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Prospective multicenter study on personalized and optimized MDCT contrast protocols: results on liver enhancement

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Abstract

Objective

To determine a personalized and optimized contrast injection protocol for a uniform and optimal diagnostic level of liver parenchymal enhancement, in a large patient population enrolled in a multicenter study.

Methods

Six hundred ninety-two patients who underwent a standardized multi-phase liver CT examination were prospectively assigned to one contrast media (CM) protocol group: G1 (100 mL fixed volume, 37 gI); G2 (600 mgI/kg of total body weight (TBW)); G3 (750 mgI/kg of fat-free mass (FFM)), and G4 (600 mgI/kg of FFM). Change in liver parenchyma CT number between unenhanced and contrast-enhanced images was measured by two radiologists, on 3-mm pre-contrast and portal phase axial reconstructions. The enhancement histograms were compared across CM protocols, specifically according to a target diagnostic value of 50 HU. The total amount of iodine dose was also compared among protocols by median and interquartile range (IQR). The Kruskal-Wallis and Mann-Whitney U tests were used to assess significant differences (p < 0.005), as appropriate.

Results

A significant difference (p < 0.001) was found across the groups with liver enhancement decreasing from median over-enhanced values of 77.0 (G1), 71.3 (G2), and 65.1 (G3) to a target enhancement of 53.2 HU for G4. Enhancement IQR was progressively reduced from 26.5 HU (G1), 26.0 HU (G2), and 17.8 HU (G3) to 14.5 HU (G4). G4 showed a median iodine dose of 26.0 gI, significantly lower (p < 0.001) than G3 (33.9 gI), G2 (38.8 gI), and G1 (37 gI).

Conclusions

The 600 mgI/kg FFM-based protocol enabled a diagnostically optimized liver enhancement and improved patient-to-patient enhancement uniformity, while significantly reducing iodine load.

Key Points

• Consistent and clinically adequate liver enhancement is observed with personalized and optimized contrast injection protocol.

• Fat-free mass is an appropriate body size parameter for correlation with liver parenchymal enhancement.

• Diagnostic oncology follow-up liver CT examinations may be obtained using 600 mgI/kg of FFM.

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Abbreviations

BMI:

Body mass index

CM:

Contrast media

CT:

Computed tomography

FFM:

Fat-free mass

MDCT:

Multidetector CT scanner

TBW:

Total body weight

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. F. Zanca and H. G. Brat contributed equally to this work.

Authors and Affiliations

  1. Palindromo Consulting, Willem de Corylaan, 51 3001, Leuven, Belgium

    F. Zanca

  2. Institut de Radiologie de Sion, Groupe 3R, Sion, Switzerland

    H. G. Brat, B. Dufour & D. Fournier

  3. GE Healthcare, Buc, France

    P. Pujadas

  4. Institute of Radiation Physics (IRA), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    D. Racine

  5. Centre d’Imagerie de Fribourg, Groupe 3R, Fribourg, Switzerland

    B. Rizk

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  1. F. Zanca
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Correspondence to F. Zanca.

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Guarantor

The scientific guarantor of this publication is Federica Zanca.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

P Pujadas is an employee of GE Healthcare.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

A written informed consent is submitted to every patient upon admission in Groupe 3r stating, among others, possible use of anonymized patient data for research purposes. The patient is free to oppose this use and listed as such. Specific written informed consent was therefore waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• multicenter study.

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Zanca, F., Brat, H.G., Pujadas, P. et al. Prospective multicenter study on personalized and optimized MDCT contrast protocols: results on liver enhancement. Eur Radiol 31, 8236–8245 (2021). https://doi.org/10.1007/s00330-021-07953-3

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  • DOI: https://doi.org/10.1007/s00330-021-07953-3

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