Individual Optimization of Contrast Media Injection Protocol at Hepatic Dynamic Computed Tomography Using Patient-Specific Contrast Enhancement Optimizer.
Adult
Aged
Aged, 80 and over
Contrast Media
/ administration & dosage
Female
Humans
Injections, Intravenous
Iohexol
/ administration & dosage
Liver
/ diagnostic imaging
Liver Neoplasms
/ diagnostic imaging
Male
Middle Aged
Prospective Studies
Radiographic Image Enhancement
/ methods
Tomography, X-Ray Computed
/ methods
Young Adult
Journal
Journal of computer assisted tomography
ISSN: 1532-3145
Titre abrégé: J Comput Assist Tomogr
Pays: United States
ID NLM: 7703942
Informations de publication
Date de publication:
Historique:
entrez:
21
3
2020
pubmed:
21
3
2020
medline:
2
4
2020
Statut:
ppublish
Résumé
We developed a patient-specific contrast enhancement optimizer (p-COP) that can exploratorily calculate the contrast injection protocol required to obtain optimal enhancement at target organs using a computer simulator. Appropriate contrast media dose calculated by the p-COP may minimize interpatient enhancement variability. Our study sought to investigate the clinical utility of p-COP in hepatic dynamic computed tomography (CT). One hundred thirty patients (74 men, 56 women; median age, 65 years) undergoing hepatic dynamic CT were randomly assigned to 1 of 2 contrast media injection protocols using a random number table. Group A (n = 65) was injected with a p-COP-determined iodine dose (developed by Higaki and Awai, Hiroshima University, Japan). In group B (n = 65), a standard protocol was used. The variability of measured CT number (SD) between the 2 groups of aortic and hepatic enhancement was compared using the F test. In the equivalence test, the equivalence margins for aortic and hepatic enhancement were set at 50 and 10 Hounsfield units (HU), respectively. The rate of patients with an acceptable aortic enhancement (250-350 HU) for the diagnosis of hypervascular liver tumors was compared using the χ test. The mean ± SD values of aortic and hepatic enhancement were 311.0 ± 39.9 versus 318.7 ± 56.5 and 59.0 ± 11.5 versus 58.6 ± 11.8 HU in groups A and B, respectively. Although the SD for aortic enhancement was significantly lower in group A (P = 0.006), the SD for hepatic enhancement was not significantly different (P = 0.871). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 groups was within the range of the equivalence margins. The number of patients with acceptable aortic enhancement was significantly greater in group A than in group B (P < 0.01). The p-COP software reduced interpatient variability in aortic enhancement and obtained acceptable aortic enhancement at a significantly higher rate compared with the standard injection protocol for hepatic dynamic CT.
Identifiants
pubmed: 32195801
doi: 10.1097/RCT.0000000000001000
pii: 00004728-202003000-00011
doi:
Substances chimiques
Contrast Media
0
Iohexol
4419T9MX03
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
230-235Références
Haider MA, Amitai MM, Rappaport DC, et al. Multi-detector row helical CT in preoperative assessment of small (< or = 1.5 cm) liver metastases: is thinner collimation better? Radiology. 2002;225:137–142.
Yanaga Y, Awai K, Nakayama Y, et al. Optimal dose and injection duration (injection rate) of contrast material for depiction of hypervascular hepatocellular carcinomas by multidetector CT. Radiat Med. 2007;25:278–288.
Heiken JP, Brink JA, McClennan BL, et al. Dynamic incremental CT: effect of volume and concentration of contrast material and patient weight on hepatic enhancement. Radiology. 1995;195:353–357.
Yamashita Y, Komohara Y, Takahashi M, et al. Abdominal helical CT: evaluation of optimal doses of intravenous contrast material—a prospective randomized study. Radiology. 2000;216:718–723.
Awai K, Kanematsu M, Kim T, et al. The optimal body size index with which to determine iodine dose for hepatic dynamic CT: a prospective multicenter study. Radiology. 2016;278:773–781.
Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256:32–61.
Matsumoto Y, Higaki T, Masuda T, et al. Minimizing individual variations in arterial enhancement on coronary CT angiographs using “contrast enhancement optimizer”: a prospective randomized single-center study. Eur Radiol. 2019;29:2998–3005.
Higaki T, Nakaura T, Kidoh M, et al. Effect of contrast material injection duration on arterial enhancement at CT in patients with various cardiac indices: analysis using computer simulation. PLoS One. 2018;13:e0191347.
Bae KT, Heiken JP, Brink JA. Aortic and hepatic peak enhancement at CT: effect of contrast medium injection rate—pharmacokinetic analysis and experimental porcine model. Radiology. 1998;206:455–464.
Bae KT, Heiken JP, Brink JA. Aortic and hepatic contrast medium enhancement at CT. Part I. Prediction with a computer model. Radiology. 1998;207:647–655.
Bae KT, Heiken JP, Brink JA. Aortic and hepatic contrast medium enhancement at CT. Part II. Effect of reduced cardiac output in a porcine model. Radiology. 1998;207:657–662.
Park YS, Park SH, Lee SS, et al. Biopsy-proven nonsteatotic liver in adults: estimation of reference range for difference in attenuation between the liver and the spleen at nonenhanced CT. Radiology. 2011;258:760–766.
Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—the ALBI grade. J Clin Oncol. 2015;33:550–558.
Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022.
Yanaga Y, Awai K, Nakaura T, et al. Optimal contrast dose for depiction of hypervascular hepatocellular carcinoma at dynamic CT using 64-MDCT. AJR Am J Roentgenol. 2008;190:1003–1009.
Vignaux O, Gouya H, Augui J, et al. Hepatofugal portal flow in advanced liver cirrhosis with spontaneous portosystemic shunts: effects on parenchymal hepatic enhancement at dual-phase helical CT. Abdom Imaging. 2002;27:536–540.
Vignaux O, Legmann P, Coste J, et al. Cirrhotic liver enhancement on dual-phase helical CT: comparison with noncirrhotic livers in 146 patients. AJR Am J Roentgenol. 1999;173:1193–1197.
Piaggio G, Elbourne DR, Pocock SJ, et al; CONSORT Group. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA. 2012;308:2594–2604.
Ho LM, Nelson RC, Delong DM. Determining contrast medium dose and rate on basis of lean body weight: does this strategy improve patient-to-patient uniformity of hepatic enhancement during multi-detector row CT? Radiology. 2007;243:431–437.
Kondo H, Kanematsu M, Goshima S, et al. 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. 2010;254:163–169.
Bae KT, Seeck BA, Hildebolt CF, et al. Contrast enhancement in cardiovascular MDCT: effect of body weight, height, body surface area, body mass index, and obesity. AJR Am J Roentgenol. 2008;190:777–784.
Onishi H, Murakami T, Kim T, et al. Abdominal multi-detector row CT: effectiveness of determining contrast medium dose on basis of body surface area. Eur J Radiol. 2011;80:643–647.
Awai K, Hiraishi K, Hori S. Effect of contrast material injection duration and rate on aortic peak time and peak enhancement at dynamic CT involving injection protocol with dose tailored to patient weight. Radiology. 2004;230:142–150.
Kondo H, Kanematsu M, Goshima S, et al. Abdominal multidetector CT in patients with varying body fat percentages: estimation of optimal contrast material dose. Radiology. 2008;249:872–877.
Masuda T, Nakaura T, Funama Y, et al. Aortic and hepatic contrast enhancement during hepatic-arterial and portal venous phase computed tomography scanning: multivariate linear regression analysis using age, sex, total body weight, height, and cardiac output. J Comput Assist Tomogr. 2017;41:309–314.