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Multidetector CT of Pancreas: Effects of Contrast Material Flow Rate and Individualized Scan Delay on Enhancement of Pancreas and Tumor Contrast¹

¹ From the Departments of Radiology (G.S., W.S., C.S., M.W., R.P.) and Surgery (A.S., M.G.), Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. From the 2004 RSNA Annual Meeting. Received July 1, 2005; revision requested September 1; revision received September 27; accepted October 4; final version accepted February 1, 2006. Address correspondence to W.S. (e-mail: wolfgang.schima{at}meduniwien.ac.at).

Purpose: To prospectively assess whether high contrast material flow rate (8 mL/sec) and individualized scan delay improve enhancement of normal pancreas with multidetector computed tomography (CT) and, as a result, tumor-to-pancreas contrast of pancreatic adenocarcinoma.

Materials and Methods: Informed consent was obtained in 40 patients (21 women, 19 men; mean age, 67.1 years); the institutional review board approved this protocol. Patients were referred for multidetector CT because they were suspected of having a pancreatic tumor and were randomized to receive 150 mL of nonionic contrast material (300 mg of iodine per milliliter) at a flow rate of 4 mL/sec (n = 21) or 8 mL/sec (n = 19). Patients underwent dynamic scanning at one level every 2 seconds for 66 seconds after intravenous administration of contrast material. Contrast enhancement of pancreas and tumors was measured with circular regions of interest (analysis of variance and Bonferroni-Holm corrected post hoc t tests).

Results: Peak contrast enhancement in pancreas was observed significantly earlier (mean ± standard deviation, 28.7 seconds ± 3.5 vs 48.2 seconds ± 5.3; P < .05) and was significantly higher (129.0 HU ± 25.7 vs 106.2 HU ± 35.4, P < .05) with a flow rate of 8 mL/sec than with a flow rate of 4 mL/sec. Tumor-to-pancreas contrast greater than 40 HU lasted significantly longer with a flow rate of 8 mL/sec than with a flow rate of 4 mL/sec (26.4 seconds ± 11.9 vs 8.6 seconds ± 8.3, P < .05). With a flow rate of 8 mL/sec, an individualized scan delay of 19 seconds after aortic transit time revealed higher tumor-to-pancreas contrast than did a fixed scan delay, and tumor conspicuity was better.

Conclusion: With 16-section CT, increased contrast material flow rate of 8 mL/sec and individualized scan delay were associated with improved pancreatic enhancement and tumor-to-pancreas contrast compared with flow rate of 4 mL/sec and fixed scan delay.

© RSNA, 2006

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