The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

• DOI: 10.1007/s00330-017-4866-0
• Publication Date: 2017-05-24T14:22:37Z
• Authors: Júlia Karády; Alexisz Panajotu; Márton Kolossváry; Bálint Szilveszter; Ádám L. Jermendy; Andrea Bartykowszki; Mihály Károlyi; Csilla Celeng; Béla Merkely; Pál Maurovich-Horvat
• Keywords: Male; Dose-Response Relationship, Drug; Computed Tomography Angiography; 610; Contrast Media; Coronary Artery Disease; Middle Aged; Coronary Angiography; Iopamidol; 3. Good health; 03 medical and health sciences; Computed Tomography; 0302 clinical medicine; Injections, Intravenous; Humans; Female; Single-Blind Method; Prospective Studies; Follow-Up Studies

Contrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA.Patients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol.2,445 consecutive patients were enrolled (mean age 60.6 ± 12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p = 0.034).Four-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA.• Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. • The saline pacer bolus substantially reduces the risk of CM extravasation. • The implementation of four-phasic injection-protocol is at no cost.