Delayed bolus-tracking trigger at CT correlates with cardiac dysfunction and suboptimal portovenous contrast phase

Abstract

Objective

To assess whether delayed trigger during bolus-tracking for CT correlates with reduced heart function and suboptimal portovenous contrast phase.

Methods and Materials

Patients who underwent portovenous abdominal CT using bolus-tracking and echocardiography within 2 weeks were included and excluded if there was a non-standard contrast injection. The bolus trigger time (BTT) at 100 Hounsfield units in the abdominal aorta, patient age, congestive heart failure (CHF) history, and ejection fraction were recorded. Two radiologists scored the liver contrast phase (1–5, 5 being an optimal portovenous phase). When applicable, the BTT and contrast score of the most recent comparison examination with equivalent technical parameters were also recorded. Simple linear regression (univariate) was used to test for associations with trigger time.

Results

114 patients with a mean age of 61 ± 15 years fulfilled criteria. The mean trigger time was 18 ± 6 s (range: 6–38 s) and the mean ejection fraction was 52 ± 12% (range: 19–69%).

A longer bolus trigger had a significant correlation with reduced ejection fraction (P = 0.0018), lower hepatic contrast score (P < 0.0001), history of CHF (P = 0.0212), and older age (P = 0.0223).

Contrast score differences between the study exam and available prior exams revealed score differences of 0 (n = 73), 1 (n = 15) and 2 (n = 5); these were associated, respectively, with a mean bolus trigger time difference between exams of 2 s (range, 0–6 s), 6 s (range, 1–15 s), and 11 s (range, 5–13). The P-value comparing bolus trigger time and contrast score differences was less than 0.0001.

A lower ejection fraction also significantly correlated with suboptimal PV contrast phase (P < 0.0001).

Conclusion

Delayed time to trigger during bolus-tracking for CT can indicate cardiac dysfunction and may not adequately adjust to provide an optimal portovenous contrast phase.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Johnson DY, Farjat AE, Vernuccio F, Hurwitz LM, Nelson RC, Marin D (2020) Evaluation of Intraindividual Contrast Enhancement Variability for Determining the Maximum Achievable Consistency in CT. AJR Am J Roentgenol 214 (1):18–23. https://doi.org/10.2214/AJR.19.21628

    Article  PubMed  Google Scholar 

  2. 2.

    Kai N, Oda S, Utsunomiya D, Nakaura T, Funama Y, Kidoh M, Taguchi N, Iyama Y, Nagayama Y, Hirata K, Yuki H, Sakabe D, Hatemura M, Yamashita Y (2018) Dual-region-of-interest bolus-tracking technique for coronary computed tomographic angiography on a 320-row scanner: reduction in the interpatient variability of arterial contrast enhancement. Br J Radiol 91 (1081):20170541. https://doi.org/10.1259/bjr.20170541

    Article  PubMed  Google Scholar 

  3. 3.

    Kalra MK, Becker HC, Enterline DS, Lowry CR, Molvin LZ, Singh R, Rybicki FJ (2019) Contrast Administration in CT: A Patient-Centric Approach. J Am Coll Radiol 16 (3):295–301. https://doi.org/10.1016/j.jacr.2018.06.026

    Article  PubMed  Google Scholar 

  4. 4.

    Bashir MR, Weber PW, Husarik DB, Howle LE, Nelson RC (2012) Improved aortic enhancement in CT angiography using slope-based triggering with table speed optimization: a pilot study. Int J Cardiovasc Imaging 28 (6):1533–1543. https://doi.org/10.1007/s10554-011-9945-8

    Article  PubMed  Google Scholar 

  5. 5.

    Bae KT, Heiken JP, Brink JA (1998) Aortic and hepatic contrast medium enhancement at CT. Part II. Effect of reduced cardiac output in a porcine model. Radiology 207 (3):657–662. https://doi.org/10.1148/radiology.207.3.9609887

  6. 6.

    Sakai S, Yabuuchi H, Chishaki A, Okafuji T, Matsuo Y, Kamitani T, Setoguchi T, Honda H (2010) Effect of cardiac function on aortic peak time and peak enhancement during coronary CT angiography. Eur J Radiol 75 (2):173–177. https://doi.org/10.1016/j.ejrad.2009.04.022

    Article  PubMed  Google Scholar 

  7. 7.

    Shors SM, Cotts WG, Pavlovic-Surjancev B, Francois CJ, Gheorghiade M, Finn JP (2003) Heart failure: evaluation of cardiopulmonary transit times with time-resolved MR angiography. Radiology 229 (3):743–748. https://doi.org/10.1148/radiol.2293021363

    Article  PubMed  Google Scholar 

  8. 8.

    Mahnken AH, Henzler D, Klotz E, Hennemuth A, Wildberger JE, Gunther RW (2004) Determination of cardiac output with multislice spiral computed tomography: a validation study. Invest Radiol 39 (8):451–454. https://doi.org/10.1097/01.rli.0000128655.58691.14

    Article  PubMed  Google Scholar 

  9. 9.

    Garrett JS, Lanzer P, Jaschke W, Botvinick E, Sievers R, Higgins CB, Lipton MJ (1985) Measurement of cardiac output by cine computed tomography. Am J Cardiol 56 (10):657–661. https://doi.org/10.1016/0002-9149(85)91030-6

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 28 (1):1–39.e14. https://doi.org/10.1016/j.echo.2014.10.003

    Article  Google Scholar 

  11. 11.

    Hota P, Simpson S (2019) Going beyond Cardiomegaly: Evaluation of Cardiac Chamber Enlargement at Non–Electrocardiographically Gated Multidetector CT: Current Techniques, Limitations, and Clinical Implications. Radiology: Cardiothoracic Imaging 1 (1):e180024

  12. 12.

    Chaturvedi A, Oppenheimer D, Rajiah P, Kaproth-Joslin KA, Chaturvedi A (2017) Contrast opacification on thoracic CT angiography: challenges and solutions. Insights Imaging 8 (1):127–140. https://doi.org/10.1007/s13244-016-0524-3

    Article  PubMed  Google Scholar 

  13. 13.

    Bae KT (2010) Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 256 (1):32–61. https://doi.org/10.1148/radiol.10090908

    Article  PubMed  Google Scholar 

  14. 14.

    Ma J, Dercle L, Lichtenstein P, Wang D, Chen A, Zhu J, Piessevaux H, Zhao J, Schwartz LH, Lu L, Zhao B (2020) Automated Identification of Optimal Portal Venous Phase Timing with Convolutional Neural Networks. Acad Radiol 27 (2):e10–e18. https://doi.org/10.1016/j.acra.2019.02.024

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Carol Pieranunzi for her crucial database search support.

Funding

Supported by institutional CCSG (cancer center support grant) from the NIH/National Cancer Institute under award number P30CA016672.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Corey T. Jensen.

Ethics declarations

Conflict of interest

The authors have no relevant disclosures.

IRB Statement

This retrospective study was approved by our institutional review board as Health Insurance Portability and Accountability Act compliant, and the need for informed consent was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jensen, C.T., Khetan, R., Adkins, J. et al. Delayed bolus-tracking trigger at CT correlates with cardiac dysfunction and suboptimal portovenous contrast phase. Abdom Radiol 46, 826–835 (2021). https://doi.org/10.1007/s00261-020-02655-8

Download citation

Keywords

  • Congestive heart failure
  • Bolus-tracking
  • Abdomen
  • CT
  • Contrast