Integrating CT-Derived Body Composition and Real-Time Injection Pressure Monitoring for Predicting Contrast Media...

Area of Science:

• Radiology
• Medical Imaging
• Body Composition Analysis

Background:

• Contrast media extravasation is a complication of CT angiography (CTA), especially with high-flow injections.
• Current risk assessment relies on clinical factors and pressure monitoring, with limited use of body composition data.

Purpose of the Study:

• To evaluate the utility of CT-derived body composition, specifically L3 skeletal muscle index (SMI), in assessing extravasation risk during abdominal CTA.
• To compare the predictive performance of models incorporating body composition, pressure parameters, and clinical factors.

Main Methods:

• Retrospective analysis of 12,460 adult patients undergoing contrast-enhanced abdominal CTA.
• Extraction of L3 SMI from routine CT images and pressure metrics from power injector logs.
• Development and validation of logistic-regression models including clinical, pressure, and body composition variables.

Main Results:

• Extravasation occurred in 3.05% of patients.
• Lower L3 SMI, sarcopenia, higher peak pressures, and elevated injection pressure-to-rate ratios (IPIRs) were associated with extravasation.
• A combined model integrating body composition and pressure data achieved superior discrimination (AUC 0.941) compared to models using only pressure, body composition, or clinical factors.

Conclusions:

• CT-derived body composition, particularly L3 SMI, can enhance extravasation risk stratification during abdominal CTA when combined with pressure monitoring.
• This integrated approach may lead to more individualized risk assessment.
• Prospective multi-center validation is recommended for clinical implementation.