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CTA Pelvis Cyclist Iliac Artery Maneuver

Last Updated: 2026-01-01 Author:

  • 1. Clinical Summary

    Series Phase Coverage
    CTA Resting Position Arterial (bolus tracked) Mid-liver to 3cm below greater trochanter
    CTA Hip Flexion Contrast (Immediately after delay) Mid-liver to 3cm below greater trochanter
    • External iliac artery endofibrosis
    • Cyclist with exercise-induced leg symptoms

  • 2. Patient Prep

    • Position: Supine initially then with hip flexion
    • NPO Status: NPO 2-4 hours

  • 3. IV Contrast & Injection

    Parameter Value
    Agent Isovue 370
    Volume Split bolus: 1st injection 1.1 mL/kg + 2nd injection 1.1 mL/kg
    Flow Rate 4 mL/s
    Duration 1st injection 18s + 2nd injection 18s
    Timing Method Dual position: Resting + Hip flexion cycling position
    ROI Placement External iliac artery
    Trigger (HU) 150 HU

    Use full dose if GFR > 30

    If GFR < 30

    Max Contrast = \(2*\left[\frac{\text{Patient Weight}}{75 \text{ kg}} * \text{eGFR}\right]\)

  • 4. Special Notes

    • TWO acquisitions: 1) Resting supine 2) Hip flexion simulating cycling position. Bilateral imaging for comparison
    • Additional Recons: Side-by-side MIP of rest vs flexion. Measure degree of stenosis. 3D VR
    • 18-20G IV

    Safety First

    • Renal Function: Verify eGFR > 30
    • Allergy: Check allergy history. Explain hip flexion positioning
    • Compare resting vs flexed position. Look for iliac artery kinking stenosis or occlusion with hip flexion. Common in competitive cyclists
    • Position patient with knees bent and hips flexed to simulate cycling. May need positioning aids
Series Name Start Location End Location Delay Slice Thickness Notes
Scout/Topogram L3 Proximal femur N/A N/A AP pelvis
CTA Resting Position L3 Mid femur Bolus tracked 0.625 mm Supine resting position
CTA Hip Flexion L3 Mid femur Immediately after 0.625 mm Hips flexed 90 degrees - cycling position
Plane Acquisition FOV Thickness/Increment Kernel IR Strength Notes
Axial Resting Pelvis 1.5 mm/1.5 mm Vascular 3 Baseline iliac artery anatomy
Axial Flexion Pelvis 1.5 mm/1.5 mm Vascular 3 Assess for kinking with flexion
Coronal Both phases Pelvis 2 mm/2 mm Vascular 3 MIP comparison rest vs flexion
Sagittal Both phases Pelvis 2 mm/2 mm Vascular 3 Lateral view iliac course