title: Right heart: split-bolus injection of diluted contrast medium for visualization at coronary CT angiography.
abstract: OBJECTIVE
  To retrospectively compare a split-bolus contrast medium injection protocol with a biphasic and a monophasic protocol in terms of visualization of the right and left heart, contrast medium-related streak artifacts, and level of attenuation in the cardiac chambers and coronary arteries at coronary computed tomographic (CT) angiography.
  
  
  METHODS
  The human research committee approved this HIPAA-compliant study and waived informed consent. Seventy-five patients had undergone 64-section coronary CT angiography: 25 were injected by using a monophasic, contrast-medium-only protocol with a single-syringe injector; 25 were injected by using a biphasic protocol with a dual-syringe injector; and 25 were injected by using a split-bolus protocol with a dual-syringe injector and an initial bolus of contrast medium followed by 50 mL of a 70%:30% saline-to-contrast medium mixture and a 30-mL saline chaser. Two radiologists rated the visualization of right and left heart structures and the degree of streak artifacts. One observer performed attenuation measurements of the cardiac chambers and of the coronary arteries. Data were analyzed with one-way analysis of variance and Duncan post-hoc multiple comparison procedures.
  
  
  RESULTS
  Data for 27 women and 48 men (mean age, 62 years) were included. Mean contrast medium attenuation in the right heart was significantly (P < .001) higher in the split-bolus group than in the biphasic injection group but was significantly (P < .001) lower than in the monophasic injection group. For the left heart and the coronary arteries, there were no significant differences among the three groups. Artifacts occurred less frequently (P < .001) in the biphasic and split-bolus groups than in the monophasic group. Visualization of right heart structures was rated significantly (P < .05) better in the split-bolus group than in the two other groups, while there was no difference for visualization of left heart structures.
  
  
  CONCLUSIONS
  Split-bolus injection provides sufficient attenuation for visualization of the right heart, while streak artifacts from high-attenuation contrast material can generally be avoided and arterial attenuation is maintained.
authors: Department of Radiology, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425, USA.
authors: J Matthias
authors: JM
authors: Kerl
authors: James G
authors: JG
authors: Ravenel
authors: Shaun A
authors: SA
authors: Nguyen
authors: Pal
authors: P
authors: Suranyi
authors: Christian
authors: C
authors: Thilo
authors: Philip
authors: P
authors: Costello
authors: Werner
authors: W
authors: Bautz
authors: U Joseph
authors: UJ
authors: Schoepf
mesh_terms: D000704:Analysis of Variance; D016477:Artifacts; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007479:Iopamidol / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol