Personalized high pitch CTPA facilitates a reduction of contrast agent volume

作者：Raoul Varga, Florian Weiß, Marcus Raudner, Helmut Prosch, Rüdiger Schernthaner · 发表于：European Journal of Radiology · 年份：2025 · DOI：10.1016/j.ejrad.2025.112172 · 被引用次数：2 · 研究领域：Venous Thromboembolism Diagnosis and Management、Acute Kidney Injury Research、Liver Disease and Transplantation

PURPOSE: Despite advancements in computed tomography pulmonary angiography (CTPA), optimizing contrast agent (CA) volume remains crucial due to inter-patient hemodynamic variability. This study aimed to evaluate a personalized scan delay approach using a test bolus technique to minimize CA volume while maintaining diagnostic image quality. PATIENT AND METHODS: A prospective trial (n = 97) was conducted on patients referred for CTPA due to suspected pulmonary embolism (PE). The study group (n = 77) underwent CTPA with a reduced CA volume (20 mL Iomeron 400 i.v.) guided by a test bolus technique to determine the optimal scan delay. Standard CTPA exclusion criteria were applied; no study-related exclusion criteria were defined. A retrospectively selected control group (n = 31) underwent CTPA using a standard bolus tracking protocol with 50 mL Iomeron 400 i.v. Two independent readers performed image analysis. RESULTS: PE was detected in 21 patients in the study group and y patients in the control group. Attenuation values in the pulmonary trunk were significantly lower in the study group (mean 336 ± 116 HU) compared to the control group (mean 517 ± 185 HU) (p < 0.001). However, a comparable proportion of patients in both groups achieved diagnostic attenuation values (>200 HU) in the pulmonary trunk. The superior vena cava (SVC) attenuation was significantly higher in the control group (mean 1241 ± 795 HU) compared to the study group (mean 430 ± 337 HU) (p < 0.001), suggesting pot...