Serial assessment of computed tomography angiography for pulmonary and systemic arteries using a reduced contrast agent dose for the diagnosis of systemic artery-to-pulmonary artery shunts

TL;DR

This study shows that a modified CT scan protocol with reduced contrast agent improves the diagnosis of abnormal blood vessel connections between systemic and pulmonary arteries.

Contribution

The study introduces a reduced contrast CT protocol (CTA-PS) that enhances diagnostic accuracy for systemic artery-to-pulmonary artery shunts.

Findings

CTA-PS achieved higher sensitivity (81.0%) and accuracy (84.0%) compared to CTA-P for diagnosing shunts.

CTA-PS showed better visualization of shunt-related findings than individual CTA-P or CTA-S assessments.

The AUC for CTA-PS (0.911) was higher than for CTA-P (0.835), though not statistically significant.

Abstract

To evaluate the diagnostic performance and feasibility of a modified computed tomography (CT) scan protocol, we performed a serial assessment of the computed tomography angiography for pulmonary artery (CTA-P) and systemic artery (CTA-S) (CTA-PS) using a reduced contrast agent dose to diagnose systemic artery-to-pulmonary artery shunts (SPSs).

Twenty-five patients who underwent multiphase contrast-enhanced chest CT and conventional chest angiography were included. Three image sets (CTA-P, CTA-S, and CTA-PS) were evaluated by two board-certified radiologists. The visualization of the CT image findings associated with SPSs, such as filling defects and enhancement in the pulmonary arteries, was evaluated using a 5-point scale.

The diagnostic performance (sensitivity, specificity, and accuracy) of CT imaging findings associated with SPSs in CTA-P and CTA-PS were as follows: CTA-P, 57.1%, 87.5%, and 62.0%; CTA-PS, 81.0%, 100.0%, and 84.0%. CT findings associated with SPSs in CTA-P were significantly sensitive to the CTA-PS protocol. There were no significant differences between the CTA-S and CTA-PS protocols. The area under the curve (AUC) of the CT imaging findings associated with SPSs in the CTA-P and CTA-PS groups was 0.835 and 0.911, respectively (P = 0.191). The AUC of the CT imaging findings associated with SPSs in CTA-S and CTA-PS were 0.891 and 0.926, respectively (P = 0.373).

CTA-PS using a reduced contrast agent dose protocol could improve the overall diagnostic confidence of SPSs, owing to better visualization of CT imaging findings associated with SPSs compared to individual assessments of CTA-P or CTA-S. Therefore, CTA-PS can be used as an alternative preembolization evaluation modality to conventional angiography in patients with hemoptysis suspected of having SPSs.

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