Vendor-agnostic versus vendor-specific boost methods in low-concentration contrast-enhanced computed tomography of the abdomen.

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Abstract

Contrast media-related adverse events pose serious risks, not only due to allergic reactions but also for patients with renal failure, older age, heart failure, and diabetes mellitus. Various efforts have been made to maximize vascular contrast enhancement (CE) using low-concentration contrast media. This study aimed to compare quantitative and qualitative image characteristics between vendor-agnostic and vendor-specific CE boost methods in low-concentration contrast medium settings against standard-concentration contrast medium settings. This retrospective study including 160 patients compared two concentrations of iodinated contrast media-350 mg I/mL (standard-concentration group) and 270 mg I/mL (low-concentration group) who underwent contrast-enhanced abdominal computed tomography (CT). Vendor-agnostic and vendor-specific boost methods were applied to the CT images of the low-concentration group. Quantitative [image noise, CT attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), noise power spectrum, and image sharpness] and qualitative (Likert scale rating by two radiologists) measures of image quality were evaluated in abdominal vessels and liver lesions. The present study included 80 patients in the standard-concentration and 80 patients in the low-concentration group, respectively. There were no significant differences in age (P=0.75), sex (P=0.99), and body mass index (P=0.98) between the two groups. Both vendor-agnostic and vendor-specific CE-boost methods significantly reduced image noise (P<0.001) and improved CT attenuation, SNR, and CNR in both vessels and liver lesions (all P<0.001) in the low-concentration group compared to the corresponding values in the standard-concentration group. The vendor-specific boost method was more effective in suppressing high-frequency noise (P<0.001), whereas the vendor-agnostic boost method yielded sharper images (0.31±0.02 <i>vs.</i> 0.29±0.01; P<0.001). Subjective image analysis revealed significantly higher image quality (P<0.001) for both boost methods compared with standard-concentration contrast medium groups. Although vendor-agnostic and vendor-specific CE-boost methods effectively enhanced image quality and CT attenuation in low-concentration contrast medium settings, subjective image analysis revealed lower ratings due to increased artificial appearance. The vendor-agnostic method provided superior image sharpness, whereas the vendor-specific method more effectively reduced structured noise and achieved higher subjective ratings for overall image quality, artificial suppression, and natural image appearance.

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