Eur J Radiol. 2025 Jan 24;184:111949. doi: 10.1016/j.ejrad.2025.111949. Online ahead of print.
ABSTRACT
OBJECTIVE: To explore the clinical value of combining split-bolus contrast injection with dual-energy CT(DECT) scanning technology in pediatric computed tomography urography (CTU) imaging.
METHODS: A total of 128 children aged 0-17 years were prospectively selected and randomly assigned to three groups: A, B, and C. For Group A, a high-pitch flash mode was employed, where a single bolus of contrast agent was followed by four-phase scanning (noncontrast, cortex, medulla, and excretory phases). In Group B, a dual-energy scanning mode was used with a split-bolus injection technique (50 % of the contrast agent was administered initially, followed by the remaining 50 % after 37-43 s), and the children underwent two-phase scanning (corticomedullary and excretory phases). In Group C, dual-energy scanning was similarly used with a split-bolus injection technique (65 % contrast agent was administered initially, followed by the remaining 35 % after 37-43 s), along with two-phase scanning (corticomedullary and excretory phases). Virtual noncontrast (VNC) images were obtained from the corticomedullary phase images using iodine subtraction techniques for Groups B and C. The image quality and radiation dose across the groups were compared and analysed.
RESULTS: When the CT values of the renal cortex, erector spinae muscles, and standard deviation (SD) values were compared between Group A’s cortical phase and Groups B and C’s corticomedullary phases, the order was Group B > Group C > Group A (P < 0.05). The comparison of the cortical CNR and SNR between Group A’s cortical phase and Groups B’s and C’s corticomedullary phases (cortices) revealed that Group C > Group B > Group A (P < 0.05). The comparison of the medullary CNR and SNR between Group A’s medullary phase and Groups B and C’s corticomedullary phases (medulla) showed that Group A > Group C > Group B (P < 0.05). The scores for the VNC images in Groups B and C were lower than those for the true noncontrast (TNC) images in Group A (P > 0.05). In the subjective evaluations of the corticomedullary and excretory phase images, Group B > Group C > Group A (P < 0.05). The comparison of radiation doses revealed that Group B < Group C < Group A (P < 0.05). A significant correlation was found between BMI and the effective radiation dose (P < 0.01), with a correlation coefficient of 0.62.
CONCLUSION: The combination of split-bolus contrast injection and DECT enhances image quality in pediatric CTU while reducing radiation dosage.
PMID:39874617 | DOI:10.1016/j.ejrad.2025.111949
