title: Detection and characterization of focal liver lesions by split-bolus multidetector-row CT: diagnostic accuracy and radiation dose in oncologic patients.
abstract: OBJECTIVE
  To assess the diagnostic accuracy and radiation dose of split-bolus multidetector-row computed tomography (MDCT) protocol in the detection and characterization of focal liver lesions in oncologic patients.
  
  
  METHODS
  We retrospectively analyzed triphasic CT at initial diagnosis and follow-up split-bolus 64-detector row CT protocol in 48 oncologic patients with focal liver lesions. Split-bolus MDCT protocol by i.v. injection of two boli of contrast medium combines hepatic arterial phase (HAP) and hepatic enhancement during portal venous phase (PVP) in a single pass. First bolus: 75-90 mL at 2.0 mL/sec to obtain adequate hepatic enhancement during the PVP; second bolus: 60 mL/sec at 3.5 mL/sec to ensure HAP. Each bolus is followed by 20 mL of saline solution at the same flow rate. Sensitivity, specificity, positive predictive value and negative predictive value of split-bolus MDCT protocol were calculated for detection and characterization of liver lesions. The effective radiation dose (ED) was calculated using dose-length product (DLP) values in mSv determined using a conversion factor.
  
  
  RESULTS
  compared to triphasic-MDCT, split-bolus MDCT protocol confirmed all the 210 lesions identified and characterized by triphasic-MDCT technique, unchanged during the follow-up. The mean ED was 27.8 ± 6 mSv for chest-abdomen-pelvis biphasic split-bolus MDCT and 45.7 ± 13.6 mSv for triphasic-MDCT.
  
  
  CONCLUSIONS
  The diagnostic efficacy of split-bolus protocol is comparable to that of triphasic protocol at MDCT with a reduction in radiation dose of approximately 35-40%.
authors: Division of Radiology 2, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy michelescialpi@libero.it.
authors: Michele
authors: M
authors: Scialpi
authors: Division of Nuclear Medicine, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.
authors: Barbara
authors: B
authors: Palumbo
authors: Division of Radiology 2, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.
authors: Luisa
authors: L
authors: Pierotti
authors: Division of Radiology 2, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.
authors: Sabrina
authors: S
authors: Gravante
authors: Division of Radiology 2, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.
authors: Alessio
authors: A
authors: Piunno
authors: Division of Radiology 2, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.
authors: Alberto
authors: A
authors: Rebonato
authors: Division of Radiology, San Giuseppe Moscati Hospital, Aversa, Caserta, Italy.
authors: Alfredo
authors: A
authors: D'Andrea
authors: Department of Experimental and Clinical Internistic, F. Magrassi-A. Lanzara, Second University of Naples, Naples, Italy.
authors: Alfonso
authors: A
authors: Reginelli
authors: Division of Radiology, Budrio Hospital, Bologna, Budrio, Italy.
authors: Irene
authors: I
authors: Piscioli
authors: Department of Health Sciences, Molise University, Contrada Tappino, Campobasso, Italy.
authors: Luca
authors: L
authors: Brunese
authors: Department of Experimental and Clinical Internistic, F. Magrassi-A. Lanzara, Second University of Naples, Naples, Italy.
authors: Antonio
authors: A
authors: Rotondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy; D011829:Radiation Dosage; D012189:Retrospective Studies
keywords: Helical Computed Tomography (CT); Liver; Multidetector row CT (MDCT); neoplasm; oncology; split-bolus technique; triphasic technique