A Solution for Homogeneous Liver Enhancement in Computed Tomography: Results From the COMpLEx Trial

Area of Science:

• Radiology
• Medical Imaging
• Diagnostic Imaging

Background:

• Achieving consistent liver enhancement in CT scans is crucial for accurate diagnosis.
• Patient factors like total body weight (TBW) and scanner settings (tube voltage) can affect contrast media (CM) dose and image quality.

Purpose of the Study:

• To evaluate the efficacy of the 10-to-10 rule for homogeneous liver enhancement in abdominal CT.
• The rule pairs a 10 kV reduction in tube voltage with a 10% decrease in CM dose.

Main Methods:

• 256 patients were randomized into four groups with varying tube voltages (120 kV, 90 kV, 100 kV, 90 kV) and CM doses.
• Objective image quality was assessed using Hounsfield units (HU), signal-to-noise ratio, and contrast-to-noise ratio.
• Subjective image quality was evaluated by two experienced readers on a 5-point Likert scale.

Main Results:

• Mean liver attenuation was comparable across groups using the 10-to-10 rule (120 kV, 100 kV, 90 kV), with no significant differences based on TBW.
• Group 2 (90 kV, standard CM dose) showed significantly higher attenuation.
• No significant differences in subjective image quality were observed between groups.

Conclusions:

• The 10-to-10 rule is a reproducible method for achieving consistent liver enhancement in portal venous phase CT.
• This approach ensures reliable image quality irrespective of total body weight or tube voltage.
• The 10-to-10 rule simplifies CM dosing protocols for abdominal CT.