Optimization of automatic bolus tracking for timing of the arterial phase of helical liver CT

The aim of this study was to optimize bolus tracking for timing of the arterial phase of biphasic helical liver CT and to compare optimized bolus tracking to a standard delay. One hundred fifty patients were examined with six protocols: 5- or 10-s delay after triggering at a threshold of 50 or 75 or 100 HU enhancement in the aorta at the origin of the celiac arteries after injection of 120 ml contrast material at 3 ml/s. Optimal arterial enhancement was defined as 20-30% of hepatic enhancement in portal venous phase. Another 50 patients were examined with the optimized protocol and compared to 50 gender- and age-matched patients who underwent a 25-s standard delay. A 10-s delay after the 75-HU threshold resulted in the most patients with an optimal arterial phase (p < 0.01). Thirty-one of 75 patients examined with this protocol showed optimal early liver enhancement. Bolus tracking compared with standard delay revealed only a trend for a difference (p = 0.07). The outcome of automatic bolus tracking differs depending on the protocol used; however, optimal arterial phase imaging was seen in only 41% of patients, indicating only a trend for superior timing compared with a standard delay.