Implementation of patient-tailored contrast volumes based on body surface area and heart rate harmonizes contrast enhancement and reduces contrast load in small patients in portal venous phase abdominal CT

Walgraeve, Marie-Sofie; Pyfferoen, Lotte; Moortele, Kris Van De; Zanca, Federica; Bielen, Didier

doi:10.1016/j.ejrad.2019.07.031

Cited by 7 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The distribution of liver CE was substantially the same in both groups. Specifically, the median liver CE was 40 (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) HU in the LBW group and 40 (35)(36)(37)(38)(39)(40)(41)(42)(43)(44) HU in the TBW group, the difference being not significant for either the median (p = 0.41) or the variability (p = 0.23). Distributions of CT value in the three phases and the correspondent CE of the liver and aorta are reported in Table 2; this table also shows the CT value in the venous phase of cava, porta and spleen.…”

Section: Primary and Secondary Endpointsmentioning

confidence: 83%

“…Other attempts were made to better personalise ICM dose by considering other indexes, such as body surface area and heart rate [40], but none of the tested parameters demonstrated any significantly better correlation with hepatic parenchymal or aortic enhancement than TBW [28]. It thus appears that liver CE originates from a nonlinear function of several variables, some of them maybe still unknown or not yet evaluated [41].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial

et al. 2020

View full text Add to dashboard Cite

Objectives Iodinated contrast media (ICM) could be more appropriately dosed on patient lean body weight (LBW) than on total body weight (TBW). Methods After Ethics Committee approval, trial registration NCT03384979, patients aged ≥ 18 years scheduled for multiphasic abdominal CT were randomised for ICM dose to LBW group (0.63 gI/kg of LBW) or TBW group (0.44 gI/kg of TBW). Abdominal 64-row CT was performed using 120 kVp, 100–200 mAs, rotation time 0.5 s, pitch 1, Iopamidol (370 mgI/mL), and flow rate 3 mL/s. Levene, Mann–Whitney U, and χ2 tests were used. The primary endpoint was liver contrast enhancement (LCE). Results Of 335 enrolled patients, 17 were screening failures; 44 dropped out after randomisation; 274 patients were analysed (133 LBW group, 141 TBW group). The median age of LBW group (66 years) was slightly lower than that of TBW group (70 years). Although the median ICM-injected volume was comparable between groups, its variability was larger in the former (interquartile range 27 mL versus 21 mL, p = 0.01). The same was for unenhanced liver density (IQR 10 versus 7 HU) (p = 0.02). Median LCE was 40 (35–46) HU in the LBW group and 40 (35–44) HU in the TBW group, without significant difference for median (p = 0.41) and variability (p = 0.23). Suboptimal LCE (< 40 HU) was found in 64/133 (48%) patients in the LBW group and 69/141 (49%) in the TBW group, but no examination needed repeating. Conclusions The calculation of the ICM volume to be administered for abdominal CT based on the LBW does not imply a more consistent LCE.

show abstract

Section: Primary and Secondary Endpointsmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Image quality and lesion detection in computed tomography (CT) scans of the chest may be improved with the use of contrast media (CM). Traditionally, enhanced CT protocols have used fixed CM doses [ 1 ]; however, personalized CM approaches have been shown to be nearly as effective as personalized approaches to patient care [ 2 , 3 ]. While iodine concentration, injection rate, scan delay, blood pressure and cardiac function can affect contrast enhancement, so too can body composition, which impacts distribution of CM in extracellular spaces due to differences in blood volume and flow [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…While iodine concentration, injection rate, scan delay, blood pressure and cardiac function can affect contrast enhancement, so too can body composition, which impacts distribution of CM in extracellular spaces due to differences in blood volume and flow [ 4 , 5 ]. As a result, new strategies have emerged aiming to customize CM dose to both total body weight (TBW) [ 1 , 6 ] and body composition [ 7 ]. Linear weight-based approaches, however, do not accurately estimate ideal enhancement as they fail to take into consideration patient characteristics, such as body fat percentage (BFP) and muscle mass [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Strategies for calculating contrast media dose for chest CT

Henning¹,

Gunn²,

Arenas³

et al. 2023

Eur Radiol Exp

View full text Add to dashboard Cite

Background Total body weight (TBW) is a frequently used contrast media (CM) strategy for dose calculation in enhanced CT, yet it is suboptimal as it lacks consideration of patient characteristics, such as body fat percentage (BFP) and muscle mass. Alternative CM dosage strategies are suggested by the literature. Our objectives were to analyze the CM dose impact when adjusting to body composition using methods of obtaining lean body mass (LBM) and body surface area (BSA) along with its correlation with demographic factors in contrast enhanced chest CT examinations. Methods Eighty-nine adult patients referred for CM thoracic CT were retrospectively included, categorized as either normal, muscular, or overweight. Patient body composition data was used to calculate the CM dose according to LBM or BSA. LBM was calculated with the James method, Boer method, and bioelectric impedance (BIA). BSA was calculated using the Mostellar formula. We then correlated the corresponding CM doses with demographic factors. Results BIA demonstrated the highest and lowest calculated CM dose in muscular and overweight groups respectively, compared to other strategies. For the normal group, the lowest calculated CM dose was achieved using TBW. The calculated CM dose was more closely correlated with BFP using the BIA method. Conclusions The BIA method is more adaptive to variations in patient body habitus especially in muscular and overweight patients and is most closely correlated to patient demographics. This study could support utilizing the BIA method for calculating LBM for a body-tailored CM dose protocol for enhanced chest CT examinations. Relevance statement The BIA-based method is adaptive to variations in body habitus especially in muscular and overweight patients and is closely correlated to patient demographics for contrast-enhanced chest CT. Key points • Calculations based on BIA showed the largest variation in CM dose. • Lean body weight using BIA demonstrated the strongest correlation to patient demographics. • Lean body weight BIA protocol may be considered for CM dosing in chest CT. Graphical Abstract

show abstract

“…In the literature, different contrast media protocols have been described to achieve homogenous attenuation between patients [ 1 , 2 ]. Some advocate the use of fixed or semi-fixed protocols [ 5 ], whilst others have advocated the use of personalized protocols based on the total body weight (TBW) [ 1 , 6 , 7 , 8 ], lean body weight (LBW) [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ], percentage of body fat [ 16 ], or body surface area [ 17 , 18 ]. Thus, there is no consensus on what protocol is best to use for what types of patients.…”

Section: Introductionmentioning

confidence: 99%

Individualized Contrast Media Application Based on Body Weight and Contrast Enhancement in Computed Tomography of Livers without Steatosis

et al. 2022

View full text Add to dashboard Cite

This study analyzes the homogeneity in liver attenuation of a body-weight-based protocol compared to a semi-fixed protocol. Patients undergoing abdominal multiphase computed tomography received 0.500 g of iodine (gI) per kilogram of body weight. Liver attenuation and enhancement were determined using regions of interest on scans in the pre-contrast and portal venous phases. The outcomes were analyzed for interpatient uniformity in weight groups. The subjective image quality was scored using a four-point Likert scale (excellent, good, moderate, and nondiagnostic). A total of 80 patients were included (56.3% male, 64 years, 78.0 kg) and were compared to 80 propensity-score-matched patients (62.5% male, 63 years, 81.7 kg). The liver attenuation values for different weight groups of the TBW-based protocol were not significantly different (p = 0.331): 109.1 ± 13.8 HU (≤70 kg), 104.6 ± 9.70 HU (70–90 kg), and 105.1 ± 11.6 HU (≥90 kg). For the semi-fixed protocol, there was a significant difference between the weight groups (p < 0.001): 121.1 ± 12.1 HU (≤70 kg), 108.9 ± 11.0 HU (70–90 kg), and 105.0 ± 9.8 HU (≥90 kg). For the TBW-based protocol, the enhancement was not significantly different between the weight groups (p = 0.064): 46.2 ± 15.1 HU (≤70 kg), 59.3 ± 6.8 HU (70–90 kg), and 52.1 ± 11.7 HU (≥90 kg). Additionally, for the semi-fixed protocol, the enhancement was not significantly different between the weight groups (p = 0.069): 59.4 ± 11.0 HU (≤70 kg), 53.0 ± 10.3 HU (70–90 kg), and 52.4 ± 7.5 HU (≥90 kg). The mean administered amount of iodine per kilogram was less for the TBW-based protocol compared to the semi-fixed protocol: 0.499 ± 0.012 and 0.528 ± 0.079, respectively (p = 0.002). Of the TBW-based protocol, 17.5% of the scans scored excellent enhancement quality, 76.3% good, and 6.3% moderate. Of the semi-fixed protocol, 70.0% scored excellent quality, 21.3% scored good, and 8.8% scored moderate. In conclusion, the TBW-based protocol increased the interpatient uniformity of liver attenuation but not the enhancement in the portal venous phase compared to the semi-fixed protocol, using an overall lower amount of contrast media and maintaining good subjective image quality.

show abstract

Implementation of patient-tailored contrast volumes based on body surface area and heart rate harmonizes contrast enhancement and reduces contrast load in small patients in portal venous phase abdominal CT

Cited by 7 publications

References 20 publications

Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial

Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial

Strategies for calculating contrast media dose for chest CT

Individualized Contrast Media Application Based on Body Weight and Contrast Enhancement in Computed Tomography of Livers without Steatosis

Contact Info

Product

Resources

About