Ces radiol. 2019, 73(2):99-106 | DOI: 10.55095/CesRadiol2019/015

Split-bolus technique of contrast medium administration used in whole body CT examination of patient with polytraumaOriginal article

Kristýna Bajcurová, Hynek Mírka, Eva Korčáková
Klinika zobrazovacích metod LF UK a FN, Plzeň
Biomedicínské centrum LF UK, Plzeň

Objective: The possibilities of CT examinations in patients with multiple trauma are: two-phase, or single-phase CT examination, after a single-bolus contrast medium (CM) administration; and a single-pass CT examination after multiphasic CM administration, also called "split-bolus technique" (SB). This article compares few protocols and seeks an optimal diagnostic quality.

Methods: Five patient groups were created. Group A and B underwent a CT examination after administration of single bolus of CM, then group A underwent a two-phase examination in arterial and venous phase and group E underwent single-phase examination. Groups C, D and E underwent single-phase CT examination with split-bolus technique of CM administration. The CM volume of 100 ml and the concentration of 350 mgI/ml was used in all groups. The groups were statistically evaluated.

Results: There was a significant difference achieved in the density measured in arteries between group A vs. groups B-E. The value of 185 HU was exceeded in all observed reference regions, with the only exception in the pelvic arteries in group C. A significant difference was found in a saturation of the hepatic parenchyma between groups A vs. groups B-E. There was an increase of measured densities in parenchymal organs, when the saline flush after first CM bolus was used. Comparing densities in the liver and the spleen parenchyma, there was no significant difference between groups C-E vs. B, although in group B the densities were lower by 6-14 HU.

Conclusion: We achieved a good image quality in all SB protocols. Use of SB protocols brings a significant reduction of radiation dose along with a smaller CM volume compared to previously published SB protocols. The single-phase CT examination after single bolus of CM didn't achieve the diagnostic quality demanded in examinations of patients with trauma.

Keywords: whole-body CT examination, multiple trauma, split-bolus technique, contrast
Grants and funding:

Podpořeno projektem MZ ČR Koncepční rozvoj výzkumné instituce 00669806 - FN Plzeň a projektem Univerzity Karlovy v Praze Progress q39.

Accepted: January 15, 2019; Published: June 1, 2019  Show citation

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Bajcurová K, Mírka H, Korčáková E. Split-bolus technique of contrast medium administration used in whole body CT examination of patient with polytrauma. Ces radiol. 2019;73(2):99-106. doi: 10.55095/CesRadiol2019/015.
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References

  1. National Trauma Institute. Trauma statistics. https://www.nattrauma.org/what-is-trauma/trauma-statistics-facts/ (zdroj z 6. 1. 2019).
  2. Chidambaram S, Goh EL, Khan MA. A meta-analysis of the efficacy of whole-body computed tomography: Imaging in the management of trauma and injury. Int J Care Injured 2017; 48: 1784-1793. Go to original source... Go to PubMed...
  3. Linsenmaier U, Krötz M, Haüser H, et al. Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 2002; 12(7): 1728-1740. Go to original source... Go to PubMed...
  4. Leung V, Sastry A, Woo TD, Jones HR. Implementation of a split bolus single-pass CT protocol at a UK major trauma centre to reduce excess radiation dose in trauma pan-CT. Clinical Radiology 2015; 70: 1110-1115. Go to original source... Go to PubMed...
  5. Loupatatzis C, Schindera S, Gralla J, et al. Whole-body computed tomography for multiple traumas using a triphasic injection protocol. Eur Radiol 2008; 18: 1206-1214. Go to original source... Go to PubMed...
  6. Nguyen D, Platon A, Shanmuganathan K, et al. Evaluation of a single-pass continuous whole-body 16-MDCT protocol for patients with polytrauma. Am J Roentgenol 2009; 192: 3-10. Go to original source... Go to PubMed...
  7. Yaniv G, Portnoy O, Simon D, et al. Revised protocol for whole-body CT for multi-trauma patients applying triphasic injection followed by a single-pass scan on a 64-MDCT. Clin Radiol 2013; 68: 668-675. Go to original source... Go to PubMed...
  8. Beenen LFM, Sierink JC, Kolkman S, et al. Split bolus technique in polytrauma: A prospective study on scan protocols for trauma analysis. Acta Radiologica 2015; 56(7): 873-880. Go to original source... Go to PubMed...
  9. Stedman JM, Franglin JM, Nicholl H, Anderson EM, Moore NR. Splenic parenchymal heterogeneity at dual-bolus single-acquisition CT in polytrauma patients - 6-months experience from Oxford, UK. Emergency Radiology 2014; 21(3): 257-260. Go to original source... Go to PubMed...
  10. Sciapli M, Schiavone R. Split-bolus single-pass in trauma pan-CT: How to ensure reproducibility and diagnostic efficacy. Clinical Radiology 2016; 71(5): 497-498. Go to original source... Go to PubMed...
  11. Marovic P, Beech PA, Koukounaras J, Kavnoudias H, Goh GS. Accuracy of dual bolus single acquisition computed tomography in the diagnosis and grading of adult traumatic splenic parenchymal and vascular injury. Journal of Medicinal Imaging and Radiation Oncology 2017; 61(6): 725-731. https://onlinelibrary.wiley.com/doi/full/10.1111/1754-9485.12619 Go to original source... Go to PubMed...
  12. Godt JC, Eken T, Schulz A, Johansen CK, Aarsnes A, Dormagen JB. Triple-split-bolus versus single-bolus CT in abdominal trauma patients: a comparative study. Acta Radiologica 2018; 59(9): 1038-1044. Go to original source... Go to PubMed...
  13. Raupach J, Krajina A, Žižka J. Metodický list intravaskulárního podání jodových kontrastních látek (JKL). Online dostupný na: http://www.crs.cz/cs/dokumenty/doporuceni-prehled/metodicky-list-intravaskularniho-podani-jodovych-kontrastnich-latek-jkl.html

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