Proposal of a novel protocol using estimated cardiac index fractional dose to improve aortic contrast enhancement for early-phase dynamic CT

Maximum aortic computed tomography value (CTV) is difficult to control because of variations in cardiac function and patient physique. Therefore, to improve early-phase aortic enhancement on dynamic computed tomography (CT), we developed an estimated cardiac index fractional dose (eciFD). The eciFD protocol is a novel and original protocol for administering fractional dose (FD), representing the amount of iodine per unit body weight per injection duration, based on cardiac index (cardiac output divided by body surface area) as estimated by age in early-phase dynamic CT. At the time of administration, by selecting FD based on the patient's age and selecting a parameter that can achieve this FD, an aortic CTV >= 300 HU (ACTV >= 300) can be obtained. This study aimed to investigate aortic enhancement on CT angiography using the eciFD protocol. This retrospective study investigated 291 consecutive patients who underwent dynamic CT from neck to abdomen after recommendation of the eciFD protocol at our institution. We compared early-phase aortic CTV distributions by scan delay between an eciFD group (eciFD applied, n=135) and a non-eciFD group (eciFD not applied, n=80). The effect of eciFD on early-phase ACTV >= 300 was evaluated using logistic regression analysis adjusted for several potentially meaningful clinical confounders related to aortic CTV, namely male sex, heart rate <= 80beats/min, estimated glomerular filtration rate <= 40 mL/min, use of eciFD, bolus tracking (BT), history of myocardial infarction, and order from the emergency center. The eciFD protocol was a significant factor for early-phase ACTV >= 300 after adjusting for several confounders (odds ratio 3.03; 95% confidence intervals 1.59-5.77; P=.001). No interaction was seen between BT and eciFD protocol (p for interaction=0.76). In terms of CTV distribution, with both a fixed scan delay time and BT, the eciFD group showed a high aortic CTV. The combination of eciFD protocol with BT provided a particularly high percentage of patients with ACTV >= 300 (86.4%). The eciFD protocol was useful for improving aortic contrast enhancement. These findings need to be validated in a randomized controlled study.