A Solution for Homogeneous Liver Enhancement in Computed Tomography: Results From the COMpLEx Trial. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Martens, Bibi; Wildberger, Joachim E.; Hendriks, Babs M.F.; Van Kuijk, Sander M.J.; Nijssen, Estelle C.; Peters, Nicky H.G.M.; De Vos-Geelen, Judith; Mihl, Casper
• Is Part Of: Investigative radiology. Volume 55:Issue 10(2020)
• Publication Date: 2020-10
• Subjects: multidetector computed tomography -- diagnostic imaging -- liver -- radiation dosage -- contrast media; Diagnosis, Radioscopic -- Periodicals; Radiology, Medical -- Periodicals; 616.0757
• DOI: 10.1097/RLI.0000000000000693
• Languages: English
• ISSNs: 0020-9996

Abstract

Abstract : Objectives: The aim of the study was to reach homogeneous enhancement of the liver, irrespective of total body weight (TBW) or tube voltage. An easy-to-use rule of thumb, the 10-to-10 rule, which pairs a 10 kV reduction in tube voltage with a 10% decrease in contrast media (CM) dose, was evaluated. Materials and Methods: A total of 256 patients scheduled for an abdominal CT in portal venous phase were randomly allocated to 1 of 4 groups. In group 1 (n = 64), a tube voltage of 120 kV and a TBW-adapted CM injection protocol was used: 0.521 g I/kg. In group 2 (n = 63), tube voltage was 90 kV and the TBW-adapted CM dosing factor remained 0.521 g I/kg. In group 3 (n = 63), tube voltage was reduced by 20 kV and CM dosing factor by 20% compared with group 1, in line with the 10-to-10 rule (100 kV; 0.417 g I/kg). In group 4 (n = 66), tube voltage was decreased by 30 kV paired with a 30% decrease in CM dosing factor compared with group 1, in line with the 10-to-10 rule (90 kV; 0.365 g I/kg). Objective image quality was evaluated by measuring attenuation in Hounsfield units (HU), signal-to-noise ratio, and contrast-to-noise ratio in the liver. Overall subjective image quality was assessed by 2 experienced readers by using a 5-point Likert scale. Two-sided P values below 0.05 were considered significant. Results: Mean attenuation values in groups 1, 3, and 4 were comparable (118.2 ± 10.0, 117.6 ± 13.9, 117.3 ± 21.6 HU, respectively), whereas attenuation in group 2 (141.0 ± 18.2 HU) was significantly higher than all other groups ( P < 0.01). No significant difference in attenuation was found between weight categories 80 kg or less and greater than 80 kg within the 4 groups ( P ≥ 0.371). No significant differences in subjective image quality were found ( P = 0.180). Conclusions: The proposed 10-to-10 rule is an easily reproducible method resulting in similar enhancement in portal venous CT of the liver throughout the patient population, irrespective of TBW or tube voltage.