Circulation, Vol 84, 2071-2078, Copyright © 1991 by American Heart Association
JM Canty Jr, RM Judd, AS Brody and FJ Klocke
BACKGROUND. Almost all x-ray-based techniques intended to assess regional
myocardial perfusion from myocardial concentration-time curves following
the administration of soluble contrast agents assume that these agents
behave as intravascular indicators and can therefore provide measurements
of intravascular transit time and intramyocardial blood volume. METHODS AND
RESULTS. We tested this assumption by comparing a conventional nonionic
contrast agent (ioversol) to a particulate emulsion (ethiodol) that
remained in the vascular space in closed-chest dogs during pharmacological
vasodilation. Using fast computed tomography (CT), pairs of myocardial CT
intensity-time curves were obtained following sequential bolus aortic
administration of the two contrast agents. The emulsion (particle size less
than 3 microns) was almost completely washed out of the myocardial region
of interest within a few seconds, as would be anticipated for a vascular
indicator. At the onset of recirculation, CT intensity for ethiodol fell to
5 +/- 1% (SEM) of peak values in normally perfused areas and to 10 +/- 4%
of peak values in an area in which flow had been reduced by 50% by a
chronically implanted coronary artery occluder (p = NS). In comparison, the
diffusible nonionic contrast agent ioversol showed substantial
intramyocardial retention at the onset of recirculation. At the time of
recirculation, CT intensities for ioversol averaged 36 +/- 2% of peak
values in normally perfused nonstenotic areas and 54 +/- 4% of peak values
in stenotic areas (p less than 0.01). Using residue function analysis for a
diffusible indicator, first-pass extractions of the conventional nonionic
agent averaged 33 +/- 2% in normally perfused areas and 50 +/- 3% in
stenotic areas (p less than 0.01). Because of the significant first-pass
myocardial retention of ioversol, both mean myocardial appearance time and
intramyocardial blood volume were consistently overestimated. CONCLUSIONS.
Soluble radiographic contrast agents, like other small molecules, enter the
interstitial space to a degree, which is important because it affects
estimates of myocardial perfusion based on transit time and intramyocardial
blood volume. Indicator dilution models intended to quantify myocardial
perfusion with conventional radiographic contrast agents need to account
for this extravascular exchange.
ARTICLES
First-pass entry of nonionic contrast agent into the myocardial extravascular space. Effects on radiographic estimates of transit time and blood volume
Department of Medicine, State University of New York, Buffalo School of Medicine.
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