High-pressure-resistant totally implantable venous power ports for improving image quality in contrast-enhanced...

Contrast-enhanced computed tomography (CECT) is essential for cancer screening, staging, and surveillance, but achieving optimal image quality requires the administration of high-pressure contrast injection via a reliable venous access. Peripheral intravenous catheters (PIVC) have significant limitations in oncology settings, including pain, extravasation risk, and contrast pooling that degrades image quality. Totally implantable venous power ports (TIVPPs) offer a central venous route resistant to high-pressure injection, yet quantitative evidence of their impact on image quality metrics remains scarce. This study aimed to evaluate the effect of TIVPP-based contrast injection on image quality and safety in chest CECT for oncology patients.

In this retrospective fixed-order sequential study, 195 oncology patients underwent two chest CECT scans at a tertiary medical center between August 1, 2022, and July 31, 2024. Each patient first received contrast injection via a PIVC and then via a TIVPP. Objective image parameters, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and CT attenuation values, were measured. Subjective image quality scores, the presence of artifacts, and complication rates were compared. Statistical analyses were performed via paired t-tests and McNemar or Fisher exact tests.

The time interval between the PIVC and TIVPP examinations was 131.0±26.2 days (median 128 days; range 71-180 days). Contrast extravasation occurred in 3.1% of examinations performed with PIVCs but in none performed with TIVPPs (P=0.030). Compared to PIVCs, TIVPPs provided significantly higher aortic attenuation (405.50 vs. 363.50 HU; P<0.001), SNR (28.32 vs. 26.45; P=0.005), and CNR (25.83 vs. 21.24; P<0.001). Pulmonary vein image quality was rated as excellent in 100% of TIVPP examinations, higher than the 93.4% of PIVC examinations (P<0.001). Visualization of the subclavian artery was markedly superior with TIVPPs (97.4% excellent) compared with PIVC (0%; P<0.001).

TIVPPs provide a safe, reliable, and diagnostically superior route for high-pressure contrast injection in chest CECT for patients with cancer. They maintain significantly superior objective and subjective image quality compared to peripheral venous access, with no contrast extravasation. However, the fixed-order sequential design might have introduced temporal confounding, which should be considered in the interpretation of our findings.