Alessandro Bevilacqua1,2, Silvia Malavasi2,3, Valérie Vilgrain4,5. 1. DISI (Department of Computer Science and Engineering), University of Bologna, Viale Risorgimento, 2, I-40136, Bologna, Italy. 2. ARCES (Advanced Research Center on Electronic Systems), University of Bologna, Via Toffano 2/2, I-40125, Bologna, Italy. 3. CIG (Interdepartmental Centre "L. Galvani" for integrated studies of Bioinformatics, Biophysics and Biocomplexity), University of Bologna, Via Petroni 26, I-40126, Bologna, Italy. 4. Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP, HUPNVS, Hôpital Beaujon, 100 bd du Général Leclerc, 92110, Clichy, France. valerie.vilgrain@aphp.fr. 5. Sorbonne Paris Cité, INSERM CRI, Université Paris Diderot, 75018, Paris, France. valerie.vilgrain@aphp.fr.
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. KEY POINTS: • 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.
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. KEY POINTS: • 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.
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