2/05/2014

3DRA protocol

General rule: Inject into chamber or vessel proximal to area of interest.
All injections are over 5 secs. (4 sec acquisition starts after 1 sec delay to allow for uniform opacification from the beginning of image acquisistion)
Contrast: Isoview

Great arteries: (Aorta, PA, RV-PA conduits)
    (i) Contrast:Saline dilution = 2:1
    (ii) Total volume of injection: 3 ml/kg over 5 seconds
    (iii) Generally, need to inject prior to segment of interest. May inject in MPA or aortic root for distal vessels

Central systemic veins: (SVC, IVC)
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 0.75 - 1.5 ml/kg
   (iii) Inject into proximal vein

Glenn anastamosis & Branch PAs:
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 1.5 ml/kg
   (iii) Inject into high SVC or Innominate vein
   (iv) Note: Wash-out from A-P collateral flow into branch PA may interfere with 3D reconstruction.

Fontan:
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 1.5 ml/kg (Divided for simultaneous SVC/IVC injections. Usually, 50/50. But, this may vary based on flow characteristics of SVC/IVC flow into each branch PAs).
   (iii) Note: Wash-out from A-P collateral flow into branch PA may interfere with 3D reconstruction.

Pulmonary veins:
   (i) Undiluted contrast
   (ii) Total volume of injection: Varies depending upon vein size, degree of stenosis, collateralization, etc.
   (iii) Inject as PA wedge angiogram. Begin injection, but wait until contrast appears in pulmonary veins before initation of rotation.

Selective Coronary Artery:
   (i) Undiluted contrast
   (ii) Total volume of injection: Inject enough to opacify vessel during the entire acquisition. Amount varies based on vessel size, stenosis, etc.

Surgical shunts (e.g. BT shunt):
   (i) Undiluted contrast
   (ii) Total volume of contrast: Enough to opacify the vessels during the entire acquisition. Amount varies depending on anatomy.
   (iii) Inject using a end-hole catheter with proximal balloon occlusion (if possible)

(Adapted from Denver Children's Hospital Protocol. Courtesy: Dr. Tom Fagan).