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Optimizing contrast-enhanced abdominal CT in infants and children using bolus tracking
D P Frush1, E B Spencer, L F Donnelly
1Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
Insights
Bolus tracking significantly improves hepatic enhancement in pediatric abdominal CT scans with manual contrast injection. This technique ensures more consistent and higher quality imaging for children undergoing helical CT examinations.
Area of Science:
- Radiology
- Medical Imaging
- Pediatric Imaging
Background:
- Manual administration of intravenous (IV) contrast material in CT scans leads to unpredictable injection rates.
- Inconsistent contrast delivery can compromise overall scan quality, particularly hepatic enhancement in pediatric abdominal helical CT.
Purpose of the Study:
- To evaluate the impact of bolus tracking on abdominal helical CT scan quality in children.
- Specifically, to assess its effect on hepatic enhancement when contrast media is manually administered.
Main Methods:
- A comparative study involving 33 abdominal helical CT scans from 29 children using bolus tracking and 22 scans from 21 children without bolus tracking.
- Both groups received contrast material via manual injection.
- Qualitative assessment of organ/vessel enhancement and scan appearance, alongside quantitative region-of-interest analysis at three anatomic levels.
Main Results:
- Bolus tracking significantly increased hepatic enhancement at superior (48.5 vs. 28.6 HU), middle (47.9 vs. 32.3 HU), and inferior (48.2 vs. 36.5 HU) levels (p < .001).
- The bolus tracking group showed more consistent enhancement across hepatic levels (p > .50) compared to the control group (p < .02).
- Improved scanning during the nephrographic phase (89% vs. 59%, p = .02) and reduced inferior vena cava flow artifact (3% vs. 27%, p = .01) were observed with bolus tracking.
Conclusions:
- Bolus tracking enhances contrast delivery in pediatric abdominal helical CT scans with manual contrast administration.
- This technique leads to significantly improved hepatic enhancement and overall scan quality in children.
- Bolus tracking is beneficial for optimizing CT imaging when injection rates are unpredictable.
Objective:
Manual administration of IV contrast material results in unpredictable injection rates. Our purpose was to determine the effect of bolus tracking on overall abdominal helical CT scan quality, particularly on hepatic enhancement, in children with manually administered contrast media.
Materials And Methods:
We compared 33 abdominal helical CT scans of 29 children in whom bolus tracking was used with 22 CT scans of a control group of 21 children in whom bolus tracking was not used. All contrast material was administered by manual injection. Qualitative assessment was made of organ and vessel enhancement and overall scan appearance. Quantitative assessment using region-of-interest cursors was performed at three anatomic levels, and the results for the two groups of children were compared.
Results:
Qualitative comparison of enhancement parameters between the bolus tracking group (number given first) and the control group (number given second) yielded the following: splenic artifact in 9% versus 23% (p = .24); inferior vena cava flow artifact in 3% versus 27% (p = .01); scanning during the nephrographic phase in 89% versus 59% (p = .02); and good quality grade in 79% versus 64% (p = .23). Significantly greater hepatic enhancement (as measured in mean Hounsfield units) was achieved in the bolus tracking group than in the control group at the superior (48.5 versus 28.6; p < .001), middle (47.9 versus 32.3; p < .001), and inferior (48.2 versus 36.5; p = .01) levels. Hepatic enhancement increased significantly from the superior to the inferior level in the control group (p < .02), whereas enhancement was homogeneous in the bolus tracking group (p > .50).
Conclusion:
Bolus tracking provides improved contrast enhancement, including significantly greater hepatic enhancement, during abdominal helical CT in children in whom the rate of injection of contrast material is unpredictable.