergency settings where rapid imaging and reduced contrast load are desirable. This approach may benefit patients at risk for contrast-induced nephropathy or those with difficulty complying with breath-hold instructions. Adoption of high-pitch dual-source CT scanning can optimize diagnostic efficiency while minimizing potential risks associated with radiation and contrast media.
Conclusion
High-pitch CTPA with minimal contrast volume is a viable protocol for pulmonary embolism detection, providing rapid acquisition and adequate image quality. This technique may improve patient safety and comfort without compromising diagnostic accuracy.
References
Various Authors/Multiple Sources/2018-2019 -- Evaluation of High-Pitch CT Pulmonary Angiography with Minimal Contrast Volume
by Tobias Schönfeld, Patrick Seitz, Christian Krieghoff, Slavica Ponorac, Alexander Wötzel, Stefan Olthoff, Sebastian Schaudt, Jonas Steglich, Matthias Gutberlet, Robin F. Gohmann
