Optimizing low contrast volume thoracic CT angiography: From the basics to the advanced

Kaproth-Joslin, Katherine; Hobbs, Susan K.; Rajiah, Prabhakar; Chaturvedi, Apeksha; Chaturvedi, Abhishek

doi:10.25259/jcis_51_2022

Cited by 4 publications

(2 citation statements)

References 49 publications

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“…This is thought to be primarily influenced by the injection rate rather than injection volume. [ 1 , 8 ] The more rapid the delivery of a fixed contrast dose, the faster contrast accumulates in the aorta leading to greater aortic opacification. Prior studies have also reported no significant difference in arterial phase liver enhancement with varying IV contrast doses.…”

Section: Discussionmentioning

confidence: 99%

Decreased portal vein attenuation and liver enhancement with reduced intravenous contrast dosage during the national iodinated contrast shortage of 2022

Ranger,

Truong,

Thompson

2024

JCIS

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Objectives: The worldwide shortage of intravenous (IV) Omnipaque iodinated contrast (Iohexol, GE Healthcare; Milwaukee, WI, USA) forced institutions to adopt various policies regarding contrast allocation. We sought to evaluate the impact of our hospital’s response to the shortage, which was to decrease the dose of IV contrast from 100 mL to 75 mL for patients weighing between 45.4 and 136 kg (100–300 lbs) undergoing abdominal computed tomography (CT) examinations. The main objective was to assess for any differences in liver attenuation and enhancement between contrast dosages. Secondary outcomes included assessing differences in aortic and portal vein attenuation, the variance in attenuation measurements, and whether radiology reports included the correct IV contrast dose. Material and Methods: Consecutive CT abdomen or CT abdomen and pelvis examinations without and with contrast were analyzed for the 3 months before the contrast shortage and for 3 months during the contrast shortage. Attenuation in Hounsfield units (HUs) was measured in the liver on pre-contrast and portal venous phase images. Vessel attenuation was measured in the aorta (arterial phase) and main portal vein (portal venous phase). Standard deviation of liver attenuation measurements was recorded as an indicator of signal-to-noise. Liver enhancement was calculated as the difference between liver portal venous phase attenuation and pre-contrast attenuations. Results: Thirty-nine fixed dose (100 mL) and 36 reduced dose (75 mL) consecutive CT studies were included in the study. There were no significant differences between the two groups with respect to baseline characteristics such as age, weight, body mass index, and gender. There was no significant difference in pre-contrast liver attenuation between groups, but there was statistically significant greater liver attenuation (99.6 vs. 91.2 HU, P = 0.04) and liver enhancement (51.5 vs. 39.1 HU, P < 0.0001) during the portal venous phase for the fixed-dose group compared to the reduced dose group. There was significantly greater main portal vein opacification during the portal venous phase for the fixed dose group (146.6 vs. 122.2 HU, P < 0.0001). No significant difference was found in aortic opacification during the arterial phase (245 vs. 254 HU, P = 0.52). There was no difference in the standard deviation of liver attenuation measurements on the portal venous phase between the groups. The dose was reported correctly in all the patients receiving the fixed dose and in 92% of patients receiving the reduced dose, which was not statistically significant (P = 0.11). Conclusion: Reducing the IV contrast dose from 100 mL to 75 mL Omnipaque 350 in patients weighing 45.4–136 kg (100–300 lbs) undergoing an abdominal CT examination resulted in significantly decreased portal vein opacification and liver enhancement. In particular, liver enhancement and calculated iodine concentrations fell below suggested thresholds for adequate conspicuity of liver lesions. The change in contrast administration protocol also led to more errors in contrast dose reporting in the radiologist’s report. These findings are broadly applicable to many practice settings and can help inform strategies in response to any potential future-iodinated contrast shortage.

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Section: Discussionmentioning

confidence: 99%

Decreased portal vein attenuation and liver enhancement with reduced intravenous contrast dosage during the national iodinated contrast shortage of 2022

Ranger,

Truong,

Thompson

2024

JCIS

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show abstract

“…We performed a Web of Science Core Collection search for the keywords ‘iodinated contrast media shortage’, and we found 14 scientific papers, 1,2,9–20 and 1 editorial, 21 all published in 2022. Almost all these papers were published by authors from the USA or Australia; the one exception was a paper with mixed authorship from Germany, Switzerland, and the USA 9 .…”

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confidence: 99%

How to prevent a repetition of the ‘not so global’ contrast media shortage of 2022?

Parizel

Mallio

2023

J Med Imag Rad Onc

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Cardiac Computed Tomography Protocols in Structural Heart Disease: A State-of-the-Art Review

Chamberlin,

Baruah,

Smith

et al. 2024

Seminars in Roentgenology

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Optimizing low contrast volume thoracic CT angiography: From the basics to the advanced

Cited by 4 publications

References 49 publications

Decreased portal vein attenuation and liver enhancement with reduced intravenous contrast dosage during the national iodinated contrast shortage of 2022

Decreased portal vein attenuation and liver enhancement with reduced intravenous contrast dosage during the national iodinated contrast shortage of 2022

How to prevent a repetition of the ‘not so global’ contrast media shortage of 2022?

Cardiac Computed Tomography Protocols in Structural Heart Disease: A State-of-the-Art Review

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