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

The study was aimed to develop a radiomic model able to identify high-risk colon cancer by analyzing pre-operative CT scans. The study population comprised 148 patients: 108 with non-metastatic colon cancer were retrospectively enrolled from January 2015 to June 2020, and 40 patients were used as the external validation cohort. The population was divided into two groups—High-risk and No-risk—following the presence of at least one high-risk clinical factor. All patients had baseline CT scans, and 3D cancer segmentation was performed on the portal phase by two expert radiologists using open-source software (3DSlicer v4.10.2). Among the 107 radiomic features extracted, stable features were selected to evaluate the inter-class correlation (ICC) (cut-off ICC > 0.8). Stable features were compared between the two groups (T-test or Mann–Whitney), and the significant features were selected for univariate and multivariate logistic regression to build a predictive radiomic model. The radiomic model was then validated with an external cohort. In total, 58/108 were classified as High-risk and 50/108 as No-risk. A total of 35 radiomic features were stable (0.81 ≤ ICC < 0.92). Among these, 28 features were significantly different between the two groups (p < 0.05), and only 9 features were selected to build the radiomic model. The radiomic model yielded an AUC of 0.73 in the internal cohort and 0.75 in the external cohort. In conclusion, the radiomic model could be seen as a performant, non-invasive imaging tool to properly stratify colon cancers with high-risk disease.

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“…The contrast medium (CM) volume was tailored for each patient following the lean body weight [ 18 , 19 ]:

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Section: Methodsmentioning

confidence: 99%

Radiomic Cancer Hallmarks to Identify High-Risk Patients in Non-Metastatic Colon Cancer

Polici

Zerunian

Gaudio

et al. 2022

Cancers

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“…The patient had already undergone contrast enhanced abdomen CT scan with a dedicated and optimized protocol ( 10 ), revealing two mass-like lesions, with diameters of 7 and 9 cm in the right iliac fossa and in the pelvis, respectively. These were characterized by moderate enhancement, rare hypodense areas due to the presence of necrotic- or cystic-changes, with focal spots of hemorrhages, and well-defined margins ( Figure 1 ).…”

Section: Case Presentationmentioning

confidence: 99%

A Case Report of Multiple Gastrointestinal Stromal Tumors: Imaging Findings, Surgical Approach, and Review of the Literature

Tarallo¹,

Carruezzo²,

Accadia³

et al. 2022

Front. Surg.

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IntroductionMultiple gastrointestinal stromal tumors (GISTs) are rare tumors. Differential diagnosis between metastatic and multiple GISTs represents a challenge for a proper workup, prediction prognosis, and therapeutic strategy.Case presentationWe present the case of 67-year-old man with computed tomography (CT) evidence of multiple exophytic lesions in the abdomen, reaching diameters ranging from 1 to 9 cm, without any signs of organs infiltration, and resulting positive at 18F-FDG-PET/CT. Laparoscopic biopsy revealed multiple GISTs, and surgical resection by using an open approach was performed to achieve radicality. Moreover, an extensive review of the current literature was performed.ResultsSmall GISTs (<5 cm) can be treated by the laparoscopic approach, while in the case of large GISTs (>5 cm), tumor location and size should be taken into account to reach the stage of radical surgery avoiding tumor rupture. For metastatic GISTs, Imatinib represents the first choice of treatment, and surgery should be considered only in a few selected cases when all lesions are resectable.ConclusionSporadic multiple GISTs are a rare event, imaging findings are not specific for GISTs, and biopsy requires a secure diagnosis and proper management. In the case of large lesions, with a high risk of vessels injury, laparotomy excision should be considered to achieve radicality and to avoid tumor rupture.

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“…2,28 Reduced CM volume is especially beneficial for dogs who require multiple CECT examinations to assess disease progression and monitor the response to therapy. 29 A limitation of CM dose reduction would be increased image noise, owing to the beam-hardening effect with increasing patient body weight, and to compensate for this, either an increased dose of iodine or an increased X-ray tube current may be needed. 30 The similar change in heart rate and blood pressure before and after CM administration in the TBW-and LBW-based protocols was unexpected, particularly given that LBW dosing permitted a reduction in iodine per kg TBW ranging from 8% to 37%.…”

Section: Ta B L Ementioning

confidence: 99%

Lean body weight‐adjusted intravenous iodinated contrast dose for abdominal CT in dogs reduces interpatient enhancement variability while providing diagnostic quality organ enhancement

Kan¹,

Milne²,

Tyrrell³

et al. 2022

Vet Radiology Ultrasound

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Contrast‐enhanced computed tomography (CECT) is increasingly used to screen for abdominal pathology in dogs, and the contrast dose used is commonly calculated as a linear function of total body weight (TBW). Body fat is not metabolically active and contributes little to dispersing or diluting contrast medium (CM) in the blood. This prospective, analytic, cross‐section design pilot study aimed to establish the feasibility of intravenous CM dosed according to lean body weight (LBW) for abdominal CECT in dogs compared to TBW. We hypothesized that when dosing intravenous CM according to LBW, studies will remain at diagnostic quality, there will be a reduced interindividual contrast enhancement (CE) variability, and there will be less change to heart rate and blood pressure in dogs compared to when administering CM calculated on TBW. Twelve dogs had two CECT studies with contrast doses according to TBW and LBW at least 8 weeks apart. Interindividual organ and vessel CE variability, diagnostic quality of the studies, and changes in physiological status were compared between protocols. The LBW‐based protocol provided less variability in the CE of most organs and vessels (except the aorta). When dosed according to LBW, liver enhancement was positively associated with grams of iodine per kg TBW during the portal venous phase (P = 0.046). There was no significant difference in physiological parameters after CM administration between dosing protocols. Our conclusion is that a CM dose based on LBW for abdominal CECT lowers interindividual CE variability and is effective at maintaining studies of diagnostic quality.

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

Cited by 20 publications

References 33 publications

Radiomic Cancer Hallmarks to Identify High-Risk Patients in Non-Metastatic Colon Cancer

Radiomic Cancer Hallmarks to Identify High-Risk Patients in Non-Metastatic Colon Cancer

A Case Report of Multiple Gastrointestinal Stromal Tumors: Imaging Findings, Surgical Approach, and Review of the Literature

Lean body weight‐adjusted intravenous iodinated contrast dose for abdominal CT in dogs reduces interpatient enhancement variability while providing diagnostic quality organ enhancement

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