Use of a saline chaser in abdominal computed tomography: a systematic review

Purpose: To perform a systematic review of the literature regarding the use of a saline chaser in abdominal computed tomography (CT). Materials and methods: The MEDLINE database was searched from 1966 to March 2007. Studies were included if they compared the magnitude of contrast enhancement with and without a saline chaser in CT and reported CT contrast enhancement values of the liver, portal vein, or abdominal aorta. For randomized controlled trials (RCTs) comparing the same dose of contrast material with and without a saline chaser, mean differences in the magnitude of contrast enhancement were pooled by using a fixed-effects model. Results: Seventeen studies met the inclusion criteria. Three RCTs using clinical images were included in the meta-analysis. The mean differences in contrast enhancement of the liver, portal vein, and aorta were -0.4 (95% CI, -2.4 to 1.7), 7.4 (95% CI, 1.3 to 14), and 11 (95% CI, -5.3 to 27), respectively. Three RCTs using a time-density analysis were included in the meta-analysis. The mean differences in peak contrast enhancement of the liver, portal vein, and aorta were 8.2 (95% CI, 4.2 to 12), 28 ( 95% CI, 16 to 40), and 15 (95% CI, 0.3 to 30), respectively. Conclusion: In clinical images, a saline chaser did not improve contrast enhancement of the liver. In time-density analysis, however, a saline chaser improved peak contrast enhancement of the liver. (C) 2009 Elsevier Inc. All rights reserved.