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Application value of split-bolus contrast injection combined with dual-energy CT scanning technology in pediatric CTU
Hongqiao Chen1, Zhikai Deng2, Ting Tan2
1Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, China; Department of Radiology University Town Hospital of Chongqing Medical University, China.
Insights
Combining split-bolus contrast injection with dual-energy CT (DECT) scanning improves pediatric computed tomography urography (CTU) image quality. This advanced technique also effectively reduces radiation dosage in young patients.
Area of Science:
- Radiology
- Medical Imaging
- Pediatric Imaging
Background:
- Pediatric computed tomography urography (CTU) is crucial for diagnosing urinary tract abnormalities.
- Optimizing image quality while minimizing radiation exposure in pediatric patients is a significant challenge.
Purpose of the Study:
- To evaluate the clinical utility of integrating split-bolus contrast injection with dual-energy CT (DECT) scanning for pediatric CTU.
- To compare image quality and radiation dose across different scanning protocols.
Main Methods:
- 128 children (0-17 years) were prospectively randomized into three groups (A, B, C).
- Group A used single-bolus contrast with four-phase scanning.
- Groups B and C utilized split-bolus contrast with DECT and two-phase scanning, with varying contrast percentages.
Main Results:
- Group B demonstrated superior CT values and subjective image quality compared to Groups A and C.
- Group C showed better cortical contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) than Group B and A.
- Group A achieved better medullary CNR and SNR; however, Groups B and C had lower radiation doses than Group A.
Conclusions:
- The combination of split-bolus contrast injection and DECT significantly enhances image quality in pediatric CTU.
- This integrated approach offers a valuable method for reducing radiation dosage in pediatric patients undergoing CTU.
Objective:
To explore the clinical value of combining split-bolus contrast injection with dual-energy CT(DECT) scanning technology in pediatric computed tomography urography (CTU) imaging.
Methods:
A total of 128 children aged 0-17 years were prospectively selected and randomly assigned to three groups: A, B, and C. For Group A, a high-pitch flash mode was employed, where a single bolus of contrast agent was followed by four-phase scanning (noncontrast, cortex, medulla, and excretory phases). In Group B, a dual-energy scanning mode was used with a split-bolus injection technique (50 % of the contrast agent was administered initially, followed by the remaining 50 % after 37-43 s), and the children underwent two-phase scanning (corticomedullary and excretory phases). In Group C, dual-energy scanning was similarly used with a split-bolus injection technique (65 % contrast agent was administered initially, followed by the remaining 35 % after 37-43 s), along with two-phase scanning (corticomedullary and excretory phases). Virtual noncontrast (VNC) images were obtained from the corticomedullary phase images using iodine subtraction techniques for Groups B and C. The image quality and radiation dose across the groups were compared and analysed.
Results:
When the CT values of the renal cortex, erector spinae muscles, and standard deviation (SD) values were compared between Group A's cortical phase and Groups B and C's corticomedullary phases, the order was Group B > Group C > Group A (P < 0.05). The comparison of the cortical CNR and SNR between Group A's cortical phase and Groups B's and C's corticomedullary phases (cortices) revealed that Group C > Group B > Group A (P < 0.05). The comparison of the medullary CNR and SNR between Group A's medullary phase and Groups B and C's corticomedullary phases (medulla) showed that Group A > Group C > Group B (P < 0.05). The scores for the VNC images in Groups B and C were lower than those for the true noncontrast (TNC) images in Group A (P > 0.05). In the subjective evaluations of the corticomedullary and excretory phase images, Group B > Group C > Group A (P < 0.05). The comparison of radiation doses revealed that Group B < Group C < Group A (P < 0.05). A significant correlation was found between BMI and the effective radiation dose (P < 0.01), with a correlation coefficient of 0.62.
Conclusion:
The combination of split-bolus contrast injection and DECT enhances image quality in pediatric CTU while reducing radiation dosage.
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