Pannu N, Many types of contrast agents can be used in computed tomography: oral, intravenous, rectal, and intrathecal. et al. Yamaguchi K, Immediate, unlimited access to all AFP content. Accessed September 12, 2012. A baseline serum creatinine level should be obtained up to one month before administration of intravenous contrast agents in patients with suspected renal insufficiency. The abdomen and pelvis contain the digestive organs as well as the urinary, endocrine, and reproductive systems. together. D'Andrea D, I agree with a lot of the points you made in this article. Aughenbaugh GL, Clear communication between the physician and radiologist is essential for obtaining the most appropriate study at the lowest cost and risk to the patient. Tonelli M; 2013;20(8):795–800. Rutten A, The specific agent and route of administration are based on clinical indications and patient factors. Contrast may also be avoided when the suspected pathology is likely to be visible on noncontrast-enhanced CT. A history should be obtained to determine if the reaction was mild (which typically requires observation but not treatment), moderate (which requires prompt treatment), or severe (which requires rapid intervention and, often, hospitalization). The first, barium sulfate, is the most common oral contrast agent used in CT. The Abdomen and Pelvis CTA Scan helps doctors in examining the blood vessels in the abdomen and pelvic area, as well as enables them to detect diseases of the colon, small bowel and other internal organs. Choe KA, Possible contraindications for using intravenous contrast agents during computed tomography include a history of reactions to contrast agents, pregnancy, radioactive iodine treatment for thyroid disease, metformin use, and chronic or acutely worsening renal disease. Here is an overview of the indications for contrasted CT: Orbits – Infection, mass; Neck – Mass, adenopathy; Chest – Mass, cancer/metastatic workup, lymphoma, sarcoid; Abdomen and Pelvis – Pain, colitis, Crohn’s, appendicitis, tumor, cancer, mass; Indications for CT Angiography. Plus, it discusses which indications require IV and Oral Contrast. because it will help you decide which protocol to use when a Strouse PJ, Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. When do you order a CT abdomen/pelvis with contrast or without contrast. Recent studies suggest that a combination of hydration, sodium bicarbonate, N-acetylcysteine, and decreased contrast volume may reduce this risk in high-risk populations.14,15, The question of whether this risk has been overstated has been raised in the medical literature. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. 2008;191(2):376–382. 1997;169(5):1275–1280. Paulson EK, Zeman RK, Brink JA, Costello P. Helical/Spiral CT: A Practical Approach. These are common questions radiologists get daily. Medical radiation exposure in the U.S. in 2006: preliminary results. 16. 19. An abdominal CT takes pictures of your abdomen. Douglas WW, The American College of Radiology proposes a three-tiered risk assessment for patients receiving metformin in whom IV contrast is to be administered (Table 3).7 Many institutions have their own protocols for metformin administration with IV contrast, so physicians should be aware of the standard of care in their community. AJR Am J Roentgenol. Risk factors include chronic kidney disease, diabetes mellitus, heart failure, older age, anemia, left ventricular systolic dysfunction, and contrast volume. Rectal contrast can be used in patients with a suspected penetrating colonic injury.2 Rectal contrast does not always reach the cecum, so the small bowel and appendix can remain unopacified. Abdominal scans can be used to help a doctor pinpoint the location of a tumor before a biopsy is performed. Get Permissions, Access the latest issue of American Family Physician. 15. Choe KA, Airoldi F, The most common contrast agents used with CT imaging are barium- and iodine-based. Please Note – In 2011 the AMA COMBINED the CT Abdomen CT Pelvis CPT Codes Previous: Diagnosis and Treatment of Peripheral Arterial Disease, Home from the Iliac crest (Belly Button) through Ischial Tuberosities (Upper Thigh). Rutten A, 1992;158(5):971–979. Cohan RH, Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. Computed Tomography With Intravenous Contrast Alone: The Role of Intra-abdominal Fat on the Ability to Visualize the Normal Appendix in Children. Lean patient (e.g. NOTE - The UHS Protocol for a CT Abdomen covers from the diaphragm dome (Xiphoid Smith RC, New York, NY: McGraw-Hill; 1995. Myers JL. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Paulson EK, To see the full article, log in or purchase access. family practice, internal medicine, surgeons, etc) on when to order a CT Abdomen with a CT Pelvis for common indications/symptoms. Accessed September 12, 2012. In general, oral contrast is used for most abdominal and pelvic CT scans unless there is no suspicion of bowel pathology (e.g., noncontrast CT to detect kidney stones) or when administration would delay a diagnosis in the trauma setting. Clinical experience at Johns Hopkins and published literature regarding PET/CT applications in the abdomen and pelvis are reviewed, and the strengths and limitations of this evolving technology are summarized. Author disclosure: No relevant financial affiliations. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. 11. In general, oral contrast is used for most abdominal and pelvic CT scans unless there is no suspicion of bowel pathology (e.g., noncontrast CT … / Vol. Coursey CA. Schabelman E, Jan SC. A CT scan uses x-rays to look at bones, muscles, body organs, and blood vessels. Coursey CA. Dillman JR, The U.S. Food and Drug Administration advises that metformin should be withheld at the time of IV contrast administration and for 48 hours afterward, and resumed only after reevaluation of renal status (i.e., return to baseline serum creatinine level).13. Abdominal CT scans (also called CAT scans), are a type of specialized X-ray. D'Andrea D, Rhea JT, Coakley FV, It is used frequently to determine stage of cancer and to follow progress. General Abdominal up for patients with Renal Cell Carcinoma in Renal Failure (recommend MRI). This shift away from the routine use of oral contrast appears to have gained momentum in the 2013-14 time frame. / Killeen KL, Incidence and severity of acute allergic-like reactions to i.v. CT protocols for acute appendicitis: time for change. This is a helpful primer for non-radiologist physicians (i.e. Oral contrast is often used to enhance CT images of the abdomen and pelvis. Witting M. A CT scan of the abdomen and pelvis can help diagnose problems in the bladder, uterus, prostate, liver or bowels. Am Fam Physician. Most Abdominal CT protocols require oral water only (no Oral Contrast). Contrast agents are used to differentiate between organs and improve lesion detection and characterization. Briguori C, Myers JL. Turning to the existing literature for answers is unrewarding, because most studies are … CT abdomen and pelvis General indications: ... abdomen and pelvis by CT, sometimes we need to opacity the gastrointestinal tract by an orally administrated contrast material [gastrographin 38%] .. et al. 2007;189(3):512]. Briguori C, Circulation. 88/No. They help your doctor see the organs, blood vessels, and bones in your abdomen. Radiology. Rao QA, Recent estimates place the number of computed tomography (CT) scans performed annually in the United States at approximately 70 million.1 Given the cost and radiation exposure, it is critical that CT is appropriate and performed with optimal technique. AJR Am J Roentgenol. Atlanta, Ga.: Sciele Pharma, Inc.; 2008. A report from the Japanese Committee on the Safety of Contrast Media. Address correspondence to James V. Rawson, MD, FACR, Medical College of Georgia at Georgia Health Sciences University, HB 4020, Augusta, GA 30912 (e-mail: Mettler FA Jr, CT abdomen is an increasingly common investigation that is used to help make diagnoses of a broad range of pathologies. Confusion abounds regarding its use, and practice patterns often appear arbitrary. Katayama H, Indications. This clinical content conforms to AAFP criteria for continuing medical education (CME). AJR Am J Roentgenol. family practice, internal medicine, surgeons, etc) on when to order a CT Abdomen with a CT Pelvis for common indications. Despite marked advances in limiting image times for magnetic resonance imaging, CT remains the primary modality for most indications for imaging the abdomen and pelvis. The use of positive oral contrast material for abdominal CT is a frequent protocol issue. Common Diagnostic Indications This section contains general abdominal, hepatobiliary, pancreatic, gastrointestinal, genitourinary, splenic, and vascular indications. Follow See the CME Quiz. Possible reactions are listed in Table 1.7 If a patient has had a previous minor reaction to an IV iodinated contrast agent, precontrast administration of oral or IV corticosteroids and diphenhydramine (Benadryl) may decrease their risk (Table 27). 1990;175 (3):621–628. Rosenfield AT, Oral contrast can be administered through a nasogastric tube to minimize the risk of aspiration. Powered by. 1. General CT Tips • Ordering a study with contrast means IV contrast, not PO • Always order CT abdomen AND pelvis • Never order CT with and without • Only exception is CT head • Patient is scanned twice (double the radiation dose) • Must have at least 20g, antecubital IV for CTA In patients with normal renal function, repeat measurement of serum creatinine is not recommended after outpatient administration of intravenous contrast agents. Alberta Kidney Disease Network. The choice of contrast agent depends on route of administration, desired tissue differentiation, and suspected diagnosis. Cohan RH, Swensen SJ, Contrast agents in x-ray computed tomography and its applications in oncology. Our team of expert physicians, nurses and technologists is led by Cindy Kallman, MD, chief, Body CT. Unenhanced CT is also used in patients with spine and extremity trauma. Mirvis SE, Matsuura K. 2008;95(5):502–507.... 2. Contrast agents in x-ray computed tomography and its applications in oncology. As with barium agents, they must be diluted for CT compared with the concentrations used in fluoroscopy. A report from the Japanese Committee on the Safety of Contrast Media. Oral contrast is not usually given in the diagnosis of some Don't miss a single issue. Although many radiology departments screen for shellfish allergy, there is no cross-reactivity between shellfish and iodinated contrast. 2009;193 (5):1268–1271. this is a CT of the Abdomen and Pelvis, Enterography protocol this is a higher quality study than a standard CT. Colon Polyps, Thanks for this blog.Farr Laboratories provide Prostate supplements/tablets online which is an effective treatment for prostate cancer & provides pain relief. American College of Radiology. When do you order a CT abdoment and pelvis together? Indirect CTV images do not look like CTA images, but they are almost always diagnostic (jus… Enlarge Takashima T, It is also a useful test to investigate acute abdominal pain. Mirvis SE, Rao QA, 2007;115(10):1211–1217. CT Angiography, or CTA, is a type of contrasted CT scan used to evaluate the blood vessels. Iodinated contrast should be avoided for two months before administration of iodine 131. Iodine allergy: an oyster without a pearl? Kozuka T, 13. More than 2,700 whole-body PET/CT scans including the abdomen and pelvis were performed for clinical indications by our nuclear medicine service from June 2001 through September … Radiology. Katayama H, Reprints are not available from the authors. The American College of Radiology recommends using IV iodinated contrast in pregnant women when the information needed affects the care of the patient and fetus and cannot be obtained without contrast, and when the referring physician thinks that imaging should not wait until after the pregnancy.7, Iodinated contrast media can saturate the thyroid gland and significantly reduce uptake of iodine 131, rendering the treatment ineffective. ACR appropriateness criteria. Prophylaxis strategies for contrast-induced nephropathy. 6. ACR manual on contrast media: version 8, 2012. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/FullManual.pdf. Pannu N, Prostate A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Choose a single article, issue, or full-access subscription. / Journals They are used for bowel opacification and are not nephrotoxic. 2001;177(6):1247–1256. The results are somewhat dependent on cardiac output, size of the intravenous line, rate of injection, and degree of hydration. Please contact the radiology attending/ resident on … Seez P, Copyright © 2020 American Academy of Family Physicians. 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Of radiocontrast, iodine, and vascular indications ( NPs ) and physician Assistants ( PA.... Pelvis at the lowest cost and risk to the patient bowel, it discusses which indications require IV oral!: //www.accessdata.fda.gov/drugsatfda_docs/label/2008/021574s010lbl.pdf obtaining the most common contrast agents can cause reversible acute renal failure IV.... Documented in patients with normal renal function, repeat measurement of serum creatinine changes in thecal!: version 8, 2012. http: //www.accessdata.fda.gov/drugsatfda_docs/label/2008/021574s010lbl.pdf intravenous contrast agents in x-ray computed tomography: Role! Would preclude IV contrast agents.7 the points you made in this article you are looking ct abdomen and pelvis with contrast indications high quality Canadian... With normal renal function who are receiving metformin Wolfe JM, et al tissue on computer... The bowel, it is used to differentiate between organs and improve detection. Academy of family physicians often must determine the most appropriate study at the time.
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