Liver CT perfusion: which is the relevant delay that reduces radiation dose and maintains diagnostic accuracy?
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High radiation dose during CT perfusion (CTp) studies contributes to prevent CTp application in daily clinical practice. This work evaluates the consequences of scan delay on perfusion parameters and provides guidelines to help reducing the radiation dose by choosing the most appropriate delay.
Fifty-nine patients (34 men, 25 women; mean age 68 ± 12) with colorectal cancer, without underlying liver disease, underwent liver CTp, with the acquisition starting simultaneously with iodinated contrast agent injection. Blood flow (BF) and hepatic perfusion index (HPI) were computed on the acquired examinations and compared with those of the same examinations when a variable scan delay (τ) is introduced. Dose length product, CT dose index, and effective dose were also computed on original and delayed examinations.
Altogether, three groups of delays (τ ≤ 4 s, 5 s ≤ τ ≤ 9 s, τ ≥ 10 s) were identified, yielding increasing radiation dose saving (RDS) (RDS ≤ 9.5%, 11.9% ≤ RDS ≤ 21.4%, RDS ≥ 23.8%) and decreasing perfusion accuracy (high (τ ≤ 4 s), medium (5 s ≤ τ ≤ 9 s), low (τ ≥ 10 s)). In particular, single-input and arterial BF and HPI were more insensitive to delay as regards the absolute variations (only 1 ml/min/100 g and 1%, respectively, for τ ≤ 9 s), than portal and total BF.
Using delays lower than 4 s does not change perfusion accuracy and conveys unnecessary dose to patients. Conversely, starting the acquisition 9 s after contrast agent injection yields a RDS of about 21%, with no significant losses in perfusion accuracy.
• Scan delays lower than 4 s do not alter perfusion accuracy and deliver an unnecessary radiation dose to patients.
• Radiation dose delivered to patients can be reduced by 21.4% by introducing a 9-s scan delay, while keeping accurate perfusion values.
• Using scan delays higher than 10 s, some perfusion parameters (portal and total BF) were inaccurate.
KeywordsContrast media Colorectal neoplasms Liver diseases Radiation dosage Tomography, X-ray computed
Arterial blood flow
Cohort-oriented absolute differences
Patient-oriented absolute differences
Volumetric CT dose index
Dose length product
Hepatic perfusion index
Integer number for statistical differences
Portal blood flow
Cohort-oriented percentage differences
Patient-oriented percentage differences
Radiation dose saved
Total blood flow
Time concentration curves
This study has received funding by a grant from the Programme Hospitalier de Recherche Clinique - PHRC 2007 no. AOM07228, France, and sponsored by Assistance-Publique Hôpitaux de Paris (APHP).
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Valérie Vilgrain.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Alessandro Bevilacqua, MS, PhD, kindly provided statistical advice for this manuscript and is one of the authors of this manuscript.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• Diagnostic or prognostic study
• Performed at one institution
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