Original Investigation|Articles in Press

Low Contrast Volume Protocol in Routine Chest CT Amid the Global Contrast Shortage: A Single Institution Experience


      To assess the effectiveness of low contrast volume (LCV) chest CT performed with multiple contrast agents on multivendor CT with varying scanning techniques.


      The study included 361 patients (65 ± 15 years; M: F 173:188) who underwent LCV chest CT on one of the six 64–256 detector-row CT scanners using single-energy (SECT) or dual-energy (DECT) modes. All patients were scanned with either a fixed-LCV (LCVf, n = 103) or weight-based LCV (LCVw, n = 258) protocol. Two thoracic radiologists independently assessed all LCV CT and patients’ prior standard contrast volume (SCV, n = 263) chest CT for optimality of contrast enhancement in thoracic vasculature, cardiac chambers, and in pleuro-parenchymal and mediastinal abnormalities. CT attenuations were recorded in the main pulmonary trunk, ascending, and descending thoracic aorta. To assess the interobserver agreement, pulmonary arterial enhancement was divided into two groups: optimal or suboptimal.


      There was no significant difference among patients’ BMI (p = 0.883) in the three groups. DECT had a significantly higher aortic arterial enhancement (250 ± 99HU vs 228 ± 76 HU for SECT, p < 0.001). Optimal enhancement was present in 558 of 624 chest CT (89.4%), whereas 66 of 624 chest CT with suboptimal enhancement was noted in 48 of 258 LCVw (18.6%) and 14 of 103 LCVf (13.6%). Most patients with suboptimal enhancement with LCVw injection protocol were overweight/obese (30/48; 62.5%), (p < 0.001).


      LCV chest CT can be performed across complex multivendor, multicontrast media, multiscanner, and multiprotocol CT practices. However, LCV chest CT examinations can result in suboptimal contrast enhancement in patients with larger body habitus.

      Key Words


      Iodinated contrast media ((ICM)), Contrast-enhanced computed tomography ((CECT)), American College of Radiology ((ACR)), Dual energy ((DECT)), Low ICM volume ((LCV)), Human Insurance Portability and Accountability Act ((HIPAA)), Standard contrast volume ((SCV)), Weight-based LCV ((LCVw)), Fixed LCV ((LCVf)), Regions of interest ((ROI)), Ascending aorta ((AA)), Descending ((DA)), Right atrium ((RA)), Right ventricle ((RV)), Left atrium ((LA)), Left ventricle ((LV)), Main pulmonary artery (MPA), Lobar pulmonary artery ((LPA)), Segmental pulmonary artery ((SPA)), Subsegmental pulmonary artery ((SSPA))
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