Abdominal Multidetector CT in Patients with Varying Body Fat Percentages: Estimation of Optimal Contrast Material Dose

Kondo, Hiroshi; Kanematsu, Masayuki; Goshima, Satoshi; Tomita, Yuhei; Miyoshi, Toshiharu; Hatcho, Atsushi; Moriyama, Noriyuki; Onozuka, Minoru; Shiratori, Yoshimune; Bae, Kyongtae T.

doi:10.1148/radiol.2492080033

Cited by 63 publications

(54 citation statements)

References 20 publications

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“…Therefore, obese patients have a tendency to receive unnecessarily high doses of contrast media while muscular patients may receive doses that are too low. The observation of an association between abdominal fat and hepatic enhancement in the present study is consistent with some previous observations (11,13). Ho et al (11) reported that body fat proportion affected hepatic enhancement greatly, and that calculations of contrast media dose on the basis of measured lean BW marginally increased patient-to-patient uniformity with respect to hepatic parenchyma and vascular enhancement.…”

Section: Discussionsupporting

confidence: 93%

“…Although anthropometric markers such as waist circumstance and body mass index are conveniently measured, they are estimates and are not accurate. Kondo et al (13) used body fat percentage to evaluate the association between body fat and hepatic enhancement, and their results indicated that the correlation with hepatic enhancement was higher for body fat percentage than for other anthropometric markers. However, the measurement of body fat percentage requires a special instrument that is not always available.…”

Section: Discussionmentioning

confidence: 99%

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Correlation of abdominal fat ratio with hepatic CT enhancement

Zhang

Guo

2015

Experimental and Therapeutic Medicine

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Abstract. The objective of the study was to evaluate the effect of abdominal fat proportion on hepatic computed tomography (CT) enhancement. CT data for 87 patients (47 men, mean age 55.09±13.27 years; 40 women, mean age 60.43±11.29 years) were analyzed by linear regression to assess the association of patient age and abdominal fat proportion with adjusted maximal hepatic enhancement (aMHE), calculated by dividing the maximal hepatic enhancement by the dose of iodine injected per kilogram of patient body weight, for each gender. The abdominal fat ratio (AFR) at the umbilical level, calculated as the volume of abdominal fat divided by the total abdominal volume, was used as a marker of abdominal fat proportion. It was found that aMHE was positively correlated with AFR for men (r=0.48, P<0.01) and women (r=0.46, P<0.01) but not with patient age (r=-0.09 and -0.14, respectively, both P>0.05). Therefore, it was concluded that determining an iodine dose on the basis of AFR might be an optimal way to maintain constant hepatic enhancement.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Correlation of abdominal fat ratio with hepatic CT enhancement

Zhang

Guo

2015

Experimental and Therapeutic Medicine

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“…Our data also indicated a weakly positive association between the patient's body weight and contrast enhancement of the liver and portal vein during the hepatic venous phase for both contrast media and both injection schemes. This trend is in agreement with the results of a recent study [28] and supports the concept that a body weight-tailored approach for determining contrast medium dose may result in inconsistent enhancement among different patients. Such an approach could lead to (1) excessively high doses of contrast material in heavier patients, thus increasing the risk of renal toxicity and material cost, or (2) inappropriately low doses in smaller patients, thus compromising the diagnostic quality of the CT examination.…”

Section: Effect Of Contrast Materials Iodine Concentrations During LIVsupporting

confidence: 91%

“…Such an approach could lead to (1) excessively high doses of contrast material in heavier patients, thus increasing the risk of renal toxicity and material cost, or (2) inappropriately low doses in smaller patients, thus compromising the diagnostic quality of the CT examination. Other more accurate descriptors of a patient's body composition, such as lean body weight, body surface area and blood volume, appear promising and are currently under investigation for reducing interpatient variability of contrast medium enhancement on abdominal MDCT [28][29][30].…”

Section: Effect Of Contrast Materials Iodine Concentrations During LIVmentioning

confidence: 99%

Effect of varying contrast material iodine concentration and injection technique on the conspicuity of hepatocellular carcinoma during 64-section MDCT of patients with cirrhosis

Guerrisi

Marin

Nelson

et al. 2011

BJR

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Objectives: The aim of this study was to compare the intraindividual effects of contrast material with two different iodine concentrations on the conspicuity of hepatocellular carcinoma (HCC) and vascular and hepatic contrast enhancement during multiphasic, 64-section multidetector row CT (MDCT) in patients with cirrhosis using two contrast medium injection techniques. Methods: Patients were randomly assigned to one of two groups with an equal iodine dose but different contrast material injection techniques: scheme A, fixed injection duration (25 s), and scheme B, fixed injection flow rate (4 ml s 21). For each group, patients were randomised to receive both moderate-concentration contrast medium (MCCM) and high-concentration contrast medium (HCCM) during two CT examinations within 3 months. Enhancement of the aorta, liver and portal vein and the tumour-toliver contrast-to-noise ratio (CNR) were compared between MCCM and HCCM. Results: 30 patients (mean age 59 years; range 45-80 years; 16 patients in scheme A and 14 in scheme B) with a total of 31 confirmed HCC nodules were prospectively enrolled. For scheme B, the mean contrast enhancement of the aorta and tumour-to-liver CNR were significantly higher with HCCM than with MCCM during the hepatic arterial phase (+350.5 HU vs +301.1 HU, p50.001, and +7.5 HU vs +5.5 HU, p50.004). For both groups, there was no significant difference between MCCM and HCCM for all other comparisons. Conclusion: For a constant injection flow rate, HCCM significantly improves the conspicuity of HCC lesions and aortic enhancement during the hepatic arterial phase on 64-section MDCT in patients with cirrhosis. Along with MRI, multidetector row CT (MDCT) is the modality of choice for the diagnosis and follow-up of patients with hepatocellular carcinoma (HCC), as well as for tumour burden assessment. With the advent of volume MDCT, enabling the acquisition of 64 or more sections during a single gantry rotation, it has become possible to scan the entire abdomen with submillimetre section widths within a short scan time (less than 5 s for 300 mm of coverage). Although this technique has shown several advantages over conventional CT, including better discrimination between different circulatory phases, the potential for scanning during peak organ enhancement throughout the entire imaging volume and true isotropic CT data sets, it has raised considerable challenges for the design of scanning and contrast material injection protocols that are optimised for the detection of hypervascular HCC lesions [1]. Recent investigations have emphasised the importance of using test bolus or bolus-tracking methods to synchronise CT data acquisition with the peak tumourto-liver contrast for hypervascular HCC lesions [2,3]; however, the most effective contrast medium injection technique for maximising tumour enhancement during the narrow temporal acquisition of modern MDCT systems remains largely unexplored. Previous studies with early generation MDCT scanners reported conflicting results with varying volumes a...

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“…Although using a fixed dose of contrast medium has been shown to be easy to implement and is generally effective, it can result in an under-or over-dosage of contrast medium in many patients [1] [2]. Preliminary evidence suggests that determining the dose and injection rate of contrast material administration based on the patient's lean body weight (LBW) may improve patient-to-patient enhancement variability during vascular and abdominal MDCT [2]- [5].…”

Section: Introductionmentioning

confidence: 99%

Optimization of Contrast Material Dose for Abdominal Multi-Detector Row CT: Predicting Patient Lean Body Weight by Using Preliminary Transverse CT Images

Guerrisi¹,

Marin²,

Barnhart³

et al. 2014

ACT

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Estimated LBW could be used to determine the contrast material dose and rate during MDCT. The aim of this study is to test the accuracy of a technique for estimation of lean body weight (LBW) from a single multi-detector row computed tomographic (MDCT) abdominal image, using a bioelectrical body composition analyzer scale as the reference standard. CT images of 21 patients with previously measured LBW (mLBW) were processed using computer-assisted, vendor-specific software (Advantage Windows 4.2; GE Healthcare, Inc). For each transverse image, a fat-fraction was automatically measured as the number of fat pixels (−200 to −50 HU) divided by the total number of pixels having an attenuation value ≥−200 HU. Estimated LBW (eLBW) of five single contiguous sections was calculated in each of three abdominal regions (upper abdomen, mid abdomen and pelvis) by multiplying TBW by (1 -fat-fraction). Bland-Altman plot with limits of agreement was used to assess agreement between mLBW and eLBW. The mean mLBW for all patients was 56 kg (range, 39 -75 kg). Mean differences and limits of agreement between mLBW and eLBW measurements for the upper abdomen, mid abdomen and pelvis reported were −8.9 kg (−25.6 kg, +7.5 kg), −10.6 kg (−27.7 kg, +6.4 kg), and +0.5 kg (−12.8 kg, +13.8 kg) respectively. eLBW deriving directly from a transverse CT image of the pelvis can accurately predict mLBW. KeywordsLean Body Weight; Multi-Detector CT; Contrast Dose A. Guerrisi et al. 2

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Abdominal Multidetector CT in Patients with Varying Body Fat Percentages: Estimation of Optimal Contrast Material Dose

Abstract: Excessive contrast material may inadvertently be given in heavier patients when the dose is determined by patient BW. Contrast material dose may need to be tailored in individual patients by using BFP.

Cited by 63 publications

References 20 publications

Correlation of abdominal fat ratio with hepatic CT enhancement

Correlation of abdominal fat ratio with hepatic CT enhancement

Effect of varying contrast material iodine concentration and injection technique on the conspicuity of hepatocellular carcinoma during 64-section MDCT of patients with cirrhosis

Optimization of Contrast Material Dose for Abdominal Multi-Detector Row CT: Predicting Patient Lean Body Weight by Using Preliminary Transverse CT Images

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