Patient body weight-tailored contrast medium injection protocol for the craniocervical vessels: a prospective computed tomography study

• Published in: PloS one 2014-02, Vol.9 (2), p.e88867-e88867
• Main Authors: Kessler, Rebecca, Hegenscheid, Katrin, Fleck, Steffen, Khaw, Alexander, Kirsch, Michael, Hosten, Norbert, Langner, Sönke
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Agfa; Angiography; Angiography - methods; Arteries; Blood vessels; Body mass; Body Mass Index; Body Weight; Carotid arteries; Computation; Computed tomography; Contrast media; Contrast Media - administration & dosage; CT imaging; Dosage; Dosage and administration; Drug dosages; Ethical aspects; Female; Humans; Image quality; Informed consent; Injections; Iodine; Male; Mathematical analysis; Medical imaging; Medicine; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Nervous System - blood supply; Noise; Patients; Precision Medicine - methods; Prospective Studies; Radiation Dosage; Signal-To-Noise Ratio; Statistical analysis; Tomography; Tomography, X-Ray Computed - methods; Triiodobenzoic Acids - administration & dosage; Veins & arteries; Vertebra; Vertebrae
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0088867

To evaluate body weight-tailored contrast medium (CM) administration for computed tomography angiography (CTA) of the craniocervical vessels. Institutional review board approval was obtained, and all patients gave written informed consent. Sixty patients were consecutively assigned to one of three dose groups (20 patients per group) with CM doses of Visipaque 270® (iodixanol 270 mg/ml) tailored to body weight at doses of 1.5, 1.0, or 0.5 ml/kg. Region-of-interest (ROI) analysis of maximum enhancement (ME) was conducted, and signal-to-noise-ratios (SNR) and contrast-to-noise-ratios (CNR) were calculated. Retrospective comparison was performed with three matched control groups examined with a standard CM dose (80 ml of Visipaque 270®). Image quality was rated by two neuroradiologists blinded to the CM dose used. Interrater reliability was calculated using kappa statistics. Body weight/BMI and ME were inversely correlated in the three control groups receiving the standard dose (r = -0.544/-0.597/-0.542/r = -0.358/r = -0.424/r = -0.280). Compared to standard dose, 1.5 ml/kg produced higher ME, SNR, and CNR in the anterior circulation (p≤0.038), 1.0 ml/kg had higher ME in cervical and medium-sized cerebral arteries (p≤0.034), and 0.5 ml/kg had lower ME, SNR and CNR for medium-sized cerebral arteries (p≤0.049). ME, SNR, and CNR were the same for 1.5 ml/kg and 1.0 ml/kg (p≥0.24), and both had higher values compared to 0.5 ml/kg (p≤0.043/p≤0.028). In patients with BMI>25, 1.5 ml/kg and 1.0 ml/kg produced higher ME than standard dose (p25 did not differ between group 1 and group 2 (p = 0.673). In patients with BMI≤25, 1.5 ml/kg and 1.0 ml/kg produced ME comparable to standard dose (p = 0.132/p = 0.403). Regardless of patient weight, 0.5 ml/kg yielded lower ME than standard dose (p = 0.019/0.002). Craniocervical CTA with a body weight-tailored CM dose of 1.0 ml/kg (270 mg iodine/ml) reduces iodine load in patients weighing 25.