Clinical radiology · 2026
The impact of individualized CT contrast media protocols on total iodine load and contrast enhancement: a systematic review and meta-analysis.
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Planken R N, den Boogert T van, Rengier F, Butler O, Ullmann A, Pieritz C, Thuering J, Mihl C
Аннотация
AIM: To evaluate the impact of individualized contrast media administration protocols, compared with fixed-volume protocols on total iodine load, image enhancement, and inter-patient variability across common CT indications.
MATERIALS AND METHODS: A PRISMA-compliant systematic review and random-effects meta-analysis of studies comparing individualized versus fixed contrast administration protocols was conducted. MEDLINE/EMBASE searches up to December 2024 identified eligible studies reporting mean total iodine load (g iodine), Hounsfield units for specific regions of interest, and inter-patient standard deviation. Weighted descriptive statistics, weighted one-sample t test, and non-inferiority were utilized for analysis. Heterogeneity was assessed with τ2, Cochran's Q, and I2; prediction intervals were calculated.
RESULTS: Eighteen studies (n=3,133 patients; nine CT angiography, nine parenchymal CT; 11 experimental and 7 proprietary individualization methods) met the predefined inclusion criteria. Mean weighted total iodine load was significantly lower with individualized versus fixed protocols: 25.59 ± 10.13 g I vs 30.62 ± 7.72 g I, a mean saving of 5.43 g I per patient (95 % CI 2.82-8.04; p<0.001), equating to a 17.7 % relative reduction. Subgroup savings were larger for CT angiography (7.99 g I) than parenchymal CT (3.27 g I). Overall HU ratio was 0.98 (95 % CI 0.94-1.02), meeting the predefined non-inferiority criterion. Inter-patient variability of enhancement was reduced with individualized protocols (CV ratio 0.75; 95 % CI 0.66-0.84), with consistent reductions across subgroups.
CONCLUSION: Individualized contrast administration protocols significantly reduce total iodine load while maintaining non-inferior contrast enhancement and substantially reducing inter-patient variability. These findings support wider adoption of patient-tailored contrast dosing to optimize resource use and harmonize image quality.
MATERIALS AND METHODS: A PRISMA-compliant systematic review and random-effects meta-analysis of studies comparing individualized versus fixed contrast administration protocols was conducted. MEDLINE/EMBASE searches up to December 2024 identified eligible studies reporting mean total iodine load (g iodine), Hounsfield units for specific regions of interest, and inter-patient standard deviation. Weighted descriptive statistics, weighted one-sample t test, and non-inferiority were utilized for analysis. Heterogeneity was assessed with τ2, Cochran's Q, and I2; prediction intervals were calculated.
RESULTS: Eighteen studies (n=3,133 patients; nine CT angiography, nine parenchymal CT; 11 experimental and 7 proprietary individualization methods) met the predefined inclusion criteria. Mean weighted total iodine load was significantly lower with individualized versus fixed protocols: 25.59 ± 10.13 g I vs 30.62 ± 7.72 g I, a mean saving of 5.43 g I per patient (95 % CI 2.82-8.04; p<0.001), equating to a 17.7 % relative reduction. Subgroup savings were larger for CT angiography (7.99 g I) than parenchymal CT (3.27 g I). Overall HU ratio was 0.98 (95 % CI 0.94-1.02), meeting the predefined non-inferiority criterion. Inter-patient variability of enhancement was reduced with individualized protocols (CV ratio 0.75; 95 % CI 0.66-0.84), with consistent reductions across subgroups.
CONCLUSION: Individualized contrast administration protocols significantly reduce total iodine load while maintaining non-inferior contrast enhancement and substantially reducing inter-patient variability. These findings support wider adoption of patient-tailored contrast dosing to optimize resource use and harmonize image quality.