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Dynamic abdominal computed tomography: "top-down" compared with "bottom-up" imaging

D B Bach1, A D Vellet, M F Levin

  • 1Department of Diagnostic Radiology and Nuclear Medicine, University Hospital, London, Ont.

Canadian Association of Radiologists Journal = Journal L'Association Canadienne Des Radiologistes
|October 1, 1993
PubMed
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The bottom-up scanning method for liver dynamic contrast-enhanced computed tomography (CT) significantly improves liver and hepatic vein enhancement compared to the traditional top-down approach. This technique offers superior opacification for better diagnostic imaging.

Area of Science:

  • Radiology
  • Medical Imaging
  • Hepatobiliary Imaging

Background:

  • Standard top-down dynamic contrast-enhanced computed tomography (CT) of the liver often results in suboptimal opacification of superior liver segments.
  • This uneven enhancement can potentially limit the diagnostic accuracy of CT in evaluating liver parenchyma and vasculature.

Purpose of the Study:

  • To investigate whether reversing the scanning direction to a bottom-up approach improves liver parenchyma and hepatic vein enhancement in dynamic contrast-enhanced CT.
  • To compare the degree of opacification between bottom-up and top-down scanning protocols.

Main Methods:

  • Thirty-two patients were prospectively assigned to either a top-down or a bottom-up dynamic contrast-enhanced CT liver protocol.
  • All patients received identical contrast agent administration (135 mL iohexol via power injector) with scanning initiated 30 seconds post-injection.

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  • Attenuation measurements were taken in specified liver regions and hepatic/portal veins to quantify enhancement.

    • Main Results:

    • The upper liver portion demonstrated significantly greater enhancement with the bottom-up sequence (123%) compared to the top-down sequence (22%) (p < 0.01).
    • Excellent overall liver enhancement was observed in the bottom-up group.
    • Hepatic veins showed significantly improved conspicuity in the bottom-up scanning method (p < 0.01).

    Conclusions:

    • The dynamic bottom-up scanning technique provides superior hepatic parenchyma enhancement and vascular opacification compared to the conventional top-down method.
    • This improved enhancement suggests the bottom-up approach is a more effective protocol for dynamic contrast-enhanced CT of the liver.