Abstract
BACKGROUND: This study aimed to evaluate the efficacy and value of a pulsed multiphase contrast media injection protocol in head and neck computed tomographic angiography (CTA). INFORMATION AND METHODOLOGY: A total of 522 patients who underwent head and neck CTA at the Second Hospital of Qiqihar Medical University between March 1, 2022, and March 31, 2024, were reviewed. After excluding 174 patients, 348 were included in the analysis. All scans were performed using a GE Revolution computed tomography (CT) scanner (256-row detector). In the conventional group (n = 179), patients received 60 mL of contrast agent followed by 40 mL of saline. In the pulse group (n = 169), patients received an initial 35 mL of contrast agent, followed by alternating injections of five mL contrast agent and five mL saline across four additional stages, and concluded with 40 mL of saline. Images were post-processed using a GE workstation with curved planar reformation (CPR), maximum intensity projection (MIP), and volume rendering (VR). CT values, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were measured for target arteries and veins. Subjective image quality was assessed using a five-point scale. RESULTS: There were no significant differences in CT values, CNR, or SNR between the conventional and pulse groups. However, the pulse group showed significantly lower CT values in the subclavian vein (SCV) and superior vena cava (SVC) compared to the conventional group (P < 0.001). Both groups achieved image quality scores of three or higher, but a statistically significant difference in subjective image quality was observed (P < 0.001). Inter-rater agreement was moderate in the conventional group (Kappa = 0.573) and substantial in the pulse group (Kappa = 0.684). Radiation dose analysis revealed a significant reduction in the pulse group (P < 0.001), with mean dose-length product (DLP) and effective dose (ED) reduced by 67.58 mGy cm and 0.16 mSv, respectively. CONCLUSION: The pulsed multiphase contrast agent injection protocol improves image quality by reducing venous contrast residue while simultaneously lowering radiation exposure and contrast agent usage.