Journal of Veterinary Science

The Korean Society of Veterinary Science (대한수의학회)
권호 표지
DOI QR코드

DOI QR Code

Split-bolus CT urography with synchronous nephrographic and excretory phase in dogs: comparison of image quality with three-phase CT urography and optimal allocation ratio of contrast medium

  • Je, Hyejin (College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University) ;
  • Lee, Sang-Kwon (College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University) ;
  • Jung, Jin-Woo (College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University) ;
  • Jang, Youjung (College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University) ;
  • Chhoey, Saran (College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University) ;
  • Choi, Jihye (College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University)
  • Received : 2020.01.17
  • Accepted : 2020.04.17
  • Published : 2020.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Computed tomography urography (CTU), based on the excretion of contrast medium after its injection, allows visualization of the renal parenchyma and the renal collecting system. Objectives: To determine the optimal contrast medium dose allocation ratio to apply in split-bolus CTU in dogs. Methods: This prospective, experimental, exploratory study used 8 beagles. In 3-phase CTU, unenhanced-, nephrographic-, and excretory-phase images were obtained with a single injection of 600 mg iodine/kg iohexol. In split-bolus CTU, two different contrast medium allocation ratios (30% and 70% for split CTU 1; 50% and 50% for split CTU 2) were used. Unenhanced phase image and a synchronous nephrographic-excretory phase image were acquired. Results: Although the attenuation of the renal parenchyma was significantly lower when using both split CTUs than the 3-phase CTU, based on qualitative evaluation, the visualization score of the renal parenchyma of split CTU 1 was as high as that of the 3-phase CTU, whereas the split CTU 2 score was significantly lower than those of the two others. Artifacts were not apparent, regardless of CTU protocol. The diameter and opacification of the ureter in both split CTUs were not significantly different from those using 3-phase CTU. Conclusions: Split-bolus CTU with a contrast medium allocation ratio of 30% and 70% is feasible for evaluating the urinary system and allows sufficient enhancement of the renal parenchyma and appropriate distention and opacification of the ureter, with similar image quality to 3-phase CTU in healthy dogs. Split-bolus CTU has the advantages of reducing radiation exposure and the number of CT images needed for interpretation.

Keywords

Acknowledgement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (NRF-2018R1A2B6006775).

References

  1. Bertolini G. The urinary system. In: Bertolini G, editor. Body MDCT in Small Animals: Basic Principles, Technology, and Clinical Applications. 1st ed. Padua: Springer; 2017, 199-201.
  2. Nolte-Ernsting C, Cowan N. Understanding multislice CT urography techniques: many roads lead to Rome. Eur Radiol. 2006;16(12):2670-2686. https://doi.org/10.1007/s00330-006-0386-z
  3. Szolar DH, Kammerhuber F, Altziebler S, Tillich M, Breinl E, Fotter R, et al. Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (< 3-cm) renal masses. Radiology. 1997;202(1):211-217. https://doi.org/10.1148/radiology.202.1.8988213
  4. Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CC, Takahashi S, Cohan RH, et al. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol. 2008;18(1):4-17. https://doi.org/10.1007/s00330-007-0792-x
  5. Yuh BI, Cohan RH. Different phases of renal enhancement: role in detecting and characterizing renal masses during helical CT. AJR Am J Roentgenol. 1999;173(3):747-755. https://doi.org/10.2214/ajr.173.3.10470916
  6. Birnbaum BA, Jacobs JE, Ramchandani P. Multiphasic renal CT: comparison of renal mass enhancement during the corticomedullary and nephrographic phases. Radiology. 1996;200(3):753-758. https://doi.org/10.1148/radiology.200.3.8756927
  7. Cohan RH, Sherman LS, Korobkin M, Bass JC, Francis IR. Renal masses: assessment of corticomedullary-phase and nephrographic-phase CT scans. Radiology. 1995;196(2):445-451. https://doi.org/10.1148/radiology.196.2.7617859
  8. O'Connor OJ, Maher MM. CT urography. AJR Am J Roentgenol. 2010;195(5):W320-W324. https://doi.org/10.2214/AJR.10.4198
  9. Potenta SE, D'Agostino R, Sternberg KM, Tatsumi K, Perusse K. CT urography for evaluation of the ureter. Radiographics. 2015;35(3):709-726. https://doi.org/10.1148/rg.2015140209
  10. Schwarz T. Urinary system. In: Schwarz T, Saunders J, editors. Veterinary Computed Tomography. 1st ed. Chichester: John Wiley & Sons; 2011, 331-338.
  11. Chow LC, Kwan SW, Olcott EW, Sommer G. Split-bolus MDCT urography with synchronous nephrographic and excretory phase enhancement. AJR Am J Roentgenol. 2007;189(2):314-322. https://doi.org/10.2214/AJR.07.2288
  12. Dahlman P, van der Molen AJ, Magnusson M, Magnusson A. How much dose can be saved in three-phase CT urography? A combination of normal-dose corticomedullary phase with low-dose unenhanced and excretory phases. AJR Am J Roentgenol. 2012;199(4):852-860. https://doi.org/10.2214/AJR.11.7209
  13. Lee D, Cho ES, Kim JH, Kim YP, Lee HK, Yu JS, et al. Optimization of split-bolus CT urography: effect of differences in allocation of contrast medium and prolongation of imaging delay. AJR Am J Roentgenol. 2017;209(1):W10-W17.
  14. Dillman JR, Caoili EM, Cohan RH, Ellis JH, Francis IR, Nan B, et al. Comparison of urinary tract distension and opacification using single-bolus 3-Phase vs split-bolus 2-phase multidetector row CT urography. J Comput Assist Tomogr. 2007;31(5):750-757. https://doi.org/10.1097/RCT.0b013e318033df36
  15. Sussman SK, Illescas FF, Opalacz JP, Yirga P, Foley LC. Renal streak artifact during contrast-enhanced CT: comparison of low versus high osmolality contrast media. Abdom Imaging. 1993;18(2):180-185. https://doi.org/10.1007/BF00198059
  16. Zeidel ML, Hoenig MP, Palevsky PM. A new CJASN series: renal physiology for the clinician. Clin J Am Soc Nephrol. 2014;9(7):1271-1271. https://doi.org/10.2215/CJN.10191012
  17. Bombinski P, Brzewski M, Warchol S, Biejat A, Banasiuk M, Golebiowski M. Computed tomography urography with iterative reconstruction algorithm in congenital urinary tract abnormalities in children - association of radiation dose with image quality. Pol J Radiol. 2018;83:e175-e182. https://doi.org/10.5114/pjr.2018.75808
  18. Chen CY, Hsu JS, Jaw TS, Shih MC, Lee LJ, Tsai TH, et al. Split-bolus portal venous phase dual-energy CT urography: protocol design, image quality, and dose reduction. AJR Am J Roentgenol. 2015;205(5):W492-W501. https://doi.org/10.2214/AJR.14.13687
  19. Kim SY, Cho JY, Lee J, Hwang SI, Moon MH, Lee EJ, et al. Low-tube-voltage CT urography using low-concentration-iodine contrast media and iterative reconstruction: a multi-institutional randomized controlled trial for comparison with conventional CT urography. Korean J Radiol. 2018;19(6):1119-1129. https://doi.org/10.3348/kjr.2018.19.6.1119
  20. Fusellier M, Desfontis JC, Madec S, Gautier F, Debailleul M, Gogny M. Influence of three anesthetic protocols on glomerular filtration rate in dogs. Am J Vet Res. 2007;68(8):807-811. https://doi.org/10.2460/ajvr.68.8.807
  21. Kushiro-Banker T, Keegan RD, Decourcey MA, Grubb TL, Greene SA, Armstrong R. Effects of tepoxalin and medetomidine on glomerular filtration rate in dogs. J Vet Med Sci. 2013;75(1):69-74. https://doi.org/10.1292/jvms.12-0062
  22. Lobetti R, Lambrechts N. Effects of general anesthesia and surgery on renal function in healthy dogs. Am J Vet Res. 2000;61(2):121-124. https://doi.org/10.2460/ajvr.2000.61.121