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Optimization of Split-Bolus CT Urography: Effect of Differences in Allocation of Contrast Medium and Prolongation of Imaging Delay

 Dahye Lee  ;  Eun-Suk Cho  ;  Joo Hee Kim  ;  Yong Pyo Kim  ;  Hyeon-Kyeong Lee  ;  Jeong-Sik Yu  ;  Jae-Joon Chung 
 American Journal of Roentgenology, Vol.209(1) : W10-W17, 2017 
Journal Title
 American Journal of Roentgenology 
Issue Date
Adult ; Aged ; Contrast Media/administration & dosage* ; Female ; Humans ; Iohexol/administration & dosage ; Iohexol/analogs & derivatives* ; Kidney Cortex/diagnostic imaging* ; Kidney Diseases/diagnostic imaging* ; Male ; Middle Aged ; Radiographic Image Interpretation, Computer-Assisted/methods ; Tomography, X-Ray Computed/methods* ; Urography/methods*
CT urography ; MDCT ; opacification ; split-bolus ; urinary system
OBJECTIVE: The purpose of this study was to find the optimal allocation ratio of contrast medium (CM) in split-bolus CT urography (CTU) and to investigate the effect of increased imaging delays for synchronous nephrographic-excretory phase imaging. SUBJECTS AND METHODS: One hundred ninety-two patients were randomly assigned to one of three protocols with different allocation ratios of CM: group A, 30% of CM at first bolus and 70% of CM at second bolus; group B, 70% and 30%; or group C, 50% and 50%. Saline (250 mL) was administered after the first CM bolus. Patients were subdivided by different imaging delay times (8, 10, 12, and 14 minutes). The attenuation values of the renal cortex and medulla were measured, and the opacification and maximal caliber of each segment of the ureter were evaluated. RESULTS: Renal cortical enhancement was significantly higher in group A (mean ± SD, 145.9 ± 17.5 HU) than group B (120.6 ± 106.3 HU). No significant difference in renal parenchymal enhancement was found with increased imaging delay times. The opacification and maximal caliber of each ureter segment showed no significant difference with different allocation ratios of CM or increased imaging delay times. CONCLUSION: A split-bolus CTU protocol with a larger CM volume administered at the second injection and an 8-minute imaging delay was the optimal protocol with regard to opacification of the ureter, renal parenchymal enhancement, and shorter examination time.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
김용표(Kim, Yong Pyo)
김주희(Kim, Joo Hee) ORCID logo https://orcid.org/0000-0001-5383-3602
유정식(Yu, Jeong Sik) ORCID logo https://orcid.org/0000-0002-8171-5838
정재준(Chung, Jae Joon) ORCID logo https://orcid.org/0000-0002-7447-1193
조은석(Cho, Eun Suk)
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