European journal of radiology · 2025
CT-angiography in acute bleeding: Is a non-enhanced scan necessary?
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Bremm Johannes, Henze Jörn, Dratsch Thomas, Kloeckner Roman, Maintz David, Dos Santos Daniel Pinto
Аннотация
OBJECTIVE: In clinical routine CT-angiography is frequently used to detect hemorrhage and to locate its source. Many centers use a triple phase protocol consisting of non-contrast, arterial and portal venous phase scan. The aim of this study was to clarify the added value of the non-contrast CT scan in detection of hemorrhage and to provide evidence for or against its usage.
MATERIALS & METHODS: We retrospectively included all patients between 2014 and 2020 who underwent triphasic CT angiography for suspected bleeding and interventional angiography within 6 h of CT confirming bleeding. Two experienced observers re-evaluated all CT scans and established consensus on whether the bleeding could confidently be detected without the non-enhanced CT scan. Additionally, we recorded data on radiation exposure.
RESULTS: We included 75 patients (44 male, 31 female, median age 64 years) in the final dataset. Of all bleedings 33 (43 %) were GI bleedings. After consensus reading, non-enhanced CT scan was deemed helpful in only 3 cases (5.2 %) with all of these being GI bleeding. Non-enhanced series contributed substantially to the overall radiation exposure (mean DLPnon contrast 927.9 mGy*cm, mean DLParterial 631.3 mGy*cm, mean DLPportal venous 915.0 mGy*cm).
CONCLUSION: Our results suggest that in the vast majority of cases non-contrast CT is not necessary to detect hemorrhage. Omission of non-enhanced CT scans results in relevant dose reduction. However, in few cases non-contrast scan can be helpful to exclude false positive findings in particular in suspected gastrointestinal bleeding.
MATERIALS & METHODS: We retrospectively included all patients between 2014 and 2020 who underwent triphasic CT angiography for suspected bleeding and interventional angiography within 6 h of CT confirming bleeding. Two experienced observers re-evaluated all CT scans and established consensus on whether the bleeding could confidently be detected without the non-enhanced CT scan. Additionally, we recorded data on radiation exposure.
RESULTS: We included 75 patients (44 male, 31 female, median age 64 years) in the final dataset. Of all bleedings 33 (43 %) were GI bleedings. After consensus reading, non-enhanced CT scan was deemed helpful in only 3 cases (5.2 %) with all of these being GI bleeding. Non-enhanced series contributed substantially to the overall radiation exposure (mean DLPnon contrast 927.9 mGy*cm, mean DLParterial 631.3 mGy*cm, mean DLPportal venous 915.0 mGy*cm).
CONCLUSION: Our results suggest that in the vast majority of cases non-contrast CT is not necessary to detect hemorrhage. Omission of non-enhanced CT scans results in relevant dose reduction. However, in few cases non-contrast scan can be helpful to exclude false positive findings in particular in suspected gastrointestinal bleeding.