CT with or without contrast - ortholove

[ArchivalUser]

I was wondering if anyone knows if they want us to know when a CT is warrented if it has to be with or without contrast..thank you please help

[ArchivalUser]

depends on the diagnostic protocol, can be either one.

[ArchivalUser]

NCCT Head - when you suspect intracranial bleed
NCCT Abdomen and KUB - when you suspect renal or ureteric calculi

All other indications warrant CECT

CECT contraindicated in nephropathy patients

Remember only these things ... will help you 99.99% of times in deciding between NCCT/CECT

[ArchivalUser]

thx

[ArchivalUser]

Thanks.

[ArchivalUser]

thanks so much!

[ArchivalUser]

Head CT:

Non contrast for trauma, headache, stroke. Pretty much most things.

Contrast is utilized for evaluation for infection (menigeal enhancement, abcess) or tumor (mets). However, contrast enhanced head CT is significantly inferior to MRI for these indications and we do very few contrast enhanced head CTs. (The only exception is CT angiogram of the head for evaluation of aneurysm, thrombosis, or dissection.)

Chest CT:

Non-contrast: Lung parenchymal evaluation. E.G. Lung nodules, interstitial lung disease.

Contrast: Evaluation of the mediastinum (lymph nodes, infection). Evaulation of the vascular structures or heart (CT Angiogram of pulmonary arteries for PE,aorta for dissection, trauma, aneurysm, coronary CT). Some role in infection (if pleural effusion, helpful to eval for empyema, if cavitary lesion, helpful to eval for lung abcess or lung necrosis). Useful in unusual lesions.

Abd/Pelvis:

Non-contrast: Only common reason to order this is to look for calculi in the kidneys or ureters (the other common indication is severe contrast allergy) Contrast enhanced scans can obscure calculi if the contrast is beginning to get excreted already. There is no need for oral for this scan.

Contrast: Pretty much everything else. Appy (although a few centers do this without contrast), pancreatitis (essential), diffuse abdominal pain, abcess, diverticulitis, liver mass, etc etc. Anything you can think of. We can make some of these diagnoses without contrast, but having it on board makes us better. For the majority of indications, oral contrast helps too.

CT angiogram: This is just a contrast enhanced CT with a faster bolus and timing of the scan on the arterial system. Useful for eval of the aorta, mesenteric vessels, renal arteries, etc.

With and Without: Only a couple indications. Hematuria evaluation (non con to look for stones, contrast to look for renal masses, delays to look for ureteral or bladder lesions). Evaluation of a incidental adrenal mass to see if you can prove its an adenoma and not badness. Can't think of any other common reasons.

Hope that helps.

[ArchivalUser]

renal colic and stroke - NCCT
all others - CECT