ArticlePediatric radiology2026
Revisiting test bolus: a plug-and-play solution for cardiac CTA timing.
Article in Pediatric radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiac computed tomography angiography (CTA) for congenital heart disease (CHD) can be technically challenging, particularly in low-volume centers. Real-time radiologist supervision can strain resources and impact productivity.
objectiveTo evaluate a standardized, delay-corrected test-bolus timing method for cardiac CTA for CHD. MATERIALS AND
methodsWe performed a retrospective review of cardiac CTA examinations (November 2020 to August 2022), comparing a delay-corrected test-bolus timing cohort to a manually triggered control cohort (institutional standard protocol during the study period). We measured quantitative enhancement (HU) at six regions of interest and assessed aorto-pulmonary differentiation. Continuous variables were compared using Welch t-tests; non-inferiority was assessed using one-sided 95% confidence intervals (margin -50 HU).
resultsWe analyzed 318 examinations (test-bolus n=98; control n=220). In a pooled non-inferiority analysis (margin -50 HU), the test-bolus method met non-inferiority for absolute aortic enhancement (difference +24.1 HU; one-sided 95% CI lower bound -22.7 HU). For left-sided examinations at 80 kVp, mean aorto-pulmonary separation was greater with test-bolus timing (264.0±225.8 HU) than with manual triggering (40.2±192.3 HU; P<0.001), indicating greater preferential enhancement of the systemic circulation when intended. For both-sided goals at 80 kVp, mean aorto-pulmonary enhancement differences did not differ significantly between groups (P=0.082); median values near 0 in both cohorts were consistent with generally balanced enhancement. Results for both-sided goals at 100 kVp were reported descriptively because of the small test-bolus subgroup size.
conclusionA patient-specific, real-time physiology-based, internally derived test-bolus framework uses measured contrast dynamics to prescribe scan timing, enabling reliable congenital cardiac CTA with diagnostic-quality target-vessel enhancement across a range of clinical goals.
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