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Does delayed phase imaging in CT angiography provide additional information in patients with suspected active bleeding?

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Abstract

Purpose

We hypothesize that delayed phase imaging does not provide additional diagnostic information in patients who undergo multi-phasic CTA for suspected active bleeding.

Methods

Data on patients who underwent multiphasic CTA (pre-contrast, arterial, porto-venous, and delayed phases) for suspected acute bleed were retrospectively collected between January 2019 and November 2021. CTA images were reviewed by a general radiologist, an interventional radiologist, and a body imaging radiologist independently. Each reader evaluated if delayed phase images provided additional information that would change the final impression of the CTA report. Additional information regarding bleeding location, time needed for delayed image acquisition, and radiation exposure were also obtained.

Results

A total of 104 patients with CTAs were analyzed with an average age of 58 years ± 22. Studies rated with absent additional findings on delayed images were 102 (98.1%) by the interventional radiologist, 101 (97.1%) by the body imaging radiologist, and 100 (96.1%) by the general radiologist with percent agreement of 96.15% (kappa 0.54, p < 0.001). All the findings were characterized as unlikely to be clinically significant. Mean time added to complete a delayed phase images was 3.61 ± 3.4 min. The average CT dose length product (DLP) for the total exam was 3621.78 ± 2129.57 mGy.cm with delayed acquisition adding a mean DLP of 847.75 ± 508.8 mGy.cm.

Conclusion

Delayed phase imaging does not provide significant additional diagnostic information in evaluating patients with suspected active bleeding but is associated with increased examination time and radiation exposure.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA

    Mihran Khdhir

  2. Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Bierut, 1107 2020, Lebanon

    Youssef Ghosn, Yara Jabbour, Riad Khouzami, Mustafa Natout & Nadim Muallem

  3. American University of Beirut, Bierut, Lebanon

    Nada Abbas

  4. Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, USA

    Ziad Tarcha

  5. Department of Radiology, University of Iowa Hospital and Clinics, Lowa, USA

    Mohamad Kayali

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  1. Mihran Khdhir
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Correspondence to Nadim Muallem.

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Khdhir, M., Ghosn, Y., Jabbour, Y. et al. Does delayed phase imaging in CT angiography provide additional information in patients with suspected active bleeding?. Emerg Radiol (2024). https://doi.org/10.1007/s10140-024-02239-9

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