Helical CT of the liver: clinical application of an automated computer technique, SmartPrep, for obtaining images with optimal contrast enhancement.

The purpose of this study was to evaluate an automated computer technique (SmartPrep) for achieving a consistently high level of contrast enhancement in the liver with helical CT. The technique compensates for variability between patients by indicating graphically the time at which scanning should be initiated to reach a desired level of hepatic enhancement. One hundred nine consecutive patients undergoing helical CT of the abdomen were randomly evaluated, using either a standard 70-sec delay from the start of the injection of contrast material to scanning or a newly developed, commercially available automated technique, SmartPrep. A series of multiple low-dose scans was performed until an arbitrary threshold of hepatic enhancement (50 H) over baseline was achieved. Three regions of interest (ROIs) were imaged on a baseline scan and on contrast-enhanced scans at the upper, mid, and lower liver. Average hepatic enhancement and the standard deviation over baseline was calculated for each group at all anatomic levels. For the SmartPrep group, the range of time between scan initiation and onset of scanning was calculated. The mean hepatic enhancement for the control group (n = 56) was 59.8 +/- 20.1 H, which differed significantly (p = .0002) from that for the SmartPrep group (n = 53), which was 71.6 +/- 15.2 H. Comparison of the variability between the two groups' enhancement levels was also significant (p = .02). The range of delay times for the SmartPrep group was 48-86 sec. In two additional cases, abnormal graphically displayed enhancement curves were the first indication of an improper injection. Use of SmartPrep yields a greater and more consistent level of hepatic enhancement from patient to patient than does use of a conventional fixed delay time. The ability to scan more efficiently to achieve greater hepatic enhancement using SmartPrep has significant implications for potential contrast cost savings.