Effect of intravenous contrast for CT abdomen and pelvis on detection of urgent and non-urgent pathology: can repeat CT within 72 hours be avoided?
To determine if administering IV contrast for CT abdomen and pelvis improves detection of urgent and clinically important non-urgent pathology in patients with urgent clinical symptoms compared to patients not receiving IV contrast, and in turn to determine whether repeat CT exams on the same patient within 72 h were of low diagnostic benefit if the first CT was performed with IV contrast.
We evaluated 400 consecutive patients who had CT abdomen and pelvis (CT AP) examinations repeated within 72 h. For each patient, demographic data, reason for examination, examination time stamps, and examination technique were documented. CT AP radiology reports were reviewed and both urgent and non-urgent pathology was extracted.
Of 400 patients, 63% had their initial CT AP without contrast. Administration of IV contrast for the first CT AP was associated with increased detection of urgent findings compared with non-contrast CT (p = 0.004) and a contrast-enhanced CT AP following an initial non-contrast CT AP examination better characterized both urgent (p = 0.002) and non-urgent findings (p < 0.001). Adherence to ACR appropriateness criteria for IV contrast administration was associated with increased detection of urgent pathology on the first CT (p = 0.02), and the second CT was more likely to be performed with IV contrast if recommended by the radiologist reading the first CT (p = 0.0006).
In the absence of contraindications, encouraging urgent care physicians to preferentially order IV contrast-enhanced CT AP examinations in adherence with ACR appropriateness criteria may increase detection of urgent pathology and avoid short-term repeat CT AP.
KeywordsIV contrast CT abdomen and pelvis Radiology Repeat CT
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest with any financial organization regarding the material discussed in the manuscript.
- 6.Abujudeh HH, Kaewlai R, McMahon PM, Binder W, Novelline RA, Gazelle GS, Thrall JH (2011) Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. AJR Am J Roentgenol 196(2):238–243CrossRefGoogle Scholar
- 7.Lameris W, van Randen A, van Es HW, van Heesewijk JPM, van Ramshorst B, Bouma WH, ten Hove W, van Leeuwen MS, van Keulen EM, Dijkgraaf MGW, Bossuyt PMM, Boermeester MA, Stoker J, on behalf of the OPTIMA study group (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ. 338:b2431CrossRefGoogle Scholar
- 13.ACR appropriateness criteria. American College of Radiology web site. http://www.acr.org
- 14.IMV (2014) CT benchmark report. Des Plaines, ill: IMV medical information division, p 2014Google Scholar