Lamoureux Christine, Weber Scott, Hanna Tarek, Grabiel Andrew J, Clark Reese H
Virtual Radiologic Professionals, Eden Prairie, MN, USA.
Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Emerg Radiol. 2019 Dec;26(6):601-608. doi: 10.1007/s10140-019-01704-0. Epub 2019 Jul 22.
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.
确定对于有紧急临床症状的患者，与未接受静脉造影剂的患者相比，腹部和盆腔CT检查时使用静脉造影剂是否能提高对紧急和临床上重要的非紧急病变的检测率，进而确定如果首次CT检查使用静脉造影剂，在72小时内对同一患者进行重复CT检查的诊断价值是否较低。
我们评估了400例在72小时内重复进行腹部和盆腔CT（CT AP）检查的连续患者。记录每位患者的人口统计学数据、检查原因、检查时间戳和检查技术。回顾CT AP放射学报告，提取紧急和非紧急病变。
400例患者中，63%的患者首次CT AP未使用造影剂。与未增强CT相比，首次CT AP使用静脉造影剂与紧急发现的检测率增加相关（p = 0.004），在首次未增强CT AP检查后进行的增强CT AP能更好地明确紧急（p = 0.002）和非紧急发现（p < 0.001）。遵循美国放射学会（ACR）静脉造影剂使用适宜性标准与首次CT上紧急病变检测率增加相关（p = 0.02），如果读片放射科医生建议，第二次CT更有可能使用静脉造影剂（p = 0.0006）。
在没有禁忌证的情况下，鼓励急诊医生按照ACR适宜性标准优先开具静脉增强CT AP检查，可能会增加紧急病变的检测率并避免短期重复CT AP检查。
