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

BACKGROUND: The contrast agent (CA) dose for abdominal computed tomography (CT) is typically based on patient total body weight (TBW), ignoring adipose tissue distribution. We report on our experience of dosing according to the lean body weight (LBW). METHODS: After Ethics Committee approval, we retrospectively screened 219 consecutive patients, 18 being excluded for not matching the inclusion criteria. Thus, 201 were analysed (106 males), all undergoing a contrast-enhanced abdominal CT with iopamidol (370 mgI/mL) or iomeprol (400 mgI/mL). LBW was estimated using validated formulas. Liver contrast-enhancement (CE(L)) was measured. Data were reported as mean ± standard deviation. Pearson correlation coefficient, ANOVA, and the Levene test were used. RESULTS: Mean age was 66 ± 13 years, TBW 72 ± 15 kg, LBW 53 ± 11 kg, and LBW/TBW ratio 74 ± 8%; body mass index was 26 ± 5 kg/m(2), with 9 underweight patients (4%), 82 normal weight (41%), 76 overweight (38%), and 34 obese (17%). The administered CA dose was 0.46 ± 0.06 gI/kg of TBW, corresponding to 0.63 ± 0.09 gI/kg of LBW. A negative correlation was found between TBW and CA dose (r = -0.683, p < 0.001). CE(L) (Hounsfield units) was 51 ± 18 in underweight patients, 44 ± 8 in normal weight, 42 ± 9 in overweight, and 40 ± 6 in obese, with a significant difference for both mean (p = 0.004) and variance (p < 0.001). A low but significant positive correlation was found between CE(L) and CA dose in gI per TBW (r = 0.371, p < 0.001) or per LBW (r = 0.333, p < 0.001). CONCLUSIONS: The injected CA dose was highly variable, with obese patients receiving a lower dose than underweight patients, as a radiologist-driven ‘compensation effect’. Diagnostic abdomen CT examinations may be obtained using 0.63 gI/kg of LBW.