CT Angiography of the Aorta: Contrast Timing by Using a Fixed versus a Patient-specific Trigger Delay

Background Optimal timing of the CT scan relative to the contrast media bolus remains a challenging task given the shorter scan durations of modern CT scanners, as well as interpatient variability. Purpose To compare contrast opacification in CT angiography of the aorta between a cohort with fixed trigger delay and a cohort with patient-specific individualized trigger delay for contrast media timing with bolus tracking. Materials and Methods In this prospective study (January-August 2018), CT angiography of the thoracoabdominal aorta with bolus tracking was performed in two different study cohorts: one with a fixed trigger delay of 4 seconds (fixed cohort) and one with a patient-specific trigger delay (individualized cohort). All CT and contrast media protocol parameters were kept identical among cohorts. Objective image quality was evaluated by one reader; two readers assessed subjective image quality. Student t test was used to test for differences in mean attenuation; the Wilcoxon-Mann-Whitney test was used to test for differences in noise, contrast-to-noise ratio, and subjective image quality. Results The fixed cohort had 108 study participants (16 women; mean age ± standard deviation, 72 years ± 10); the individualized cohort had 108 participants (16 women; mean age, 72 years ± 12). The trigger delay in the individualized cohort ranged from 6.4-11.3 seconds (mean, 9.2 seconds). There was higher overall attenuation in the individualized cohort than in the fixed cohort (486 HU ± 92 for individualized vs 438 HU ± 99 for fixed; P < .001), with increasing differences from the aortic arch (8 HU) to the iliac arteries (95 HU). The regression model indicated uniform attenuation in the individualized cohort and decreasing attenuation in the fixed cohort (decrease of 87 HU by the iliac arteries; P < .001). There was no difference between cohorts for image noise (20 vs 19; P = .41), but contrast-to-noise ratio (21 vs 19; P = .04) and subjective image quality were higher in the individualized cohort than in the fixed cohort (excellent or good image quality, 100% vs 67%; P < .001). Conclusion Compared with a fixed delay time after bolus tracking, a patient-specific individualized trigger delay improves image quality and provides uniform contrast attenuation for CT angiography of the aorta. ©RSNA, 2019.