Lean Body Weight Group Research Articles

Does Contrast Dose Based in Lean body Weight Allow Lesser Volumes on High BMI Patients for CT Angiography?

Objectives:The objective was to evaluate whether contrast dose based on lean body weight (LBW) protocol has the potential to reduce contrast volume in patients with high basal metabolic index (BMI) compared to total body weight (TBW)-based protocols.Material and Methods:The Institutional Review Board approval was obtained for this prospective study. Initially, a pilot study with a sample size of 150 patients was conducted to estimate the average fat fraction in our population. Then, CT angiography (CTA) for the thoracic and abdominal aorta was performed using a 256-multidetector computed tomography scanner in 117 patients who were undergoing screening for aortic aneurysm and vascular assessment of prospective transplant donors. The patients were divided into two groups: A TBW group (n = 60) and LBW group (n = 57). Lean body weight (LBW) was estimated from the patient weight, height, and gender using Hume’s equation. The TBW group received 1.2 ml/kg contrast dose and the LBW group received 1.6 ml/kg contrast dose to achieve approximately equal iodine dose in both groups. Differences in the degree of aortic enhancement between the estimated LBW and TBW group were evaluated. In higher BMI patients (>25), the mean aortic enhancement (MAEnh) and the contrast volume delivered between the LBW and TBW group were compared.Results:Mean aortic enhancement (MAEnh) 422.45 (±74.5) Hounsfield unit (HU) in the TBW group and 432.67 (±69.4) HU in the LBW group showed no statistical difference (P = 0.439). In population with BMI >25, the contrast delivered in LBW protocol patients was significantly less (P = 0.00) compared to TBW protocol patients, with no significant difference in the MAEnh between the groups (P = 0.479).Conclusion:CTA using a LBW protocol helps to significantly reduce the volume of contrast delivered, especially in patients with BMI >25 compared to TBW protocol, without compromising the aortic enhancement.

Optimization of contrast medium volume for abdominal CT in oncologic patients: prospective comparison between fixed and lean body weight-adapted dosing protocols

BackgroundPatient body size represents the main determinant of parenchymal enhancement and by adjusting the contrast media (CM) dose to patient weight may be a more appropriate approach to avoid a patient over dosage of CM. To compare the performance of fixed-dose and lean body weight (LBW)-adapted contrast media dosing protocols, in terms of image quality and parenchymal enhancement.ResultsOne-hundred cancer patients undergoing multiphasic abdominal CT were prospectively enrolled in this multicentric study and randomly divided in two groups: patients in fixed-dose group (n = 50) received 120 mL of CM while in LBW group (n = 50) the amount of CM was computed according to the patient’s LBW. LBW protocol group received a significantly lower amount of CM (103.47 ± 17.65 mL vs. 120.00 ± 0.00 mL, p < 0.001). Arterial kidney signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and pancreatic CNR were significantly higher in LBW group (all p ≤ 0.004). LBW group provided significantly higher arterial liver, kidney, and pancreatic contrast enhancement index (CEI) and portal venous phase kidney CEI (all p ≤ 0.002). Significantly lower portal vein SNR and CNR were observed in LBW-Group (all p ≤ 0.020).ConclusionsLBW-adapted CM administration for abdominal CT reduces the volume of injected CM and improves both image quality and parenchymal enhancement.

Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial

ObjectivesIodinated contrast media (ICM) could be more appropriately dosed on patient lean body weight (LBW) than on total body weight (TBW).MethodsAfter Ethics Committee approval, trial registration NCT03384979, patients aged ≥ 18 years scheduled for multiphasic abdominal CT were randomised for ICM dose to LBW group (0.63 gI/kg of LBW) or TBW group (0.44 gI/kg of TBW). Abdominal 64-row CT was performed using 120 kVp, 100–200 mAs, rotation time 0.5 s, pitch 1, Iopamidol (370 mgI/mL), and flow rate 3 mL/s. Levene, Mann–Whitney U, and χ2 tests were used. The primary endpoint was liver contrast enhancement (LCE).ResultsOf 335 enrolled patients, 17 were screening failures; 44 dropped out after randomisation; 274 patients were analysed (133 LBW group, 141 TBW group). The median age of LBW group (66 years) was slightly lower than that of TBW group (70 years). Although the median ICM-injected volume was comparable between groups, its variability was larger in the former (interquartile range 27 mL versus 21 mL, p = 0.01). The same was for unenhanced liver density (IQR 10 versus 7 HU) (p = 0.02). Median LCE was 40 (35–46) HU in the LBW group and 40 (35–44) HU in the TBW group, without significant difference for median (p = 0.41) and variability (p = 0.23). Suboptimal LCE (< 40 HU) was found in 64/133 (48%) patients in the LBW group and 69/141 (49%) in the TBW group, but no examination needed repeating.ConclusionsThe calculation of the ICM volume to be administered for abdominal CT based on the LBW does not imply a more consistent LCE.

Comparative study of anaesthesia induction in obese dogs using propofol dosages based on lean body weight or total body weight

The objective of this study was to compare the dosages for anesthesia induction in obese dogs using propofol based on lean body weight or total body weight. For this purpose, seven dogs with ideal body condition score (BCS) (BCS 4-5; 17.3 ± 2.5% fat mass) were included in the control group (CG), seven obese dogs (BCS 8-9; 45.7 ± 2.9% fat mass) in the total body weight group (TBWG) and seven obese dogs (BCS 8-9; 42.8 ± 6.3% fat mass) in the lean body weight group (LBWG). Anaesthesia was induced by a constant rate infusion of propofol at 150 mg kg−1 hour−1 through a propofol infusion pump until the loss of consciousness; the animals in CG and TBWG received a propofol infusion based on total body weight; the animals in LBWG received a propofol infusion based on lean body mass (in kg) determined by the deuterium dilution method. The results were compared between the groups using the Tukey test (p < 0.05). The propofol dosage used was 11.4 ± 3.2 mg kg−1, 8.0± 2.0 mg kg−1 and 14.1 ± 4.7 mg kg−1 in groups CG, TBWG and LBWG, respectively, and they were different among all groups (p < 0.001). There was also a statistical difference in the time between the start of propofol infusion and loss of consciousness in which LBWG took longer than CG and TBWG (p = 0.004). This study shows that obese dogs require lower dosages of propofol when inducing anesthesia than ideal BCS dogs anesthetized with dosages based on total body weight, when the propofol dosages are calculated on the basis of muscle mass it should be increased.

Body size indices to determine iodine mass with contrast-enhanced multi-detector computed tomography of the upper abdomen: does body surface area outperform total body weight or lean body weight?

To compare total body weight (TBW), lean body weight (LBW) and body surface area (BSA) for the adjustment of the iodine dose required for contrast-enhanced multi-detector computed tomography (MDCT) of the aorta and the liver. One hundred and three patients undergoing MDCT of the abdomen were randomised into three groups: the TBW group receiving 0.6 g iodine/kg of TBW (n = 33), the LBW group receiving 0.75 g iodine/kg of LBW (n = 35) and the BSA group receiving 22 g iodine/m(2) (n = 35). ∆HU (increases in CT value) per gram of iodine (∆HU/g) and adjusted maximum hepatic enhancement (adjusted MHE; ∆HU/[g iodine/kg]) correlated with three groups using linear regressions. Correlation coefficients of ∆HU/g were 0.67 (TBW), 0.86 (LBW) and 0.85 (BSA) for the aorta, and 0.74 (TBW), 0.77 (LBW) and 0.84 (BSA) for the liver. Adjusted MHE was constant at 70.2 with LBW and at 2.69 with BSA, but correlated positively with TBW (r = 0.58, P < 0.001). Iodine load may need to be tailored by LBW or BSA in contrast enhanced MDCT of the abdomen. BSA is a simple and feasible index for the determination of iodine dose in individual patients. • Optimisation of enhancement is very important for high quality MDCT. • Iodine dose is best adjusted according to LBW or BSA. • BSA may be adopted because calculation is simple. • Iodine dose of 0.712 g/kg LBW/18.6 g/m (2) BSA gives 50 HU hepatic enhancement.

Body Size Indexes for Optimizing Iodine Dose for Aortic and Hepatic Enhancement at Multidetector CT: Comparison of Total Body Weight, Lean Body Weight, and Blood Volume

To evaluate and compare total body weight (TBW), lean body weight (LBW), and estimated blood volume (BV) for the adjustment of the iodine dose required for contrast material-enhanced multidetector computed tomography (CT) of the aorta and liver. Institutional review committee approval and written informed consent were obtained. One hundred twenty patients (54 men, 66 women; mean age, 64.1 years; range, 19-88 years) who underwent multidetector CT of the upper abdomen were randomized into three groups of 40 patients each: (a) TBW group (0.6 g of iodine per kilogram of TBW), (b) LBW group (0.821 g of iodine per kilogram of LBW), and (c) BV group (men, 8.6 g of iodine per liter of BV; women, 9.9 g of iodine per liter of BV). Change in CT number between unenhanced and contrast-enhanced images per gram of iodine and maximum hepatic enhancement (MHE) adjusted for iodine dose were examined for correlation with TBW, LBW, and BV by using linear regression analysis. In the portal venous phase, correlation coefficients for the correlation of change in CT number per gram of iodine with TBW for the aorta and liver were -0.71 and -0.79, respectively, in the TBW group; -0.80 and -0.86, respectively, in the LBW group; and -0.68 and -0.66, respectively, in the BV group. In the liver, they were marginally higher in the LBW group than in the BV group (P = .03). Adjusted MHE remained constant at 77.9 HU +/- 10.2 (standard deviation) in the LBW group with respect to TBW, but it increased in the TBW (r = 0.80, P < .001) and BV (r = 0.70, P < .001) groups as TBW increased. When LBW, rather than TBW or BV, is used, the iodine dose required to achieve consistent hepatic enhancement may be estimated more precisely and with reduced patient-to-patient variability.

Effect of Contrast Injection Protocols with Dose Adjusted to the Estimated Lean Patient Body Weight on Aortic Enhancement at CT Angiography

The objective of our study was to investigate the effect on aortic enhancement of iodine doses adjusted for the patient estimated lean body weight (LBW) at CT angiography (CTA). CTA for the whole aorta using a 64-MDCT scanner was performed in 97 patients (mean age, 67.4 years) with confirmed or suspected aortoiliac disease. The patients were divided into two groups: a total body weight (TBW) group (n = 49) and an estimated LBW group (n = 48). LBW was estimated from the patient weight (TBW) and height. The TBW and estimated LBW groups received 360 mg I/kg of TBW and 450 mg I/kg of estimated LBW of contrast medium, respectively. The relative dose ratio for the estimated LBW group versus the TBW group was based on the fact that the standard percentage of body fat in Japanese adults with an average TBW of 60 kg is 20% (360 = 0.8 x 450). Differences in the degree of aortic enhancement and interpatient variability in aortic enhancement between the estimated LBW and TBW group were evaluated. Mean aortic enhancement was 308.9 HU for the estimated LBW group and 314.1 HU for the TBW group, indicating no significant difference in the degree of enhancement (Welch's t test, p = 0.61). The interquartile range was smaller for the LBW group than the TBW group (52.8 vs 79.1 HU, respectively); interpatient variability was lower in the estimated LBW group. The aortic attenuation gradient in the TBW group and estimated LBW group was 20.7 and 25.8 HU, respectively; the difference was not statistically significant. The CTA protocol using an estimated LBW-tailored dose yielded more consistent aortic enhancement with reduced interpatient variability than the CTA protocol using a TBW-based dose.