Clinical evaluation of a novel multibolus contrast agent injection protocol for thoraco-abdominal CT angiography: Assessment of homogeneity of arterial contrast enhancement

EUROPEAN JOURNAL OF RADIOLOGY(2020)

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Abstract
Purpose: To evaluate the in vivo feasibility of a multibolus contrast agent (CA) injection protocol with a reduced CA volume for thoraco-abdominal CT angiography (CTA) and to compare it to a single-bolus CA injection protocol. Method: 63 patients who underwent CTA with the multibolus protocol (60 ml CA) were divided in two groups either without (group 1, n=48) or with (group 2, n=15) aortic dissection. The aortic contrast enhancement was measured in group 1 using manual ROI analysis (10 segments), as well as semi-automated linear attenuation profiles. A subgroup (n=18) of group 1, who also underwent imaging with the single-bolus protocol (94 ml CA), was used to compare both protocols. In group 2, differences in attenuation of the true and the false lumen for both the single- and the multibolus protocol were assessed with ROI attenuation measurements in both lumina. Comparisons were made using Wilcoxon test. Results: Average attenuation was above 200 HU for 98 % of cases using the multibolus protocol. There was superior contrast homogeneity for the multibolus protocol with a lower standard deviation of attenuation values along the length of the scan (p=0.003), while average attenuation was higher for the single-bolus protocol (p=0.002). Prolonged enhancement plateau lead to a more uniform opacification of the true and the false lumen in patients with aortic dissection using the multibolus protocol (p=0.012). Conclusions: The multibolus protocol in thoraco-abdominal CTA is feasible in patients. It shows consistently high arterial enhancement with superior contrast homogeneity compared to a single-bolus protocol in patients with and without aortic dissection.
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Key words
CT-angiography,Scan range,Contrast agent,Injection protocol,Bolus shaping
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