Lean Body Weight-Tailored Iodinated Contrast Injection in Obese Patient: Boer versus James Formula

Abstract

Purpose To prospectively compare the performance of James and Boer formula in contrast media (CM) administration, in terms of image quality and parenchymal enhancement in obese patients undergoing CT of the abdomen. Materials and Methods Fifty-five patients with a body mass index (BMI) greater than 35 kg/m2 were prospectively included in the study. All patients underwent 64-row CT examination and were randomly divided in two groups: 26 patients in Group A and 29 patients in Group B. The amount of injected CM was computed according to the patient's lean body weight (LBW), estimated using either Boer formula (Group A) or James formula (Group B). Patient's characteristics, CM volume, contrast-to-noise ratio (CNR) of liver, aorta and portal vein, and liver contrast enhancement index (CEI) were compared between the two groups. For subjective image analysis readers were asked to rate the enhancement of liver, kidneys, and pancreas based on a 5-point Likert scale. Results Liver CNR, aortic CNR, and portal vein CNR showed no significant difference between Group A and Group B (all P ≥ 0.177). Group A provided significantly higher CEI compared to Group B (P = 0.007). Group A and Group B returned comparable overall subjective enhancement values (3.54 and vs 3.20, all P ≥ 0.199). Conclusions Boer formula should be the method of choice for LBW estimation in obese patients, leading to an accurate CM amount calculation and an optimal liver contrast enhancement in CT.

CT based radiomic approach on first line pembrolizumab in lung cancer

“…The Lean Body Weight related James formula 18 , 19 was applied to calculate personalized amount of contrast medium per patient using iso-osmolar non-ionic contrast medium (Iodixanol 320 mg I/mL, Visipaque 320; GE Healthcare, Cork, Ireland) 20 . The contrast medium was intravenously administered through an 18 or 16-gauge antecubital intravenous access at a flux of 3.5 mL/s followed by a 50 mL saline flush at the same flow rate.…”

Abdominal CT: a radiologist-driven adjustment of the dose of iodinated contrast agent approaches a calculation per lean body weight

“…There are several prediction formulas for LBW [33, 37–39] that may yield different results. However, for the aim of our study, the formulas we used are considered the simplest methods for retrospective calculation of the LBW, confirmed by Caruso et al [40].…”

Optimization of contrast medium volume for abdominal CT in oncologic patients: prospective comparison between fixed and lean body weight-adapted dosing protocols

“…Third, we calculated the LBW of each patient by using James formula; however, several prediction formulas for LBW have been previously reported and their application may yield results different from those observed in our study [ 27 , 28 ]. However, the James formula is frequently used for estimating the CM dose and, although the use of Boer formula has been recommended in patients with a high BMI [ 33 ], no significant differences in objective image quality have been reported between these two formulas, when applied in a range of BMI as that observed in our population [ 14 ]. Furthermore, we determined the CM volume to be administered for LBW protocol group according to the calculated LBW rather than measured LBW, estimated by measuring patient fat body percentage with the aid of an analyzer scale [ 34 ].…”

“…Dosing CM according to patient TBW does not require complicated calculations and, given its quickness and ease of use, can be readily implemented in the daily routine; nonetheless, it fails to take into account differences in body composition. In particular, TBW-adapted regimens may lead to an overestimation of CM volume in overweight and obese patients, in which scarcely perfused adipose tissue contributes for a considerable proportion of body weight [ 14 , 15 ]. Differences in body fat percentage between men and women may also result in excessive amount of CM being administered to women, when dosing CM according to TBW [ 16 , 17 ].…”