Using Patient-Specific Contrast Enhancement Optimizer Simulation Software During the Transcatheter Aortic Valve Implantation-Computed Tomography Angiography in Patients With Aortic Stenosis.

OBJECTIVES: This study assessed whether patient-specific contrast enhancement optimizer simulation software (p-COP) can reduce the contrast material (CM) dose compared with the conventional body weight (BW)-tailored scan protocol during transcatheter aortic valve implantation-computed tomography angiography (TAVI-CTA) in patients with aortic stenosis. METHODS: We used the CM injection protocol selected by the p-COP in group A (n = 30). p-COP uses an algorithm that concerns data on an individual patient's cardiac output. Group B (n = 30) was assigned to the conventional BW-tailored CM injection protocol group. We compared the CM dose, CM amount, injection rate, and computed tomography (CT) values in the abdominal aorta between the 2 groups and classified them as acceptable (>280 Hounsfield units (HU)) or unacceptable (<279 HU) based on the optimal CT value and visualization scores for TAVI-CTA. We used the Mann-Whitney U test to compare patient characteristics and assess the interpatient variability of subjects in both groups. RESULTS: Group A received 56.2 mL CM and 2.6 mL/s of injection, whereas group B received 76.9 mL CM and 3.4 mL/s of injection (P < 0.01). The CT value for the abdominal aorta at the celiac level was 287.0 HU in group A and 301.7HU in group B (P = 0.46). The acceptable (>280 HU) and unacceptable (<280 HU) CT value rates were 22 and 8 patients in group A and 24 and 6 patients in group B, respectively (P = 0.76). We observed no significant differences in the visualization scores between groups A and B (visualization score = 3, P = 0.71). CONCLUSION: The utilization of p-COP may decrease the CM dosage and injection rate by approximately 30% in individuals with aortic stenosis compared with the body-weight-tailored scan protocol during TAVI-CTA.

Medium-Term Outcomes of Treatment with a VIABAHN VBX Covered Stent for Aortoiliac Occlusive Lesions in Patients with Peripheral Artery Disease.

BACKGROUND: Endovascular treatment (EVT) for aortoiliac (AI) occlusive lesions is now conducted worldwide, but there are challenges in EVT for complex AI lesions. The VIABAHN VBX (W.L. Gore & Associates, Flagstaff, AZ) is a next-generation balloon-expandable covered stent designed for use with complex AI lesions. The purpose of this study is to evaluate the medium-term outcomes of VIABAHN VBX for such lesions. METHODS: Symptomatic patients who underwent EVT with VIABAHN VBX for an AI lesion from 2018 to 2020 at 7 Japanese centers were reviewed retrospectively. The primary endpoints were primary patency and freedom from target lesion revascularization (TLR). RESULTS: A total of 95 EVT procedures with VIABAHN VBX for AI occlusive lesions were performed in 71 patients. The patients had high rates of dyslipidemia (53%) and chronic kidney disease (61%), and 22% had chronic limb-threatening ischemia (CLTI). The Transatlantic Inter-Society Consensus (TASC Ⅱ) class was A in 12 patients (17%), B in 12 (17%), C in 10 (14%), and D in 37 (52%). Severe calcification (360°) of the treated lesion was present in 31 patients (33%). The median procedure time was 84 (49-158) min, with a technical success rate of 100%. The median follow-up period was 36 (32-43) months. The 3-year primary and secondary patency of VIABAHN VBX were 91% and 99%, the 3-year freedom from TLR was 92%, and the 3-year freedom from major adverse limb event (MALE) was 98%. No limbs required major amputation. Lesion severity (TASC Ⅱ C or D) and severe calcification did not affect the primary patency or freedom from TLR. CONCLUSIONS: Medium-term outcomes after EVT with VIABAHN VBX for AI lesions were acceptable regardless of lesion severity and calcification. These results suggest that VIABAHN VBX may be suitable for AI occlusive lesions with severe anatomical complexity and/or severe calcification.

Clinical impact of fluoropolymer-based drug-eluting stent thrombosis in femoropopliteal artery occlusive lesions.

BACKGROUND: Endovascular treatment (EVT) is recommended for superficial femoral artery (SFA) lesions, and good results have been reported after implantation of drug-eluting stents (DES) for SFA. However, the major concern after implantation is acute thrombosis during the follow-up period, resulting in major amputation and major adverse limb events. In this study, we examined the incidence and outcome of acute thrombosis after DES implantation in the SFA. OBJECTIVES AND METHODS: DES implantation for a femoropopliteal lesion was performed in 288 patients at multiple centers in Japan from 2019 to 2021. A total of 25 patients (8.6%) with DES acute occlusion were analyzed retrospectively. The primary endpoint was amputation-free survival (AFS) after acute occlusion. RESULTS: The median patient age was 77 years, with 48% having diabetes, 40% undergoing maintenance dialysis, and 66% having chronic limb-threatening ischemia (CLTI). The mean time from initial DES implantation to acute occlusion was 153.5 ± 177.6 days, with a median of 104 days. EVT was performed in 18 patients (72%), surgical revascularization in 3 (12%), and conservative treatment in 4 (16%). Two deaths within 30 days were both due to sepsis. No major amputation or major adverse cardiovascular events occurred within 30 days. The 1-year rates of patency and freedom from target lesion revascularization after DES thrombosis were 22.9% and 48.8%, respectively. AFS at 1 year was 55.1%. CONCLUSION: Acute DES occlusion is relatively frequent, and the outcome is poor. Therefore, the indication of DES implantation for a complex SFA lesion may require careful consideration. Further investigation may be needed in DES implantation for a complex SFA lesion.

Can Machine Learning Identify the Intravenous Contrast Dose and Injection Rate Needed for Optimal Enhancement on Dynamic Liver Computed Tomography?

OBJECTIVES: This study aimed to investigate whether machine learning (ML) is useful for predicting the contrast material (CM) dose required to obtain a clinically optimal contrast enhancement in hepatic dynamic computed tomography (CT). METHODS: We trained and evaluated ensemble ML regressors to predict the CM doses needed for optimal enhancement in hepatic dynamic CT using 236 patients for a training data set and 94 patients for a test data set. After the ML training, we randomly divided using the ML-based (n = 100) and the body weight (BW)-based protocols (n = 100) by the prospective trial. The BW protocol was performed using routine protocol (600 mg/kg of iodine) by the prospective trial. The CT numbers of the abdominal aorta and hepatic parenchyma, CM dose, and injection rate were compared between each protocol using the paired t test. Equivalence tests were performed with equivalent margins of 100 and 20 Hounsfield units for the aorta and liver, respectively. RESULTS: The CM dose and injection rate for the ML and BW protocols were 112.3 mL and 3.7 mL/s, and 118.0 mL and 3.9 mL/s ( P < 0.05). There were no significant differences in the CT numbers of the abdominal aorta and hepatic parenchyma between the 2 protocols ( P = 0.20 and 0.45). The 95% confidence interval for the difference in the CT number of the abdominal aorta and hepatic parenchyma between 2 protocols was within the range of predetermined equivalence margins. CONCLUSIONS: Machine learning is useful for predicting the CM dose and injection rate required to obtain the optimal clinical contrast enhancement for hepatic dynamic CT without reducing the CT number of the abdominal aorta and hepatic parenchyma.

Non-contrast magnetic resonance angiography for systemic artery evaluation in Kawasaki disease.

BACKGROUND: Kawasaki disease (KD) is a systemic vasculitis; systemic arteries other than the coronary arteries should therefore also be evaluated. This study investigated the feasibility of evaluating coronary aneurysms, systemic artery aneurysms (SAAs), and cerebrovascular diseases in patients with KD using non-contrast magnetic resonance angiography (NC-MRA). METHODS: Coronary artery protocols, including coronary magnetic resonance angiography (MRA) and vessel wall imaging, were performed in 57 examinations of 28 patients. Systemic artery protocol, including SAA scans and head MRA, along with coronary artery protocol, were performed in 42 examinations of 42 patients. The image quality of the SAAs was evaluated on a 4-point scale. Examination time and sedation dosage were compared between the protocols. The presence of SAAs and cerebrovascular disease was also evaluated. RESULTS: The image quality score of SAAs was 4 (interquartile range [IQR]: 4-4) for the aorta, 4 (IQR: 3-4) for the subclavian artery, 4 (IQR: 3-4) for the renal artery, and 3 (IQR: 3-4) for the iliac artery. No differences were found between examination time (47.0 [IQR: 43.0-61.0] min vs. 51.0 [IQR: 45.0-60.0] min, p = 0.48) and sedative dose (4.63 [IQR: 3.93-5.79] mg/kg vs. 4.21 [IQR: 3.56-5.71] mg/kg, p = 0.37) between the protocols. Systemic artery protocol detected SAAs in three patients (7.1%), and cerebrovascular disease was not detected. CONCLUSIONS: Evaluating the coronary and systemic arteries in patients with KD using NC-MRA on a single examination was possible without compromising examination time or sedation dose. The systemic artery protocol was useful in finding SAAs.

Prediction of Aortic Contrast Enhancement on Dynamic Hepatic Computed Tomography-Performance Comparison of Machine Learning Methods and Simulation Software.

OBJECTIVES: The aim of this study was to compare prediction ability between ensemble machine learning (ML) methods and simulation software for aortic contrast enhancement on dynamic hepatic computed tomography. METHODS: We divided 339 human hepatic dynamic computed tomography scans into 2 groups. One group consisted of 279 scans used to create cross-validation data sets, the other group of 60 scans were used as test data sets. To evaluate the effect of the patient characteristics on enhancement, we calculated changes in the contrast medium dose per enhancement of the abdominal aorta in the hepatic arterial phase. The parameters for ML were the patient sex, age, height, body weight, body mass index, and cardiac output. We trained 9 ML regressors by applying 5-fold cross-validation, integrated the predictions of all ML regressors for ensemble learning and the simulations, and used the training and test data to compare their Pearson correlation coefficients. RESULTS: Comparison of different ML methods showed that the Pearson correlation coefficient for the real and predicted contrast medium dose per enhancement of the abdominal aorta was highest with ensemble ML (r = 0.786). It was higher than that obtained with the simulation software (r = 0.350). With ensemble ML, the Bland-Altman limit of agreement [mean difference, 5.26 Hounsfield units (HU); 95% limit of agreement, -112.88 to 123.40 HU] was narrower than that obtained with the simulation software (mean difference, 11.70 HU; 95% limit of agreement, -164.71 to 188.11 HU). CONCLUSION: The performance for predicting contrast enhancement of the abdominal aorta in the hepatic arterial phase was higher with ensemble ML than with the simulation software.

Usefulness of the patient-specific contrast enhancement optimizer simulation software during the whole-body computed tomography angiography.

To evaluate whether the patient-specific contrast enhancement optimizer simulation software (p-COP) is useful for predicting contrast enhancement during whole-body computed tomography angiography (WBCTA). We randomly divided the patients into two groups using a random number table. We used the contrast material (CM) injection protocol selected by p-COP in group A (n = 52). The p-COP used an algorithm including data on the individual patient's cardiac output. Group B (n = 50) was assigned to the conventional CM injection protocol based on body weight. We compared the CT number in the abdominal aorta at the celiac artery level between the two groups and classified them as acceptable (> 280 HU) and unacceptable (< 279 HU) based on the optimal CT number for the WBCTA scans. To evaluate the difference in both injection protocols, we compared the visual inspection of the images of the artery of Adamkiewicz in both protocols. The CM dosage and injection rate in group A were significantly lower than those in group B (480.8 vs. 501.1 mg I/kg and 3.1 vs. 3.3 ml/s, p < 0.05). The CT number of the abdominal aorta at the celiac level was 382.4 ± 62.3 HU in group A and 363.8 ± 71.3 HU in group B (p = 0.23). CM dosage and injection rate were positively correlated to cardiac output for group A (r = 0.80, p < 0.05) and group B (r = 0.16, p < 0.05). The number of patients with an acceptable CT number was higher in group A [46/6 (86.7%)] than in group B [43/7 (71.4%)], but not significant (p = 0.71). The visualization rate for the Adamkiewicz artery was not significantly different between groups A and B (p = 0.89). The p-COP was useful for predicting contrast enhancement during WBCTA with a lower CM dosage and a lower contrast injection rate than that based on the body weight protocol. In patients with lower cardiac output a reduction in contrast injection rate and CM dosage did not lead to a reduced imaging quality, thus particularly in this group CM dosage can be reduced by p-COP.

Individual Optimization of Contrast Media Injection Protocol at Hepatic Dynamic Computed Tomography Using Patient-Specific Contrast Enhancement Optimizer.

OBJECTIVE: We developed a patient-specific contrast enhancement optimizer (p-COP) that can exploratorily calculate the contrast injection protocol required to obtain optimal enhancement at target organs using a computer simulator. Appropriate contrast media dose calculated by the p-COP may minimize interpatient enhancement variability. Our study sought to investigate the clinical utility of p-COP in hepatic dynamic computed tomography (CT). METHODS: One hundred thirty patients (74 men, 56 women; median age, 65 years) undergoing hepatic dynamic CT were randomly assigned to 1 of 2 contrast media injection protocols using a random number table. Group A (n = 65) was injected with a p-COP-determined iodine dose (developed by Higaki and Awai, Hiroshima University, Japan). In group B (n = 65), a standard protocol was used. The variability of measured CT number (SD) between the 2 groups of aortic and hepatic enhancement was compared using the F test. In the equivalence test, the equivalence margins for aortic and hepatic enhancement were set at 50 and 10 Hounsfield units (HU), respectively. The rate of patients with an acceptable aortic enhancement (250-350 HU) for the diagnosis of hypervascular liver tumors was compared using the χ test. RESULTS: The mean ± SD values of aortic and hepatic enhancement were 311.0 ± 39.9 versus 318.7 ± 56.5 and 59.0 ± 11.5 versus 58.6 ± 11.8 HU in groups A and B, respectively. Although the SD for aortic enhancement was significantly lower in group A (P = 0.006), the SD for hepatic enhancement was not significantly different (P = 0.871). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 groups was within the range of the equivalence margins. The number of patients with acceptable aortic enhancement was significantly greater in group A than in group B (P < 0.01). CONCLUSIONS: The p-COP software reduced interpatient variability in aortic enhancement and obtained acceptable aortic enhancement at a significantly higher rate compared with the standard injection protocol for hepatic dynamic CT.

[Comparison of Contrast Enhancement between Bolus-tracking and Test-bolus Methods on Coronary CT Angiography].

PURPOSE: To compare the contrast enhancement between bolus-tracking (BT) and test-bolus (TB) methods in coronary computed tomography angiography (CCTA). METHOD: We enrolled 300 patients who underwent CCTA by BT (245 mg I/kg main bolus) or TB (77.4 mg I/kg test bolus with 245 mg I/kg main bolus) methods. In group BT (n=150), scanning was started automatically 5-second after contrast enhancement exceeded a predefined threshold of 150 Hounsfield units (HU). In group TB (n=150), TB peak attenuation plus 2-second was used as a delay. We recorded the CT number in the ascending aorta and determined whether the CT number was equivalent in two groups. For the equivalence test, we adopted 70 HU as the equivalence margin. The standard deviation (SD) in the CT number and the rate of patients with an acceptable CT number were compared. We also compared total iodine dose and total dose length product (DLP). RESULT: The CT number of the ascending aorta was 437.6±68.9 HU in group BT and 438.9±69.7 HU in group TB; the 95% confidence interval for the difference between the groups was from -11.6 to 20.2 HU and within the range of the equivalence margins. The SD of the CT number and the rate of patients with acceptable CT number did not differ significantly between the two groups (p=0.857 and p=0.614, respectively). Total iodine dose in group TB was significantly higher than in group BT (p<0.001), and total DLP was not statistically significant (p=0.197). CONCLUSION: The contrast enhancement between BT and TB methods in CCTA was equivalent, and the distribution was not significantly different between the two groups.

[New Potential Method for Optimizing the ATCM Technique in Pediatric CT Examination].

PURPOSE: To compare the radiation dose and image quality using the conventional method for performing the front and side scout view and a new method for performing the side scout view, and then correct the table height at the scan isocenter and perform the front scout view. METHODS: We retrospectively analyzed fifty-six children who had underwent computed tomography (CT) examination between June 2014 and August 2018. We divided them into two groups. The conventional method was performed in 3 steps: 1. obtain the front scout view, 2. obtain the side scout view, and 3. main scan. Without table position correction, the new method was performed in 4 steps: 1. obtain the side scout view with table position correction, 2. patient correction at the scan isocenter, 3. obtain the front scout view, and 4. main scan. We used a 64-row CT scanner (LightSpeed VCT; GE Healthcare). Scan parameters were tube voltage 80 kV, automatic tube current modulation, noise index 16, slice thickness 5 mm, rotation time 0.4 s/rot, helical pitch 1.375, and reconstruction kernel standard. We recorded the volume dose index (CTDIvol) and dose length product (DLP) on the CT console and compared the radiation dose in both groups. To evaluate the image quality in both groups, the mean standard deviation of CT number (SD value) was measured within an approximately 5-10 mm2  circular region of interest. We measured the scan length of the pediatric patient and accuracy of pediatric positioning at the CT examination. A grid was displayed on the CT axial image, taken to evaluate the error from the scan isocenter during alignment, and the error between the height of half the body thickness and the scan isocenter was recorded. RESULTS: Scan lengths were median (minimum-maximum) values of 16.2 cm (10.8-21.5 cm) and 16.8 cm (11.5-23.0 cm). There were no significant differences in the scan length between both groups (p=0.47). In the group with table position correction, median (minimum-maximum) values for CTDIvol, DLP and SD value were 0.40 mGy (0.3-0.7 mGy), 7.6 mGyï½¥cm (4.4-11.5 mGyï½¥cm), and 24.0 HU (18.3-37.5 HU), respectively. In the group without the table position correction, median (minimum-maximum) values for CTDIvol, DLP and SD value were 0.40 mGy (0.3-0.6 mGy), 7.1 mGyï½¥cm (4.2-13.8 mGyï½¥cm), and 20.3 HU (11.3-28.8 HU), respectively. There were no significant differences in the CTDIvol and DLP values between both groups (p=0.42 and p=0.44, respectively); however, there were significant differences in the SD value in both groups (p<0.01). The error for the accuracy of pediatric positioning was 0 mm (0 to 0 mm) and 10 mm (-16 to+59 mm) using the conventional and new methods (p<0.01), respectively. CONCLUSIONS: It was suggested that the optimum image could be obtained during CT scan with automatic tube current modulation by using this potential new method (1. obtain the side scout view, 2. patient correction at the scan isocenter, 3. obtain the side scout view, and 4. main scan).

Minimizing individual variations in arterial enhancement on coronary CT angiographs using "contrast enhancement optimizer": a prospective randomized single-center study.

OBJECTIVES: To investigate the clinical utility of our newly developed contrast enhancement optimizer (CEO) software for coronary CT angiography (CCTA). METHODS: We randomly assigned 295 patients (168 males, 127 females, median age 71 years) undergoing CCTA to one of two contrast media injection protocols. Group A (n = 150) was injected with a CEO-selected iodine dose based on patient factors. In group B (n = 145), we used our standard protocol (245 mg I/kg). We recorded the CT number in the ascending aorta and determined whether the CT number was equivalent in groups A and B. For the equivalence test, we adopted 75 Hounsfield units (HU) as the equivalence margin. The standard deviation in the CT number and the rate of patients with an acceptable CT number were compared using the F test and the chi-square test, respectively. RESULTS: The iodine dose in group A was significantly smaller than that in group B (235.7 vs. 253.6 mg I/kg, p < 0.001). The CT number of the ascending aorta was 428.6 ± 55.5 HU in group A and 436.1 ± 68.7 HU in group B; the 95% confidence interval for the difference between the groups was -4.3 HU to 16.9 HU and within the range of the predetermined equivalence margins. In group A, the variance was significantly smaller than that in group B (p = 0.009). The number of patients with an acceptable CT number was significantly higher in group A than in group B (84.7% vs. 71.7%, p = 0.007). CONCLUSIONS: The use of our CEO for CCTA studies yielded optimal aortic contrast enhancement in significantly more patients than the standard protocol based on the body weight. KEY POINTS: • With our contrast enhancement optimizer (CEO) software, optimal and stable aortic enhancement can be obtained on coronary CT angiography scans irrespective of patient factors. • Management of contrast media becomes more appropriate by the CEO software. • The CEO software can control contrast enhancement at different tube voltage levels.

Contrast Material Injection Protocol With the Dose Determined According to Lean Body Weight at Hepatic Dynamic Computed Tomography: Comparison Among Patients With Different Body Mass Indices.

OBJECTIVE: The objective of this study was to compare enhancement of the aorta and liver on hepatic dynamic computed tomography scans acquired with contrast material doses based on the lean body weight (LBW) or the total body weight (TBW). METHODS: We randomly divided 529 patients (279 men, 250 women; median age, 66 years) scheduled for hepatic dynamic computed tomography into 2 groups. The LBW patients (n = 278) were injected with 679 mg iodine/kg (men) or 762 mg iodine/kg (women). The TBW group (n = 251) was injected with 600 mg iodine/kg TBW. Each group was subdivided into the 3 classes based on the body mass index (BMI; low, normal, high). Aortic enhancement during the hepatic arterial phase and hepatic enhancement during the portal venous phase was compared. The aortic and hepatic equivalence margins were 100 and 20 Hounsfield units, respectively. RESULTS: Comparison of the median iodine dose in patients with a normal or high BMI showed that it was significantly lower under the LBW protocol than the TBW protocol (558.2 and 507.0 mg iodine/kg, P < 0.001, respectively). However, in patients with a low BMI, the LBW protocol delivered a significantly higher dose than the TBW protocol (620.7 vs 600.0 mg iodine/kg, P < 0.001). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 protocols was within the range of the predetermined equivalence margins in all BMI subgroups. CONCLUSIONS: Contrast enhancement was equivalent under both protocols. The LBW protocol can avoid iodine overdosing, especially in patients with a high BMI.

Does the Tube Voltage Affect the Characterization of Coronary Plaques on 100- and 120-kVp Computed Tomography Scans.

OBJECTIVE: The aim of this study was to compare the diagnostic performance of 100- and 120-kVp coronary computed tomography (CT) angiography (CCTA) scans for the identification of coronary plaque components. METHODS: We included 116 patients with coronary plaques who underwent CCTA and integrated backscatter intravascular ultrasound studies. On 100-kVp scans, we observed 24 fibrous and 24 fatty/fibrofatty plaques; on 120-kVp scans, we noted 27 fibrous and 41 fatty/fibrofatty plaques. We compared the fibrous and the fatty/fibrofatty plaques, the CT number of the coronary lumen, and the radiation dose on scans obtained at 100 and 120 kVp. We also compared the area under the receiver operating characteristic (ROC) curve of the coronary plaques on 100- and 120-kVp scans with their ROC curves on integrated backscatter intravascular ultrasound images. RESULTS: The mean CT numbers of fatty and fatty/fibrofatty plaques were 5.71 ± 36.5 and 76.6 ± 33.7 Hounsfield units (HU), respectively, on 100-kVp scans; on 120-kVp scans, they were 13.9 ± 29.4 and 54.5 ± 22.3 HU, respectively. The CT number of the coronary lumen was 323.1 ± 81.2 HU, and the radiation dose was 563.7 ± 81.2 mGy-cm on 100-kVp scans; these values were 279.3 ± 61.8 HU and 819.1 ± 115.1 mGy-cm on 120-kVp scans. The results of ROC curve analysis identified 30.5 HU as the optimal diagnostic cutoff value for 100-kVp scans (area under the curve = 0.93, 95% confidence interval = 0.87-0.99, sensitivity = 95.8%, specificity = 78.9%); for 120-kVp plaque images, the optimal cutoff was 37.4 HU (area under the curve = 0.87, 95% confidence interval = 0.79-0.96, sensitivity = 82.1%, specificity = 85.7%). CONCLUSIONS: For the discrimination of coronary plaque components, the diagnostic performance of 100- and 120-kVp CCTA scans is comparable.

Effect of Patient Characteristics on Vessel Enhancement in Pediatric Chest Computed Tomography Angiography.

INTRODUCTION: To evaluate the effect of sex, age, height, cardiac output (CO), total body weight (TBW), body surface area (BSA), and lean body weight (LBW) on vessel enhancement of the ascending aorta in pediatric chest computed tomography angiography (c-CTA). MATERIALS AND METHODS: This retrospective study received institutional review board approval; parental prior informed consent for inclusion was obtained for all patients. All 50 patients were examined using our routine protocol; iodine (600 mg/kg) was the contrast medium (CM). Unenhanced and contrast-enhanced scans were obtained. We calculated the CM volume per vessel enhancement and performed univariate and multivariate linear regression analysis of the relationship between CM volume per vessel enhancement and each of the body parameters. RESULTS: All patient characteristics were significantly related to CM volume per vessel enhancement (P < .05). Multivariate linear regression analysis revealed a significant correlation between CM volume per vessel enhancement and TBW, BSA, and LBW, but not the patient sex, age, CO, and height. The LBW model for CM volume per vessel enhancement yielded the highest determination coefficient (R2 = .913) and the lowest Akaike Information Criterion (400.324). CONCLUSIONS: Our findings support the delivery of an iodine dose adjusted to the LBW at c-CTA.

[Usefulness of Fenestrated Catheters for i.v. Contrast Infusion Cardiac CT Angiography for Newborn Patients during the Congenital Heart Disease].

PURPOSE: A three-dimensional (3D) image from computed tomography (CT) angiography is a useful method for evaluation of complex anatomy such as congenital heart disease. However, 3D imaging requires high contrast enhancement for distinguishing between blood vessels and soft tissue. To improve the contrast enhancement, many are increasing the injection rate. However, one method is the use of fenestrated catheters, it allows use of a smaller gauge catheter for high-flow protocols. The purpose of this study was to compare the pressure of injection rate and CT number of a 24-gauge fenestrated catheter with an 22-gauge non-fenestrated catheter for i.v. contrast infusion during CT. METHODS: Between December 2014 and March 2015, 50 newborn patients were randomly divided into two protocols; 22-gauge conventional non-fenestrated catheter (24 newborn; age range 0.25-8 months, body weight 3.6±1.2 kg) and 24-gauge new fenestrated catheter (22 newborn; age range 0.25-12 months, body weight 3.3±0.9 kg). Helical scan of the heart was performed using a 64-detector CT (LightSpeed VCT, GE Healthcare) (tube voltage 80 kV; detector configuration 64×0.625 mm, rotation time 0.4 s/rot, helical pitch 1.375, preset noise index for automatic tube current modulation 40 at 0.625 mm slice thickness). RESULTS: We compared the maximum pressure of injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement between both protocols. The median injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement were 0.9 (0.5-3.4) ml/s, 455.5 (398-659) HU, and 500.0 (437-701) HU in 22-gauge conventional non-fenestrated catheter and 0.9 (0.5-2.0) ml/s, 436.5 (406-632) HU, and 479.5 (445-695) HU in the 24-gauge fenestrated catheter, respectively. There are no significantly different between a 24-gauge fenestrated catheter and 22-gauge non-fenestrated catheters at injection rate and CT number. Maximum pressure of injection rate was lower with 24-gauge non-fenestrated catheters (0.33 kg/cm2) than 22-gauge non-fenestrated catheters (0.55 kg/cm2) (p<0.01Conclusion: A 24-gauge fenestrated catheter performs similarly to an 22-gauge non-fenestrated catheter with respect to i.v. contrast infusion and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 22-gauge catheter.

Conversion of carlactone to carlactonoic acid is a conserved function of MAX1 homologs in strigolactone biosynthesis.

Strigolactones (SLs) are a class of plant hormones which regulate shoot branching and function as host recognition signals for symbionts and parasites in the rhizosphere. However, steps in SL biosynthesis after carlactone (CL) formation remain elusive. This study elucidated the common and diverse functions of MAX1 homologs which catalyze CL oxidation. We have reported previously that ArabidopsisMAX1 converts CL to carlactonoic acid (CLA), whereas a rice MAX1 homolog has been shown to catalyze the conversion of CL to 4-deoxyorobanchol (4DO). To determine which reaction is conserved in the plant kingdom, we investigated the enzymatic function of MAX1 homologs in Arabidopsis, rice, maize, tomato, poplar and Selaginella moellendorffii. The conversion of CL to CLA was found to be a common reaction catalyzed by MAX1 homologs, and MAX1s can be classified into three types: A1-type, converting CL to CLA; A2-type, converting CL to 4DO via CLA; and A3-type, converting CL to CLA and 4DO to orobanchol. CLA was detected in root exudates from poplar and Selaginella, but not ubiquitously in other plants examined in this study, suggesting its role as a species-specific signal in the rhizosphere. This study provides new insights into the roles of MAX1 in endogenous and rhizosphere signaling.

Radiation Dose Reduction With a Low-Tube Voltage Technique for Pediatric Chest Computed Tomographic Angiography Based on the Contrast-to-Noise Ratio Index.

INTRODUCTION: The aim of this study was to evaluate the radiation dose and image quality at low tube-voltage pediatric chest computed tomographic angiography (CTA) that applies the same contrast-to-noise ratio (CNR) index as the standard tube voltage technique. MATERIALS AND METHODS: Contrast-enhanced chest CTA scans of 100 infants were acquired on a 64-row multidetector computed tomography (MDCT) scanner. In the retrospective study, we evaluated 50 images acquired at 120 kVp; the image noise level was set at 25 Hounsfield units. In the prospective study, we used an 80-kVp protocol; the image noise level was 40 Hounsfield units because the iodine contrast was 1.6 times higher than on 120-kVp scans; the CNR was as in the 120-kVp protocol. We compared the CT number, image noise, CT dose index volume (CTDIvol), and the dose-length product on scans acquired with the 2 protocols. A diagnostic radiologist and a pediatric cardiologist visually evaluated all CTA images. RESULTS: The mean CTDIvol and the mean dose-length product were 0.5 mGy and 7.8 mGy-cm for 80- and 1.2 mGy and 20.8 mGy-cm for 120-kVp scans, respectively (P < .001). The mean CTDIvol was 42% lower at 80 kVp than at 120 kVp, and there was no significant difference in the visual scores assigned to the CTA images (P = .28). CONCLUSIONS: With the CNR index being the same at 80-kVp and 120-kVp imaging, the radiation dose delivered to infants subjected to chest CTA can be reduced without degradation of the image quality.

CT Angiography of Suspected Peripheral Artery Disease: Comparison of Contrast Enhancement in the Lower Extremities of Patients Undergoing and Those Not Undergoing Hemodialysis.

OBJECTIVE: The objective of our study was to compare contrast enhancement on CT angiography (CTA) images of the lower extremity in patients with suspected peripheral artery disease who did not undergo hemodialysis (HD) and patients who were scanned before or after HD. MATERIALS AND METHODS: We divided 287 consecutive patients who underwent CTA of the lower extremity on a 64-MDCT scanner into three groups: group 1 patients (n = 151) were not dependent on HD, group 2 patients (n = 70) were dependent on HD and underwent HD less than 24 hours after CTA, and group 3 (n = 66) were dependent on HD and underwent HD less than 24 hours before CTA. We then compared the CT number in the popliteal artery at the level of the patella on all CTA images. A cardiologist and a radiology technologist visually evaluated the depiction of the descending genicular artery (DGA) on the CTA images and assigned a visualization score. RESULTS: The median CT number was lowest in group 2 patients (373 HU vs 429 [group 1] and 418 [group 3] HU). The score for visualization of the DGA was significantly lower in group 2 than in group 1 (p = 0.02) and group 3 (p = 0.04). CONCLUSION: At CTA, arterial enhancement decreases with the passage of time after HD likely because of the increase in intravascular volume. CTA that is performed within 24 hours after HD generates higher-quality images of the lower extremities than CTA that is performed within 24 hours before HD.

Aortic and Hepatic Contrast Enhancement During Hepatic-Arterial and Portal Venous Phase Computed Tomography Scanning: Multivariate Linear Regression Analysis Using Age, Sex, Total Body Weight, Height, and Cardiac Output.

OBJECTIVE: We evaluated the effect of the age, sex, total body weight (TBW), height (HT) and cardiac output (CO) of patients on aortic and hepatic contrast enhancement during hepatic-arterial phase (HAP) and portal venous phase (PVP) computed tomography (CT) scanning. METHODS: This prospective study received institutional review board approval; prior informed consent to participate was obtained from all 168 patients. All were examined using our routine protocol; the contrast material was 600 mg/kg iodine. Cardiac output was measured with a portable electrical velocimeter within 5 minutes of starting the CT scan. We calculated contrast enhancement (per gram of iodine: [INCREMENT]HU/gI) of the abdominal aorta during the HAP and of the liver parenchyma during the PVP. We performed univariate and multivariate linear regression analysis between all patient characteristics and the [INCREMENT]HU/gI of aortic- and liver parenchymal enhancement. RESULTS: Univariate linear regression analysis demonstrated statistically significant correlations between the [INCREMENT]HU/gI and the age, sex, TBW, HT, and CO (all P < 0.001). However, multivariate linear regression analysis showed that only the TBW and CO were of independent predictive value (P < 0.001). Also, only the CO was independently and negatively related to aortic enhancement during HAP and to liver parenchymal enhancement when the contrast material injection protocol was adjusted for the TBW (P < 0.001). CONCLUSION: By multivariate linear regression analysis only the TBW and CO were significantly correlated with aortic and liver parenchymal enhancement; the age, sex, and HT were not. The CO was the only independent factor affecting aortic and liver parenchymal enhancement at hepatic CT when the protocol was adjusted for the TBW.

[Study of CT Automatic Exposure Control System (CT-AEC) Optimization in CT Angiography of Lower Extremity Artery by Considering Contrast-to-Noise Ratio].

PURPOSE: To evaluate the image quality and effect of radiation dose reduction by setting for computed tomography automatic exposure control system (CT-AEC) in computed tomographic angiography (CTA) of lower extremity artery. METHODS: Two methods of setting were compared for CT-AEC [conventional and contrast-to-noise ratio (CNR) methods]. Conventional method was set noise index (NI): 14and tube current threshold: 10-750 mA. CNR method was set NI: 18, minimum tube current: (X+Y)/2 mA (X, Y: maximum X (Y)-axis tube current value of leg in NI: 14), and maximum tube current: 750 mA. The image quality was evaluated by CNR, and radiation dose reduction was evaluated by dose-length-product (DLP). RESULTS: In conventional method, mean CNRs for pelvis, femur, and leg were 19.9±4.8, 20.4±5.4, and 16.2±4.3, respectively. There was a significant difference between the CNRs of pelvis and leg (P<0.001), and between femur and leg (P<0.001). In CNR method, mean CNRs for pelvis, femur, and leg were 15.2±3.3, 15.3±3.2, and 15.3±3.1, respectively; no significant difference between pelvis, femur, and leg (P=0.973) in CNR method was observed. Mean DLPs were 1457±434 mGy⋅cm in conventional method, and 1049±434 mGy·cm in CNR method. There was a significant difference in the DLPs of conventional method and CNR method (P<0.001). CONCLUSION: CNR method gave equal CNRs for pelvis, femur, and leg, and was beneficial for radiation dose reduction in CTA of lower extremity artery.