Abstract
Objectives
Optimal vascular and parenchymal enhancement for multi-region paediatric body computed tomography (CT) has many challenges. A variety of approaches are currently employed, associated with varying image quality and radiation dose implications. We present a dual bolus intravenous (DBI) contrast technique for single-acquisition imaging of the chest, abdomen and pelvis, with evaluation of multi-compartmental vascular enhancement.
Methods
A DBI regime was designed for use with a programmable dual head pump injector. A larger initial bolus (two-thirds volume) is followed by a smaller bolus (one-third volume) before imaging the chest, abdomen and pelvis in a single acquisition, 45–65 seconds from the start of initial injection. Flow rates and second bolus timing were tailored to patient weight and contrast volume, using five weight categories. Multi-compartmental vascular opacification was graded and image quality was assessed in a cohort of 130 patients.
Results
The DBI technique resulted in concordant multi-compartmental (thoracic aortic, pulmonary arterial, abdominal aortic and portal venous) vascular enhancement. Early splenic parenchymal enhancement artefacts and alterations to renal enhancement were observed.
Conclusion
We present a weight-stratified dual bolus intravenous contrast technique to improve image quality in paediatric multi-region body CT.
Key Points
• In children, optimal vascular and parenchymal enhancement in multi-region CT is challenging.
• A dual bolus contrast technique offers concordant arterial and portal venous opacification.
• Adaptation to patient size is achieved by stratification into five weight categories.
• Dose penalties of ‘overlap’ and ‘dual phase’ imaging techniques can be avoided.
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Abbreviations
- MDCT:
-
Multi-detector Computed Tomography
- DBI:
-
Dual Bolus Intravenous
- CAP:
-
Chest/Abdomen/Pelvis CT
- NCAP:
-
Neck/Chest/Abdomen/Pelvis CT
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Acknowledgments
We thank our team of CT technologists who welcomed change, assisted in feedback during the development of the new IV contrast regime, and enabled its smooth introduction into clinical practice. The scientific guarantor of this publication is KE Thomas. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, cross-sectional study, performed at one institution.
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Thomas, K.E., Mann, E.H., Padfield, N. et al. Dual bolus intravenous contrast injection technique for multiregion paediatric body CT. Eur Radiol 25, 1014–1022 (2015). https://doi.org/10.1007/s00330-014-3501-6
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DOI: https://doi.org/10.1007/s00330-014-3501-6