Delayed bolus-tracking trigger at CT correlates with cardiac dysfunction and suboptimal portovenous contrast phase

Objective: To assess whether delayed trigger during bolus-tracking for CT correlates with reduced heart function and suboptimal portovenous contrast phase. Methods and Materials: Patients who underwent portovenous abdominal CT using bolus-tracking and echocardiography within 2 weeks were included and excluded if there was a non-standard contrast injection. The bolus trigger time (BTT) at 100 Hounsfield units in the abdominal aorta, patient age, congestive heart failure (CHF) history, and ejection fraction were recorded. Two radiologists scored the liver contrast phase (1–5, 5 being an optimal portovenous phase). When applicable, the BTT and contrast score of the most recent comparison examination with equivalent technical parameters were also recorded. Simple linear regression (univariate) was used to test for associations with trigger time. Results: 114 patients with a mean age of 61 ± 15 years fulfilled criteria. The mean trigger time was 18 ± 6 s (range: 6–38 s) and the mean ejection fraction was 52 ± 12% (range: 19–69%). A longer bolus trigger had a significant correlation with reduced ejection fraction (P = 0.0018), lower hepatic contrast score (P < 0.0001), history of CHF (P = 0.0212), and older age (P = 0.0223). Contrast score differences between the study exam and available prior exams revealed score differences of 0 (n = 73), 1 (n = 15) and 2 (n = 5); these were associated, respectively, with a mean bolus trigger time difference between exams of 2 s (range, 0–6 s), 6 s (range, 1–15 s), and 11 s (range, 5–13). The P-value comparing bolus trigger time and contrast score differences was less than 0.0001. A lower ejection fraction also significantly correlated with suboptimal PV contrast phase (P < 0.0001). Conclusion: Delayed time to trigger during bolus-tracking for CT can indicate cardiac dysfunction and may not adequately adjust to provide an optimal portovenous contrast phase.