The impact of individualized CT contrast media protocols on total iodine load and contrast enhancement: a systematic review and meta-analysis

R. N. Planken; T. van den Boogert; F. Rengier; O. Butler; A. Ullmann; C. Pieritz; J. Thuering; C. Mihl

doi:10.1016/j.crad.2026.107247

The impact of individualized CT contrast media protocols on total iodine load and contrast enhancement: a systematic review and meta-analysis

R. N. Planken
, T. van den Boogert
, F. Rengier
, O. Butler
, A. Ullmann
, C. Pieritz
, J. Thuering^*
, C. Mihl

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

Aim To evaluate the impact of individualized contrast media administration protocols, compared with fixed-volume protocols on total iodine load, image enhancement, and inter-patient variability across common CT indications. Materials and Methods A PRISMA-compliant systematic review and random-effects meta-analysis of studies comparing individualized versus fixed contrast administration protocols was conducted. MEDLINE/EMBASE searches up to December 2024 identified eligible studies reporting mean total iodine load (g iodine), Hounsfield units for specific regions of interest, and inter-patient standard deviation. Weighted descriptive statistics, weighted one-sample t test, and non-inferiority were utilized for analysis. Heterogeneity was assessed with t<sup>2</sup>, Cochran's Q, and I<sup>2</sup>; prediction intervals were calculated. Results Eighteen studies (n=3,133 patients; nine CT angiography, nine parenchymal CT; 11 experimental and 7 proprietary individualization methods) met the predefined inclusion criteria. Mean weighted total iodine load was significantly lower with individualized versus fixed protocols: 25.59 ± 10.13 g I vs 30.62 ± 7.72 g I, a mean saving of 5.43 g I per patient (95 % CI 2.82–8.04; p<0.001), equating to a 17.7 % relative reduction. Subgroup savings were larger for CT angiography (7.99 g I) than parenchymal CT (3.27 g I). Overall HU ratio was 0.98 (95 % CI 0.94–1.02), meeting the predefined non-inferiority criterion. Inter-patient variability of enhancement was reduced with individualized protocols (CV ratio 0.75; 95 % CI 0.66–0.84), with consistent reductions across subgroups. Conclusion Individualized contrast administration protocols significantly reduce total iodine load while maintaining non-inferior contrast enhancement and substantially reducing inter-patient variability. These findings support wider adoption of patient-tailored contrast dosing to optimize resource use and harmonize image quality.

Original language	English
Article number	107247
Number of pages	10
Journal	Clinical Radiology
Volume	94
DOIs	https://doi.org/10.1016/j.crad.2026.107247
Publication status	Published - 1 Mar 2026

Access to Document

10.1016/j.crad.2026.107247Licence: CC BY

Cite this

@article{48ade5ba7ecf4c0d8192a08354cffd38,

title = "The impact of individualized CT contrast media protocols on total iodine load and contrast enhancement: a systematic review and meta-analysis",

abstract = "Aim To evaluate the impact of individualized contrast media administration protocols, compared with fixed-volume protocols on total iodine load, image enhancement, and inter-patient variability across common CT indications. Materials and Methods A PRISMA-compliant systematic review and random-effects meta-analysis of studies comparing individualized versus fixed contrast administration protocols was conducted. MEDLINE/EMBASE searches up to December 2024 identified eligible studies reporting mean total iodine load (g iodine), Hounsfield units for specific regions of interest, and inter-patient standard deviation. Weighted descriptive statistics, weighted one-sample t test, and non-inferiority were utilized for analysis. Heterogeneity was assessed with t2, Cochran's Q, and I2; prediction intervals were calculated. Results Eighteen studies (n=3,133 patients; nine CT angiography, nine parenchymal CT; 11 experimental and 7 proprietary individualization methods) met the predefined inclusion criteria. Mean weighted total iodine load was significantly lower with individualized versus fixed protocols: 25.59 ± 10.13 g I vs 30.62 ± 7.72 g I, a mean saving of 5.43 g I per patient (95 \% CI 2.82–8.04; p<0.001), equating to a 17.7 \% relative reduction. Subgroup savings were larger for CT angiography (7.99 g I) than parenchymal CT (3.27 g I). Overall HU ratio was 0.98 (95 \% CI 0.94–1.02), meeting the predefined non-inferiority criterion. Inter-patient variability of enhancement was reduced with individualized protocols (CV ratio 0.75; 95 \% CI 0.66–0.84), with consistent reductions across subgroups. Conclusion Individualized contrast administration protocols significantly reduce total iodine load while maintaining non-inferior contrast enhancement and substantially reducing inter-patient variability. These findings support wider adoption of patient-tailored contrast dosing to optimize resource use and harmonize image quality.",

author = "Planken, \{R. N.\} and \{den Boogert\}, \{T. van\} and F. Rengier and O. Butler and A. Ullmann and C. Pieritz and J. Thuering and C. Mihl",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s).",

year = "2026",

month = mar,

day = "1",

doi = "10.1016/j.crad.2026.107247",

language = "English",

volume = "94",

journal = "Clinical Radiology",

issn = "0009-9260",

publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - The impact of individualized CT contrast media protocols on total iodine load and contrast enhancement

T2 - a systematic review and meta-analysis

AU - Planken, R. N.

AU - den Boogert, T. van

AU - Rengier, F.

AU - Butler, O.

AU - Ullmann, A.

AU - Pieritz, C.

AU - Thuering, J.

AU - Mihl, C.

PY - 2026/3/1

Y1 - 2026/3/1

N2 - Aim To evaluate the impact of individualized contrast media administration protocols, compared with fixed-volume protocols on total iodine load, image enhancement, and inter-patient variability across common CT indications. Materials and Methods A PRISMA-compliant systematic review and random-effects meta-analysis of studies comparing individualized versus fixed contrast administration protocols was conducted. MEDLINE/EMBASE searches up to December 2024 identified eligible studies reporting mean total iodine load (g iodine), Hounsfield units for specific regions of interest, and inter-patient standard deviation. Weighted descriptive statistics, weighted one-sample t test, and non-inferiority were utilized for analysis. Heterogeneity was assessed with t2, Cochran's Q, and I2; prediction intervals were calculated. Results Eighteen studies (n=3,133 patients; nine CT angiography, nine parenchymal CT; 11 experimental and 7 proprietary individualization methods) met the predefined inclusion criteria. Mean weighted total iodine load was significantly lower with individualized versus fixed protocols: 25.59 ± 10.13 g I vs 30.62 ± 7.72 g I, a mean saving of 5.43 g I per patient (95 % CI 2.82–8.04; p<0.001), equating to a 17.7 % relative reduction. Subgroup savings were larger for CT angiography (7.99 g I) than parenchymal CT (3.27 g I). Overall HU ratio was 0.98 (95 % CI 0.94–1.02), meeting the predefined non-inferiority criterion. Inter-patient variability of enhancement was reduced with individualized protocols (CV ratio 0.75; 95 % CI 0.66–0.84), with consistent reductions across subgroups. Conclusion Individualized contrast administration protocols significantly reduce total iodine load while maintaining non-inferior contrast enhancement and substantially reducing inter-patient variability. These findings support wider adoption of patient-tailored contrast dosing to optimize resource use and harmonize image quality.

AB - Aim To evaluate the impact of individualized contrast media administration protocols, compared with fixed-volume protocols on total iodine load, image enhancement, and inter-patient variability across common CT indications. Materials and Methods A PRISMA-compliant systematic review and random-effects meta-analysis of studies comparing individualized versus fixed contrast administration protocols was conducted. MEDLINE/EMBASE searches up to December 2024 identified eligible studies reporting mean total iodine load (g iodine), Hounsfield units for specific regions of interest, and inter-patient standard deviation. Weighted descriptive statistics, weighted one-sample t test, and non-inferiority were utilized for analysis. Heterogeneity was assessed with t2, Cochran's Q, and I2; prediction intervals were calculated. Results Eighteen studies (n=3,133 patients; nine CT angiography, nine parenchymal CT; 11 experimental and 7 proprietary individualization methods) met the predefined inclusion criteria. Mean weighted total iodine load was significantly lower with individualized versus fixed protocols: 25.59 ± 10.13 g I vs 30.62 ± 7.72 g I, a mean saving of 5.43 g I per patient (95 % CI 2.82–8.04; p<0.001), equating to a 17.7 % relative reduction. Subgroup savings were larger for CT angiography (7.99 g I) than parenchymal CT (3.27 g I). Overall HU ratio was 0.98 (95 % CI 0.94–1.02), meeting the predefined non-inferiority criterion. Inter-patient variability of enhancement was reduced with individualized protocols (CV ratio 0.75; 95 % CI 0.66–0.84), with consistent reductions across subgroups. Conclusion Individualized contrast administration protocols significantly reduce total iodine load while maintaining non-inferior contrast enhancement and substantially reducing inter-patient variability. These findings support wider adoption of patient-tailored contrast dosing to optimize resource use and harmonize image quality.

U2 - 10.1016/j.crad.2026.107247

DO - 10.1016/j.crad.2026.107247

M3 - (Systematic) Review article

SN - 0009-9260

VL - 94

JO - Clinical Radiology

JF - Clinical Radiology

M1 - 107247

ER -

The impact of individualized CT contrast media protocols on total iodine load and contrast enhancement: a systematic review and meta-analysis

Abstract

Access to Document

Fingerprint

Cite this