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Old 02-21-2016
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Default when to use contrast in imaging?

i'm a little bit confused about when to use contrast and when not to use it?
i mean imaging in general CT, MRI , abdomen, brain ...etc
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Old 02-21-2016
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Head CT:

Noncontrast for trauma, certain types of headaches, stroke. Pretty much most things.

Contrast is utilized for evaluation for infection (meningeal 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 an 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). Evaluation 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 a cavitary lesion, helpful to eval for lung abscess or lung necrosis). Useful in unusual lesions.

Abd/Pelvis:

Non-contrast: the only 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, abscess, diverticulitis, liver mass, 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 an incidental adrenal mass to see if you can prove its an adenoma and not badness. Can't think of any other common reasons.
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Old 02-21-2016
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thanks very much, that's was helpful
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