Skip to main content
SpringerLink
Log in

Contrast media injection protocol for portovenous phase abdominal CT: does a fixed injection duration improve hepatic enhancement over a fixed injection rate?

  • Technical
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess whether a fixed contrast media (CM) injection duration improves the magnitude and inter-patient variability in hepatic enhancement over a fixed injection rate.

Methods

Outpatients who underwent portovenous phase abdominal CT (fixed duration, February–November 2018; fixed rate, January–July 2020) with 1.22 mL/kg iohexol 350 were included. Subjects with liver, kidney or heart disease were excluded. The number of subjects and injection protocols were as follows: fixed duration arm, 56 women, 60 men, 35 s injection duration; fixed rate arm, 66 women, 62 men, 3 mL/s injection rate. Liver attenuation measurements were obtained from regions of interest on pre- and post-contrast images. Mean hepatic enhancement (MHE) and MHE normalized to iodine dose (MHE/I) were compared (unpaired t-tests and F-tests).

Results

There was no statistically significant difference in age, weight, body mass index or CM dosing (p > 0.05). Enhancement indices were significantly lower in the fixed rate group as compared to the fixed duration group, as follows: MHE, 50.0 ± 12 vs. 54.8 ± 11 HU (p = 0.001); and MHE/I, 1.53 ± 0.43 vs. 1.66 ± 0.51 HU/g, (p = 0.04). However, there was no significant difference in the variances of MHE (p = 0.51) and MHE/I (p = 0.08).

Conclusion

A fixed CM injection duration yields a greater magnitude in hepatic enhancement indices than a fixed injection rate. Inter-patient variability in hepatic enhancement indices do not significantly differ between the two injection protocols.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CM:

Contrast media

CT:

Computed tomography

MHE:

Mean hepatic enhancement

MHE/I:

MHE normalized according to iodine dose

ROI:

Region of interest

TBW:

Total body weight

BMI:

Body mass index

DLP:

Dose-length product

References

  1. Fleischmann D, Kamaya A (2009) Optimal vascular and parenchymal contrast enhancement: the current state of the art. Radiologic clinics of North America 47 (1):13–26. https://doi.org/10.1016/j.rcl.2008.10.009

  2. Bae KT (2010) Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 256 (1):32–61. https://doi.org/10.1148/radiol.10090908

  3. Benbow M, Bull RK (2011) Simple weight-based contrast dosing for standardization of portal phase CT liver enhancement. Clinical radiology 66 (10):940–944. https://doi.org/10.1016/j.crad.2010.12.022

  4. Davenport MS, Parikh KR, Mayo-Smith WW, Israel GM, Brown RK, Ellis JH (2017) Effect of Fixed-Volume and Weight-Based Dosing Regimens on the Cost and Volume of Administered Iodinated Contrast Material at Abdominal CT. Journal of the American College of Radiology : JACR 14 (3):359–370. https://doi.org/10.1016/j.jacr.2016.09.001

  5. George AJ, Manghat NE, Hamilton MC (2016) Comparison between a fixed-dose contrast protocol and a weight-based contrast dosing protocol in abdominal CT. Clinical radiology 71 (12):1314 e1311–1314 e1319. https://doi.org/10.1016/j.crad.2016.07.009

  6. Awai K, Kanematsu M, Kim T, Ichikawa T, Nakamura Y, Nakamoto A, Yoshioka K, Mochizuki T, Matsunaga N, Yamashita Y (2016) The Optimal Body Size Index with Which to Determine Iodine Dose for Hepatic Dynamic CT: A Prospective Multicenter Study. Radiology 278 (3):773–781. https://doi.org/10.1148/radiol.2015142941

  7. Kondo H, Kanematsu M, Goshima S, Tomita Y, Kim MJ, Moriyama N, Onozuka M, Shiratori Y, Bae KT (2010) Body size indexes for optimizing iodine dose for aortic and hepatic enhancement at multidetector CT: comparison of total body weight, lean body weight, and blood volume. Radiology 254 (1):163–169. https://doi.org/10.1148/radiol.09090369

  8. Kondo H, Kanematsu M, Goshima S, Tomita Y, Miyoshi T, Hatcho A, Moriyama N, Onozuka M, Shiratori Y, Bae KT (2008) Abdominal multidetector CT in patients with varying body fat percentages: estimation of optimal contrast material dose. Radiology 249 (3):872–877. https://doi.org/10.1148/radiol.2492080033

  9. Kondo H, Kanematsu M, Goshima S, Watanabe H, Kawada H, Moriyama N, Bae KT (2013) Body size indices to determine iodine mass with contrast-enhanced multi-detector computed tomography of the upper abdomen: does body surface area outperform total body weight or lean body weight? European radiology 23 (7):1855–1861. https://doi.org/10.1007/s00330-013-2808-z

  10. Yanaga Y, Awai K, Nakayama Y, Nakaura T, Tamura Y, Hatemura M, Yamashita Y (2007) Pancreas: patient body weight tailored contrast material injection protocol versus fixed dose protocol at dynamic CT. Radiology 245 (2):475–482. https://doi.org/10.1148/radiol.2452061749

  11. Tanaka J, Kozawa E, Inoue K, Okamoto Y, Toya M, Sato Y (2011) Should the dose of contrast medium be determined solely on the basis of body weight regardless of the patient's sex? Japanese journal of radiology 29 (5):330–334. https://doi.org/10.1007/s11604-011-0563-0

  12. Rengo M, Caruso D, De Cecco CN, Lucchesi P, Bellini D, Maceroni MM, Ferrari R, Paolantonio P, Iafrate F, Carbone I, Vecchietti F, Laghi A (2012) High concentration (400 mgI/mL) versus low concentration (320 mgI/mL) iodinated contrast media in multi detector computed tomography of the liver: a randomized, single centre, non-inferiority study. European journal of radiology 81 (11):3096–3101. https://doi.org/10.1016/j.ejrad.2012.05.017

  13. Matoba M, Kitadate M, Kondou T, Yokota H, Tonami H (2009) Depiction of hypervascular hepatocellular carcinoma with 64-MDCT: comparison of moderate- and high-concentration contrast material with and without saline flush. AJR American journal of roentgenology 193 (3):738–744. https://doi.org/10.2214/AJR.08.2028

  14. Marin D, Nelson RC, Guerrisi A, Barnhart H, Schindera ST, Passariello R, Catalano C (2011) 64-section multidetector CT of the upper abdomen: optimization of a saline chaser injection protocol for improved vascular and parenchymal contrast enhancement. European radiology 21 (9):1938–1947. https://doi.org/10.1007/s00330-011-2139-x

  15. Bae KT, Heiken JP (2005) Scan and contrast administration principles of MDCT. European radiology 15 Suppl 5:E46–59

  16. Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J (2013) New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 266 (2):376–382. https://doi.org/10.1148/radiol.12121698

  17. Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, Ganesan K, Yaghmai V, Guimaraes AR, Sahani DV, Miller FH (2018) LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY) 43 (1):56–74. https://doi.org/10.1007/s00261-017-1325-y

  18. Eddy K, Costa AF (2017) Assessment of Cirrhotic Liver Enhancement With Multiphasic Computed Tomography Using a Faster Injection Rate, Late Arterial Phase, and Weight-Based Contrast Dosing. Can Assoc Radiol J 68 (4):371–378. https://doi.org/10.1016/j.carj.2017.01.001

  19. Costa AF, Peet K, Abdolell M (2019) Dosing iodinated contrast media according to lean vs. total body weight at abdominal CT: A stratified randomized controlled trial. Academic radiology. https://doi.org/10.1016/j.acra.2019.07.014

  20. Awai K, Hori S (2003) Effect of contrast injection protocol with dose tailored to patient weight and fixed injection duration on aortic and hepatic enhancement at multidetector-row helical CT. European radiology 13 (9):2155–2160. https://doi.org/10.1007/s00330-003-1904-x

  21. Tsuge Y, Kanematsu M, Goshima S, Kondo H, Yokoyama R, Miyoshi T, Onozuka M, Moriyama N, Bae KT (2011) Abdominal vascular and visceral parenchymal contrast enhancement in MDCT: effects of injection duration. European journal of radiology 80 (2):259–264. https://doi.org/10.1016/j.ejrad.2010.06.044

  22. Heiken JP, Brink JA, McClennan BL, Sagel SS, Crowe TM, Gaines MV (1995) Dynamic incremental CT: effect of volume and concentration of contrast material and patient weight on hepatic enhancement. Radiology 195 (2):353–357. https://doi.org/10.1148/radiology.195.2.7724752

  23. Peet K, Clarke SE, Costa AF (2019) Hepatic enhancement differences when dosing iodinated contrast media according to total versus lean body weight. Acta radiologica 60 (7):807–814. https://doi.org/10.1177/0284185118801137

  24. Heshmatzadeh Behzadi A, Farooq Z, Newhouse JH, Prince MR (2018) MRI and CT contrast media extravasation: A systematic review. Medicine (Baltimore) 97 (9):e0055. https://doi.org/10.1097/MD.0000000000010055

  25. Park HJ, Son JH, Kim T-B, Kang MK, Han K, Kim EH, Kim AY, Park SH Relationship between Lower Dose and Injection Speed of Iodinated Contrast Material for CT and Acute Hypersensitivity Reactions: An Observational Study. Radiology 0 (0):190829. https://doi.org/10.1148/radiol.2019190829

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada

    Andreu F. Costa & Kris Peet

Authors
  1. Andreu F. Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kris Peet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreu F. Costa.

Ethics declarations

Ethical approval

IRB approval was obtained for this work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Costa, A.F., Peet, K. Contrast media injection protocol for portovenous phase abdominal CT: does a fixed injection duration improve hepatic enhancement over a fixed injection rate?. Abdom Radiol 46, 2968–2975 (2021). https://doi.org/10.1007/s00261-020-02919-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02919-3

Keywords

Search

Navigation