Veterinary Science Collected Works - Theses
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ItemLean body weight adjusted intravenous contrast medium dose for abdominal Computed Tomography in dogs( 2022-01)Contrast-enhanced computed tomography (CT) is a common diagnostic modality to investigate abdominal pathology in dogs. For the animal’s safety, the minimum contrast media (CM) dose to achieve diagnostically appropriate contrast enhancement should be administered. Although acute adverse reaction to non-ionic iodinated CM is rare, moderate (>20% from baseline) alteration of heart rate and systemic blood pressure has been reported in dogs. Use of less iodinated contrast is particularly crucial in patients with pre-existing renal dysfunction, as CM is concentrated in renal tubules, having a direct toxic effect, modulating tubular regulatory mechanisms, and producing renal vasoactive substances. Risk of contrast induced nephropathy is considered low in human patients with no history or symptoms of renal disease. In dogs, iodinated contrast dose is commonly linearly increased based on total body weight (TBW). Lean body weight (LBW) has been considered in particularly obese human patients when prescribing a dose of CM, as body fat is not metabolically active and contributes little to dispersing or diluting the CM in the blood. This thesis consists of two published articles (chapter 2 and 4), of which the final research aim was to determine if less iodinated contrast per kilogram TBW can be administered to overweight/obese dogs while maintaining adequate organ and vessel opacification to make a confident radiologic diagnosis. Chapter 2 is a retrospective study performed to determine the variability of major abdominal vessel and organ contrast enhancement and to establish any relationship with abdominal fat percentage in contrast enhanced CT studies, performed on 62 clinical patients at U-Vet Werribee Animal Hospital between February 2014 and February 2019. Intravenous Iohexol (240 or 350 mgI/ml) with a dose range of 660-880 mgI/kg TBW administered by a power injector (1.8 - 3.0 ml/s) and saline chaser was the standard injection protocol used at this institution. Findings based on a linear regression model showed a positive association of aorta (p = 0.005), liver parenchymal (p = 0.045) and portal vein (p = 0.001) enhancement to abdominal fat percentage during the portal venous phase. Following this retrospective study, variability of abdominal organ/vessel contrast enhancement contributed by CM injection method was evaluated and outlined in chapter 3. This was done in attempt to minimise contribution of varied CM injection techniques on organ/vessel contrast enhancement variances prior to the second part of the research project. Out of the three injection techniques explored, the fixed injection duration protocol was found to have the smallest organ and vessel enhancement interquartile range. The fixed injection duration protocol; Iohexol 350 mgI/ml at 700 mgI/kg TBW administration by a cephalic vein intravenous catheter, and a CT study performed with a fixed injection duration of 20 s, with the arterial and portal venous acquisition triggered 10 s and 35 s after aortic arrival respectively, was used for the subsequent part of the research project. Chapter 4 was a prospective study where we hypothesised that LBW adjusted dosing would not affect the diagnostic quality of the abdominal CT study, will minimise negative physiological effects, and reduce variability of contrast enhancement in major abdominal organs and vessels as compared to dosing according to TBW. Results from 12 dogs showed that LBW dosed abdominal CT studies were of diagnostic quality (based on subjective radiologist’s assessment) and reduced inter-individual enhancement (smaller interquartile range) variability in dogs. Contrary to our second hypothesis, there was no significant difference in the change in heart rate and blood pressure after CM administration when dosed according to TBW or LBW. Based on reports in the human literature and findings from the present study, LBW is a better body size index for determining CM dose compared to TBW and is discussed in the final chapter.