The improvement of cardiac multispiral computed tomography protocol for planning interventional arrhythmia management

Purpose . Comparison of computer tomography (СT) contrast enhancement (CE) protocols for optimal visualization of cardiac chamber, definition it’s influence on results of non-invasive superficial cardiac mapping. Materials and methods. The study included 93 patients with heart rhythm disorders who planned catheter ablation of arrhythmia. Noninvasive cardiac mapping was made for topical diagnostics. It includes multichannel ECG-registration and CT with intravenous СE (1st group monophasic (50 patients), 2nd group split-bolus (18 patients), 3rd group with pre-bolus (25 patients). Qualitative and quantitative (measurement of mean blood attenuation in four chambers, calculation of ventricular-myocardial contrast-to-noise ratio VM-LV и VM-RV for left ventricle (LV) and right ventricle (RV), respectively) parameters were compared between groups. Fusion of ECG and CT data was made semi-automatic with diagnostic complex «Amycard 01К». Results. Regardless of CE technique was noted sufficient and homogeneous contrast attenuation of left atrium (LA) and LV (mean blood attenuation in LA more than 278 HU, LV 250 HU, VM-LV 0,582). Enhancement of right heart was insufficient with monophasic protocol, in most cases the average CT density was lower than 200 HU, VM-RV 0,256. Split-bolus protocol improves visualization of right atrium (RA) and RV (blood density in RA 258HU, RV 227HU, VM-RV 0,541), however there was heterogeneity of RA cavity because of artifacts from superior vena cava (VC) and unenhanced blood from inferior inferior VC. Using of pre-bolus increases contrast ratio between RA myocardium and blood due to increasing CT density of blood in inferior VC (blood density 294 HU). Quality of right ventricle CE was similar to 2nd group (blood density 264 HU, VM-RV 0,565). Conclusion. CE protocols split-bolus and with pre-bolus improve visualization of right ventricle, supporting the high level enhancement of left heart. Protocol with pre-bolus is preferable for exact differentiation of right atrial endocardial contour.