{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:48:31Z","timestamp":1790884111515,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"1092","license":[{"start":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T00:00:00Z","timestamp":1538352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate the visualization of mediastinal lymph nodes during thoracic CT employing a multiphasic contrast media (CM) protocol.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Institutional review board approved retrospective study consisting of 300 patients with known chest malignancy. Patients were allocated to one of two CM protocols: Protocol A, consisted of dual bolus (Phase 1:100 ml CM followed by 100 ml saline chaser) i.v. injected at 2.5 ml s\u22121; Protocol B employed 100 ml of CM using a multiphasic injection protocol (Phase 1 and 2:60 ml contrast and saline, followed by Phase 3 and 4:40 ml contrast and saline injected at 2.5 ml s\u22121) with a fixed scan delay of 70 s for each acquisition. Attenuation profiles of the thoracic arteries and veins were calculated as well as the arterio-venous contrast ratios (AVCR). Receiver operating characteristic (ROC), visual grading characteristic (VGC), and Cohen's kappa analysis were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Arterial opacification was up to 24% (p &amp;lt; 0.032) higher in protocol B than A, whereas, in the veins it was significantly lower in protocol B than A, with a maximum reduction of up to 84% (p &amp;lt; 0.0001). There was no statistical significance between the central and peripheral pulmonary arteries [&amp;gt;263 Hounsfield units (HU)] in each protocol. Protocol B, demonstrated significant improvement in AVCR at various anatomical sites (p &amp;lt; 0.002). Radiation dose was significantly reduced in protocol B compared to A (p &amp;lt; 0.004). Both ROC and VGC demonstrated significantly higher Az score for protocol B compared to A (p &amp;lt; 0.0001) with an increased inter reader agreement from poor to excellent.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Employing a multiphasic CM protocol significantly improves opacification of the thoracic vasculature and visualization of mediastinal lymph nodes during thoracic CT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Advances in knowledge<\/jats:title>\n                  <jats:p>Uniform opacification between thoracic arteries and veins increases the delineation between vasculature and lymph nodes, reduces radiation dose when employing a multiphase contrast media injection protocol.<\/jats:p>\n               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