Improving image quality consistency and diagnostic accuracy in lower extremity CT angiography using a split-bolus...

Area of Science:

• Radiology
• Medical Imaging
• Vascular Imaging

Background:

• Lower extremity CT angiography (CTA) is crucial for diagnosing peripheral artery disease.
• Optimizing contrast delivery is essential for consistent image quality and accurate stenosis assessment.
• Traditional fixed-bolus techniques can lead to suboptimal enhancement and image variability.

Purpose of the Study:

• To evaluate the clinical utility of a split-bolus contrast injection protocol for lower extremity CTA.
• To compare image quality consistency and diagnostic accuracy between split-bolus and fixed-bolus CTA protocols.
• To determine the impact of split-bolus technique on arterial enhancement and vessel stenosis evaluation.

Main Methods:

• A comparative study involving 50 patients (split-bolus) and 39 patients (fixed-bolus) undergoing lower extremity CTA.
• Objective and subjective image quality assessments were performed.
• Diagnostic efficacy for vessel stenosis was compared against digital subtraction angiography as the gold standard.

Main Results:

• The split-bolus protocol significantly improved arterial enhancement (337.87 HU vs. 254.74 HU), SNR (22.58 vs. 7.14), and CNR (37.21 vs. 31.10) in the infrapopliteal segment (P<.001).
• Subjective image quality was superior with the split-bolus technique (P<.001).
• Diagnostic accuracy for >50% stenosis (96.00% vs. 91.67%) and occlusion (97.00% vs. 89.10%) was higher in the split-bolus group (P<.05).

Conclusions:

• The split-bolus contrast injection protocol enhances image quality consistency and diagnostic accuracy in lower extremity CTA.
• This technique is particularly beneficial for evaluating the infrapopliteal arteries.
• Split-bolus CTA offers improved overall image quality and uniform contrast enhancement compared to fixed-bolus methods.