Application value of split-bolus contrast injection combined with dual-energy CT scanning technology in pediatric CTU imaging.

Eur J Radiol

Department of Radiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, China. Electronic address:

Published: January 2025

Objective: To explore the clinical value of combining split-bolus contrast injection with dual-energy CT(DECT) scanning technology in pediatric computed tomography urography (CTU) imaging.

Methods: A total of 128 children aged 0-17 years were prospectively selected and randomly assigned to three groups: A, B, and C. For Group A, a high-pitch flash mode was employed, where a single bolus of contrast agent was followed by four-phase scanning (noncontrast, cortex, medulla, and excretory phases). In Group B, a dual-energy scanning mode was used with a split-bolus injection technique (50 % of the contrast agent was administered initially, followed by the remaining 50 % after 37-43 s), and the children underwent two-phase scanning (corticomedullary and excretory phases). In Group C, dual-energy scanning was similarly used with a split-bolus injection technique (65 % contrast agent was administered initially, followed by the remaining 35 % after 37-43 s), along with two-phase scanning (corticomedullary and excretory phases). Virtual noncontrast (VNC) images were obtained from the corticomedullary phase images using iodine subtraction techniques for Groups B and C. The image quality and radiation dose across the groups were compared and analysed.

Results: When the CT values of the renal cortex, erector spinae muscles, and standard deviation (SD) values were compared between Group A's cortical phase and Groups B and C's corticomedullary phases, the order was Group B > Group C > Group A (P < 0.05). The comparison of the cortical CNR and SNR between Group A's cortical phase and Groups B's and C's corticomedullary phases (cortices) revealed that Group C > Group B > Group A (P < 0.05). The comparison of the medullary CNR and SNR between Group A's medullary phase and Groups B and C's corticomedullary phases (medulla) showed that Group A > Group C > Group B (P < 0.05). The scores for the VNC images in Groups B and C were lower than those for the true noncontrast (TNC) images in Group A (P > 0.05). In the subjective evaluations of the corticomedullary and excretory phase images, Group B > Group C > Group A (P < 0.05). The comparison of radiation doses revealed that Group B < Group C < Group A (P < 0.05). A significant correlation was found between BMI and the effective radiation dose (P < 0.01), with a correlation coefficient of 0.62.

Conclusion: The combination of split-bolus contrast injection and DECT enhances image quality in pediatric CTU while reducing radiation dosage.

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http://dx.doi.org/10.1016/j.ejrad.2025.111949DOI Listing

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