Abstract
Purpose To prospectively compare the performance of James and Boer formula in contrast media (CM) administration, in terms of image quality and parenchymal enhancement in obese patients undergoing CT of the abdomen. Materials and Methods Fifty-five patients with a body mass index (BMI) greater than 35 kg/m2 were prospectively included in the study. All patients underwent 64-row CT examination and were randomly divided in two groups: 26 patients in Group A and 29 patients in Group B. The amount of injected CM was computed according to the patient's lean body weight (LBW), estimated using either Boer formula (Group A) or James formula (Group B). Patient's characteristics, CM volume, contrast-to-noise ratio (CNR) of liver, aorta and portal vein, and liver contrast enhancement index (CEI) were compared between the two groups. For subjective image analysis readers were asked to rate the enhancement of liver, kidneys, and pancreas based on a 5-point Likert scale. Results Liver CNR, aortic CNR, and portal vein CNR showed no significant difference between Group A and Group B (all P ≥ 0.177). Group A provided significantly higher CEI compared to Group B (P = 0.007). Group A and Group B returned comparable overall subjective enhancement values (3.54 and vs 3.20, all P ≥ 0.199). Conclusions Boer formula should be the method of choice for LBW estimation in obese patients, leading to an accurate CM amount calculation and an optimal liver contrast enhancement in CT.
Highlights
Contrast media (CM) enhancement, during Computed tomography Hounsfield Units (HU) (CT) exams, is influenced by multiple factors: patients and tissue characteristics, CM type, volume, and concentration, injection time, and scan timing [1,2,3,4,5]
contrast-to-noise ratio (CNR) of liver, aorta, and portal vein and liver contrast enhancement index (CEI) and image quality have been analyzed on portal venous phase
Our results demonstrate both formulas achieve comparable image quality, while Boer formula allowed for higher enhancement compared to James formula
Summary
Contrast media (CM) enhancement, during CT exams, is influenced by multiple factors: patients and tissue characteristics, CM type, volume, and concentration, injection time, and scan timing [1,2,3,4,5]. A large proportion of body weight consists of adipose tissue, which is poorly perfused compared to solid parenchymas and in which CM distributes poorly [9]. The adipose tissue does not substantially contribute to contrast distribution. Such approach can result in an over- or underdosage of CM in the obese population [10]
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