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<meta name="DC.Title" content="Use of CTA Test Dose to Trigger a Low Cardiac Output Protocol Improves Acute Stroke CTP Data Analyzed with RAPID Software" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7428" />
<meta name="DC.Date" content="2022-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2022 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Contrast curve truncation in CTP protocols may introduce errors. We sought to identify risk factors and design a protocol to avoid truncation while limiting radiation.

MATERIALS AND METHODS: In an initial fixed-timing cohort, patients underwent a 65-second CTP with 2-second delay postcontrast injection. Multivariable analysis identified factors associated with truncation. A later case-specific cohort underwent either the original protocol or a low cardiac output protocol with a 7-second delay and 75-second scanning window, with selection determined by CTA test-dose enhancement upswing delay. Time-density curves were assessed for truncation and compared between the 2 groups, and the radiation dose was evaluated.

RESULTS: From September 2017 through May 2018, one hundred fifty-three patients underwent the standard fixed-timing protocol. Age (OR, 1.82/10-year increase; P  = .019), reduced left ventricle ejection fraction (OR, 9.23; P  = .001), and hypertension (OR, 0.32; P  = .06) were independently associated with truncation in an exploratory multivariable model. From May 2018 through April 2019, one hundred fifty-seven patients underwent either the standard (72 patients) or low cardiac output protocol (85 patients). The fixed-timing cohort had 15 truncations (9.8%) versus 4 in the case-specific cohort (2.5%; P  = .009). If the low cardiac output protocol were applied to those with &gt;10.6% predicted risk of truncation based on age, left ventricle ejection fraction, and hypertension, the number of truncations would have decreased from 15 to 4 in the fixed-timing cohort.

CONCLUSIONS: Older age, left ventricle ejection fraction, and the absence of hypertension increase the risk of time-density curve truncation. However, a CTA test-dose-directed case-specific protocol can reduce truncation to ensure accurate data while mitigating radiation dose increases.

AUC
:   area under the curve
DLP
:   dose-length product
LCO
:   low cardiac output
rLVEF
:   reduced left ventricular ejection fraction
TDC
:   time density curve" />
<meta name="DC.Contributor" content="J.B. Hartman" />
<meta name="DC.Contributor" content="S. Moran" />
<meta name="DC.Contributor" content="C. Zhu" />
<meta name="DC.Contributor" content="J. Sharp" />
<meta name="DC.Contributor" content="D.S. Hippe" />
<meta name="DC.Contributor" content="D.A. Zamora" />
<meta name="DC.Contributor" content="M. Mossa-Basha" />
<meta name="article:published_time" content="2022-03-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Use of CTA Test Dose to Trigger a Low Cardiac Output Protocol Improves Acute Stroke CTP Data Analyzed with RAPID Software" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Contrast curve truncation in CTP protocols may introduce errors. We sought to identify risk factors and design a protocol to avoid truncation while limiting radiation.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;In an initial fixed-timing cohort, patients underwent a 65-second CTP with 2-second delay postcontrast injection. Multivariable analysis identified factors associated with truncation. A later case-specific cohort underwent either the original protocol or a low cardiac output protocol with a 7-second delay and 75-second scanning window, with selection determined by CTA test-dose enhancement upswing delay. Time-density curves were assessed for truncation and compared between the 2 groups, and the radiation dose was evaluated.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;From September 2017 through May 2018, one hundred fifty-three patients underwent the standard fixed-timing protocol. Age (OR, 1.82/10-year increase; &lt;i&gt;P &lt;/i&gt;= .019), reduced left ventricle ejection fraction (OR, 9.23; &lt;i&gt;P &lt;/i&gt;= .001), and hypertension (OR, 0.32; &lt;i&gt;P &lt;/i&gt;= .06) were independently associated with truncation in an exploratory multivariable model. From May 2018 through April 2019, one hundred fifty-seven patients underwent either the standard (72 patients) or low cardiac output protocol (85 patients). The fixed-timing cohort had 15 truncations (9.8%) versus 4 in the case-specific cohort (2.5%; &lt;i&gt;P &lt;/i&gt;= .009). If the low cardiac output protocol were applied to those with &amp;gt;10.6% predicted risk of truncation based on age, left ventricle ejection fraction, and hypertension, the number of truncations would have decreased from 15 to 4 in the fixed-timing cohort.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Older age, left ventricle ejection fraction, and the absence of hypertension increase the risk of time-density curve truncation. However, a CTA test-dose-directed case-specific protocol can reduce truncation to ensure accurate data while mitigating radiation dose increases.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2022/03/01" />
<meta name="citation_mjid" content="ajnr;43/3/388" />
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<meta name="citation_issn" content="0195-6108" />
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<meta name="citation_doi" content="10.3174/ajnr.A7428" />
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<meta name="citation_firstpage" content="388" />
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<meta name="citation_author" content="J.B. Hartman" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-1378-8015" />
<meta name="citation_author" content="S. Moran" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-5801-3598" />
<meta name="citation_author" content="C. Zhu" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington" />
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<meta name="citation_author" content="J. Sharp" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington" />
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<meta name="twitter:title" content="Use of CTA Test Dose to Trigger a Low Cardiac Output Protocol Improves Acute Stroke CTP Data Analyzed with RAPID Software" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/43/3.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Contrast curve truncation in CTP protocols may introduce errors. We sought to identify risk factors and design a protocol to avoid truncation while limiting radiation.

MATERIALS AND METHODS: In an initial fixed-timing cohort, patients underwent a 65-second CTP with 2-second delay postcontrast injection. Multivariable analysis identified factors associated with truncation. A later case-specific cohort underwent either the original protocol or a low cardiac output protocol with a 7-second delay and 75-second scanning window, with selection determined by CTA test-dose enhancement upswing delay. Time-density curves were assessed for truncation and compared between the 2 groups, and the radiation dose was evaluated.

RESULTS: From September 2017 through May 2018, one hundred fifty-three patients underwent the standard fixed-timing protocol. Age (OR, 1.82/10-year increase; P  = .019), reduced left ventricle ejection fraction (OR, 9.23; P  = .001), and hypertension (OR, 0.32; P  = .06) were independently associated with truncation in an exploratory multivariable model. From May 2018 through April 2019, one hundred fifty-seven patients underwent either the standard (72 patients) or low cardiac output protocol (85 patients). The fixed-timing cohort had 15 truncations (9.8%) versus 4 in the case-specific cohort (2.5%; P  = .009). If the low cardiac output protocol were applied to those with &gt;10.6% predicted risk of truncation based on age, left ventricle ejection fraction, and hypertension, the number of truncations would have decreased from 15 to 4 in the fixed-timing cohort.

CONCLUSIONS: Older age, left ventricle ejection fraction, and the absence of hypertension increase the risk of time-density curve truncation. However, a CTA test-dose-directed case-specific protocol can reduce truncation to ensure accurate data while mitigating radiation dose increases.

AUC
:   area under the curve
DLP
:   dose-length product
LCO
:   low cardiac output
rLVEF
:   reduced left ventricular ejection fraction
TDC
:   time density curve" />
<meta name="og-title" property="og:title" content="Use of CTA Test Dose to Trigger a Low Cardiac Output Protocol Improves Acute Stroke CTP Data Analyzed with RAPID Software" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/43/3/388" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Contrast curve truncation in CTP protocols may introduce errors. We sought to identify risk factors and design a protocol to avoid truncation while limiting radiation.

MATERIALS AND METHODS: In an initial fixed-timing cohort, patients underwent a 65-second CTP with 2-second delay postcontrast injection. Multivariable analysis identified factors associated with truncation. A later case-specific cohort underwent either the original protocol or a low cardiac output protocol with a 7-second delay and 75-second scanning window, with selection determined by CTA test-dose enhancement upswing delay. Time-density curves were assessed for truncation and compared between the 2 groups, and the radiation dose was evaluated.

RESULTS: From September 2017 through May 2018, one hundred fifty-three patients underwent the standard fixed-timing protocol. Age (OR, 1.82/10-year increase; P  = .019), reduced left ventricle ejection fraction (OR, 9.23; P  = .001), and hypertension (OR, 0.32; P  = .06) were independently associated with truncation in an exploratory multivariable model. From May 2018 through April 2019, one hundred fifty-seven patients underwent either the standard (72 patients) or low cardiac output protocol (85 patients). The fixed-timing cohort had 15 truncations (9.8%) versus 4 in the case-specific cohort (2.5%; P  = .009). If the low cardiac output protocol were applied to those with &gt;10.6% predicted risk of truncation based on age, left ventricle ejection fraction, and hypertension, the number of truncations would have decreased from 15 to 4 in the fixed-timing cohort.

CONCLUSIONS: Older age, left ventricle ejection fraction, and the absence of hypertension increase the risk of time-density curve truncation. However, a CTA test-dose-directed case-specific protocol can reduce truncation to ensure accurate data while mitigating radiation dose increases.

AUC
:   area under the curve
DLP
:   dose-length product
LCO
:   low cardiac output
rLVEF
:   reduced left ventricular ejection fraction
TDC
:   time density curve" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.B. Hartman</span>, <span class="highwire-citation-author" data-delta="1">S. Moran</span>, <span class="highwire-citation-author" data-delta="2">C. Zhu</span>, <span class="highwire-citation-author" data-delta="3">J. Sharp</span>, <span class="highwire-citation-author" data-delta="4">D.S. Hippe</span>, <span class="highwire-citation-author" data-delta="5">D.A. Zamora</span> and <span class="highwire-citation-author" data-delta="6">M. Mossa-Basha</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2022,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">388-393; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7428 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-96112--61406933244" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.B. Hartman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.B.%2BHartman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hartman%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.B.%2BHartman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1378-8015" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.B. Hartman</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S. Moran </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BMoran%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Moran%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BMoran%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5801-3598" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Moran</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">C. Zhu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BZhu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhu%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BZhu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6898-549X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Zhu</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J. Sharp </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.B.H., S.M., C.Z., J.S., D.A.Z., M.M.-B.), University of Washington, Seattle, Washington</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BSharp%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sharp%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BSharp%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6920-4680" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Sharp</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">D.S. Hippe </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Clinical Research Division (D.S.H.), Fred Hutchinson Cancer Research Center, Seattle, Washington</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.S.%2BHippe%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hippe%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.S.%2BHippe%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2427-4404" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.S. Hippe</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">D.A. 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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.B.</span> <span class="nlm-surname">Hartman</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Moran</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Zhu</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Sharp</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.S.</span> <span class="nlm-surname">Hippe</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.A.</span> <span class="nlm-surname">Zamora</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Mossa-Basha</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">388-393; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7428 </span></div>
  
  
  
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      <div class="highwire-cite-title">Use of CTA Test Dose to Trigger a Low Cardiac Output Protocol Improves Acute Stroke CTP Data Analyzed with RAPID Software</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.B.</span> <span class="nlm-surname">Hartman</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Moran</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Zhu</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Sharp</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.S.</span> <span class="nlm-surname">Hippe</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.A.</span> <span class="nlm-surname">Zamora</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Mossa-Basha</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2022, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">388-393; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A7428 </span></div>
  
  
  
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