Lean body weight-based contrast injection protocol in liver CT: optimization of contrast medium dose

Objectives: To evaluate liver enhancement and image quality of abdominal CECT examinations acquired with multiple LBW-based contrast medium injection protocols.

Material & methods: One hundred fifty patients who underwent a clinically indicated CECT examination were prospectively and randomly assigned to one of the following contrast medium injection protocol groups: A, 700 mg iodine(I)/kg of LBW; B, 650 mgI/kg of LBW; and C, 600 mgI/kg of LBW. Liver signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and magnitude of contrast enhancement (ΔHU) were calculated. Subjective image quality was assessed with 5-point Likert scale.

Results: The final population included 145 patients (64 females), with 50, 48, and 47 in group A, B, and C, respectively. Group A showed significantly higher SNR, CNR and ΔHU than group B (p = .018, p = .004, and p = .031, respectively) and group C (p = .024, p = .043, and p = .004). Group B had similar SNR, CNR, and ΔHU to group C (all p = 1). ΔHU was < 50 HU in 2, 7, and 11 patients in group A (48.2 ± 0.1), B (43.7 ± 5), and C (44.4 ± 5), respectively. Group A achieved the highest scores in terms of overall image quality, artifacts, and diagnostic confidence (both scores: 4; IQRs: 4-5) compared to group B (both scores: 3; IQRs: 3-5; p ≥ .037) and group C (overall image quality score: 3; IQR: 2-5; p = .011. Artifact and diagnostic confidence score: 3; IQR: 1-4; p ≥ .009).

Conclusions: A dosage of 700 mgI/kg of LBW yields optimal liver enhancement and grants higher image quality compared to lower contrast medium dosages.