Catheter contrast-enhanced coronary CT-angiography using an aortic root injection- preliminary technical development in four patients

The feasibility of performing coronary computed tomographic angiography (CTA) with an intra-aortic injection of iodinated contrast was tested in four patients immediately following diagnostic cardiac catheterization and placement of a 6-french pigtail catheter into the aortic root. A diluted contrast mixture [75 cc Omnipaque 350 mixed with 125 cc normal saline (4-slice scanner) vs. 40 cc Omnipaque 350 mixed with 60 cc normal saline (16-slice scanner)] was injected at a rate of 6 to 7.7 cc/sec at the onset of breath-hold and helical (4 slice, n = 3, and 16-slice, n = 1) retrospective ECG-triggered acquisition. The proximal and distal coronary vasculature including small tributaries were depicted with high signal-to-noise (S/N) and free from underlying blood pool enhancement. The right coronary artery was sub optimally enhanced in two patients. No significant disease was found on CTA or XRA in two patients; however, severe multi-vessel disease was demonstrated on both modalities in two patients. Catheter contrast-enhanced coronary CTA is feasible utilizing low injection rates and low iodinated contrast volumes, however, catheter modifications are required for consistent and homogeneous opacification of the aortic root.