Ultra-Low-Dose Intra-Arterial Contrast Injection for Iliofemoral Computed Tomographic Angiography
Subodh B. Joshi, MBBS*, ,*,
Dorinna D. Mendoza, MD*,
Daniel H. Steinberg, MD*,
Matthew A. Goldstein, MD*,
Cristian F. Lopez, MD*,
Arnold Raizon, MD*,
Gaby Weissman, MD*,
Lowell F. Satler, MD*,
Augusto D. Pichard, MD*,
Wm. Guy Weigold, MD*
* Section of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC
Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Figure 1 3-Dimensional Image From CT Angiogram
Volume-rendered image of intra-arterial computed tomography (CT) angiogram obtained with 10 ml of intra-arterial contrast injection. The catheter and sheath can be seen entering the right common femoral artery (arrow).
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Figure 2 Intra-Arterial CT Angiogram
Multiplanar reformatted images of intra-arterial computed tomography (CT) angiogram. The cross-sectional minimal luminal diameter is measured perpendicular to the long axis of the vessel. The catheter is visible in the aorta and right common iliac artery (blue arrows), and there is calcified plaque evident in both common iliac arteries. In the bottom right image, calcification is noted at the ostium of the left internal iliac artery (red arrow), although the true reduction in luminal diameter cannot be assessed on this imaging plane.
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Figure 3 Focal Arterial Stenosis
(A) Conventional angiogram. (B) Intra-arterial computed tomography angiogram of the same patient revealing severe focal left iliac artery stenosis (arrow) on curved multiplanar reformatted images. The top right inset image shows the reduction in lumen size with the vessel in cross-section, the middle inset image is a volume-rendered image, and the bottom inset image is another curved multiplanar reformation orthogonal to the main image.
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Figure 4 Tortuous Course
(A) Conventional angiogram. (B) Volume-rendered image of an intra-arterial computed tomography angiogram of the same patient, confirming marked tortuosity of the right iliac artery as it courses posteriorly in the pelvis.
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Figure 5 Arterial Dissection
(A) Conventional angiogram. (B) Curved multiplanar reformatted images of an intra-arterial computed tomography angiogram revealing extensive dissection of the right iliac and femoral arteries. The intimal flap (red arrows) and its association with the catheter (blue arrows) can be seen. (The dissection is likely to have been iatrogenic as part of the diagnostic cardiac catheterization and had no clinical sequelae).
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Figure 6 Atherosclerotic Plaque
(A) Conventional angiogram. (B) Maximum-intensity projection reformatted image of an intra-arterial computed tomography angiogram revealing calcified atherosclerotic plaque in the proximal left common iliac artery. The catheter is also visible (blue arrow).
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Figure 7 Bland-Altman Plot
Bland-Altman plot showing a 1-mm overestimation of vessel diameter by conventional angiography (CA) compared with intra-arterial contrast injection computed tomographic angiography (IA-CTA), and limits of agreement.
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