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Single-Bolus Technique for Spiral CT of Laryngopharyngeal Squamous Cell Carcinoma: Comparison of Different Contrast Material Volumes, Flow Rates, and Start Delays¹

¹ From the Department of Radiology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany. Received May 7, 2001; revision requested June 22; revision received October 1; accepted December 18. Address correspondence to M.K. (e-mail: marc.keberle@mail.uni-wuerzburg.de).

View larger version (61K): [in a new window]   Figure 1. Time-attenuation curves obtained in the carotid artery. Contrast material injections of 125 mL at 2.5 mL/sec and 100 mL at 2.0 mL/sec resulted in more peaked curves, and injections of 90 mL at 1.5 mL/sec and 70 mL at 1.0 mL/sec resulted in more level curves. A volume of 90 mL administered at 1.5 mL/sec appears to provide a reliably long enhancement that is well over 150 HU.

View larger version (61K): [in a new window]   Figure 2a. (a) Time-attenuation curves obtained in the tumor boundary. Except for injection of 70 mL at 1.0 mL/sec, the three other protocols yielded comparable curves that reached maximum enhancement after approximately 52 seconds. (b) Time-attenuation curves obtained in the tumor center. Regardless of protocol, maximum enhancement was approximately 10 HU lower than that of the tumor boundary in a.

View larger version (62K): [in a new window]   Figure 2b. (a) Time-attenuation curves obtained in the tumor boundary. Except for injection of 70 mL at 1.0 mL/sec, the three other protocols yielded comparable curves that reached maximum enhancement after approximately 52 seconds. (b) Time-attenuation curves obtained in the tumor center. Regardless of protocol, maximum enhancement was approximately 10 HU lower than that of the tumor boundary in a.

View larger version (108K): [in a new window]   Figure 3a. (a-d) Transverse CT images show tumor enhancement (large arrowheads) achieved by using different protocols (a, 125 mL at 2.5 mL/sec; b, 100 mL at 2.0 mL/sec; c, 90 mL at 1.5 mL/sec; and d, 70 mL at 1.0 mL/sec) 64 seconds after the start of injection. Note the difference in carotid arterial enhancement (small arrowheads in a). The attenuation values (in Hounsfield units) measured in the common carotid artery (CCA), tumor boundary (TB), and tumor center (TC) are as follows: 125 mL: CCA = 247, TB = 103, TC = 94; 100 mL: CCA = 230, TB = 92, TC = 92; 90 mL: CCA = 178, TB = 99, TC = 85; and 70 mL: CCA = 131, TB = 68, TC = 67. The regions of interest were omitted from the figures to better depict contrast enhancement.

View larger version (108K): [in a new window]   Figure 3b. (a-d) Transverse CT images show tumor enhancement (large arrowheads) achieved by using different protocols (a, 125 mL at 2.5 mL/sec; b, 100 mL at 2.0 mL/sec; c, 90 mL at 1.5 mL/sec; and d, 70 mL at 1.0 mL/sec) 64 seconds after the start of injection. Note the difference in carotid arterial enhancement (small arrowheads in a). The attenuation values (in Hounsfield units) measured in the common carotid artery (CCA), tumor boundary (TB), and tumor center (TC) are as follows: 125 mL: CCA = 247, TB = 103, TC = 94; 100 mL: CCA = 230, TB = 92, TC = 92; 90 mL: CCA = 178, TB = 99, TC = 85; and 70 mL: CCA = 131, TB = 68, TC = 67. The regions of interest were omitted from the figures to better depict contrast enhancement.

View larger version (94K): [in a new window]   Figure 3c. (a-d) Transverse CT images show tumor enhancement (large arrowheads) achieved by using different protocols (a, 125 mL at 2.5 mL/sec; b, 100 mL at 2.0 mL/sec; c, 90 mL at 1.5 mL/sec; and d, 70 mL at 1.0 mL/sec) 64 seconds after the start of injection. Note the difference in carotid arterial enhancement (small arrowheads in a). The attenuation values (in Hounsfield units) measured in the common carotid artery (CCA), tumor boundary (TB), and tumor center (TC) are as follows: 125 mL: CCA = 247, TB = 103, TC = 94; 100 mL: CCA = 230, TB = 92, TC = 92; 90 mL: CCA = 178, TB = 99, TC = 85; and 70 mL: CCA = 131, TB = 68, TC = 67. The regions of interest were omitted from the figures to better depict contrast enhancement.

View larger version (112K): [in a new window]   Figure 3d. (a-d) Transverse CT images show tumor enhancement (large arrowheads) achieved by using different protocols (a, 125 mL at 2.5 mL/sec; b, 100 mL at 2.0 mL/sec; c, 90 mL at 1.5 mL/sec; and d, 70 mL at 1.0 mL/sec) 64 seconds after the start of injection. Note the difference in carotid arterial enhancement (small arrowheads in a). The attenuation values (in Hounsfield units) measured in the common carotid artery (CCA), tumor boundary (TB), and tumor center (TC) are as follows: 125 mL: CCA = 247, TB = 103, TC = 94; 100 mL: CCA = 230, TB = 92, TC = 92; 90 mL: CCA = 178, TB = 99, TC = 85; and 70 mL: CCA = 131, TB = 68, TC = 67. The regions of interest were omitted from the figures to better depict contrast enhancement.

View larger version (56K): [in a new window]   Figure 4a. (a) Time-attenuation curves obtained in muscle. Except for injection of 70 mL at 1.0 mL/sec, the other three protocols yielded comparable curves. (b) Time-contrast curves for tumor boundary versus muscle. All protocols yielded comparable curves, reaching maximum enhancement after approximately 52 seconds.

View larger version (63K): [in a new window]   Figure 4b. (a) Time-attenuation curves obtained in muscle. Except for injection of 70 mL at 1.0 mL/sec, the other three protocols yielded comparable curves. (b) Time-contrast curves for tumor boundary versus muscle. All protocols yielded comparable curves, reaching maximum enhancement after approximately 52 seconds.

View larger version (47K): [in a new window]   Figure 5. Time-attenuation curves beginning at 52 seconds for the time of maximum enhancement in the tumor boundary. Curves show the mean carotid arterial enhancements after subtraction of SDs. As a consequence, the points of intersection of the curves with the 150-HU line (dotted line) reveal the duration of the SD-corrected diagnostic windows: approximately 68 seconds for 125 mL at 2.5 mL/sec, 63 seconds for 100 mL at 2.0 mL/sec, and 73 seconds for 90 mL at 1.5 mL/sec. Injection of 70 mL at 1.0 mL/sec lacks such a SD-corrected diagnostic window because all respective attenuation values are below 150 HU.

View larger version (35K): [in a new window]   Figure 6. Graph shows attenuation values (in Hounsfield units) measured in the tumor boundary during routine CT of the neck (90 mL at 1.5 mL/sec). All values were acquired 51-69 seconds after the start of injection. They corresponded predominantly with the mean attenuation values (± SD) obtained from the dynamic series (solid lines), except for in one almost isoattenuating tumor. Symbols represent individual patients.

View larger version (106K): [in a new window]   Figure 7a. Transverse CT images show enhancement of neck structures during the (a) lower and (b) upper spiral of a routine examination (90 mL at 1.5 mL/sec with a start delay of 40 seconds). a shows a well-delineated hypopharyngeal tumor (90 HU in the tumor boundary 62 seconds after the start of injection; large arrowhead) and excellent enhancement of the carotid arteries (194 HU; small arrowheads). b shows adequate enhancement of the internal carotid arteries (116 HU at 107 seconds after the start of injection; arrowheads).

View larger version (125K): [in a new window]   Figure 7b. Transverse CT images show enhancement of neck structures during the (a) lower and (b) upper spiral of a routine examination (90 mL at 1.5 mL/sec with a start delay of 40 seconds). a shows a well-delineated hypopharyngeal tumor (90 HU in the tumor boundary 62 seconds after the start of injection; large arrowhead) and excellent enhancement of the carotid arteries (194 HU; small arrowheads). b shows adequate enhancement of the internal carotid arteries (116 HU at 107 seconds after the start of injection; arrowheads).