CT with IV contrast - Revision history

Mikael Häggström: /* Phases */ Corrected

2019-07-08T09:43:00Z

Phases: Corrected

Mikael Häggström: /* Phases */ +Protocol

2019-07-08T09:40:33Z

Phases: +Protocol

Mikael Häggström: /* Phases */ Specified

2019-07-08T09:26:27Z

Phases: Specified

Mikael Häggström: /* Risk factors */ s

2019-07-08T09:25:33Z

Risk factors: s

Mikael Häggström: /* Pregnancy */ thyroid gland

2019-07-08T09:24:57Z

Pregnancy: thyroid gland

Mikael Häggström: delinked

2019-07-08T09:24:39Z

delinked

Mikael Häggström: /* Risk factors */ Expanded

2019-07-08T09:23:19Z

Risk factors: Expanded

Mikael Häggström: /* Risk factors */ Organized

2019-07-08T08:56:31Z

Risk factors: Organized

Mikael Häggström: /* Risk factors */ Linked

2019-07-08T08:56:08Z

Risk factors: Linked

Mikael Häggström: Organized

2019-07-08T08:53:01Z

Organized

@@ Line 74: / Line 74: @@
 | 6-13 sec<ref name=IFMBE>[https://books.google.se/books?id=oVGjnOLXUgkC&pg=PA584 Page 584] in: {{cite book|title=5th European Conference of the International Federation for Medical and Biological Engineering 14 - 18 September 2011, Budapest, Hungary. Volume 37 of IFMBE Proceedings|author=Ákos Jobbágy|publisher=Springer Science & Business Media|year=2012|isbn=9783642235085}}</ref>  || -
+|
-*[[CT of pulmonary embolism]] (can use [[bolus tracking]] in [[pulmonary trunk]] + 5 seconds)<ref>{{cite web|url=https://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&doi=10.1594/ecr2018/C-1831|title=Introducing the use of Flash CTPA; how does it compare to standard CTPA?|website=Postering|author=Pavan Nandra|year=2018}}</ref>
+*[[CT of pulmonary embolism]] (can use [[bolus tracking]] in [[pulmonary trunk]] + 6 seconds)<ref>{{cite web|url=https://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&doi=10.1594/ecr2018/C-1831|title=Introducing the use of Flash CTPA; how does it compare to standard CTPA?|website=Postering|author=Pavan Nandra|year=2018}}</ref>
 |-
 ! [[Pulmonary vein|Pulmonary venous]] phase

@@ Line 74: / Line 74: @@
 | 6-13 sec<ref name=IFMBE>[https://books.google.se/books?id=oVGjnOLXUgkC&pg=PA584 Page 584] in: {{cite book|title=5th European Conference of the International Federation for Medical and Biological Engineering 14 - 18 September 2011, Budapest, Hungary. Volume 37 of IFMBE Proceedings|author=Ákos Jobbágy|publisher=Springer Science & Business Media|year=2012|isbn=9783642235085}}</ref>  || -
+|
-*[[CT of pulmonary embolism]]
+*[[CT of pulmonary embolism]] (can use [[bolus tracking]] in [[pulmonary trunk]] + 5 seconds)<ref>{{cite web|url=https://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&doi=10.1594/ecr2018/C-1831|title=Introducing the use of Flash CTPA; how does it compare to standard CTPA?|website=Postering|author=Pavan Nandra|year=2018}}</ref>
 |-
 ! [[Pulmonary vein|Pulmonary venous]] phase

@@ Line 74: / Line 74: @@
 | 6-13 sec<ref name=IFMBE>[https://books.google.se/books?id=oVGjnOLXUgkC&pg=PA584 Page 584] in: {{cite book|title=5th European Conference of the International Federation for Medical and Biological Engineering 14 - 18 September 2011, Budapest, Hungary. Volume 37 of IFMBE Proceedings|author=Ákos Jobbágy|publisher=Springer Science & Business Media|year=2012|isbn=9783642235085}}</ref>  || -
+|
-*[[Pulmonary embolism]]
+*[[CT of pulmonary embolism]]
 |-
 ! [[Pulmonary vein|Pulmonary venous]] phase

@@ Line 16: / Line 16: @@
 *Thyroid disorders
 *Myasthenia gravis: Older forms of iodinated contrast have caused an increased risk of exacerbation of the disease, but modern forms have no immediate increased risk.<ref name="MehriziPascuzzi2014">{{cite journal|last1=Mehrizi|first1=Mehyar|last2=Pascuzzi|first2=Robert M.|title=Complications of radiologic contrast in patients with myasthenia gravis|journal=Muscle & Nerve|volume=50|issue=3|year=2014|pages=443–444|issn=0148639X|doi=10.1002/mus.24254|pmid=24677227}}</ref>
-*Diabetes and heart disease: These are aggravating factor in low renal function (see [[CT with IV contrast in low renal function]])
+*Diabetes and heart disease: These are aggravating factors in low renal function (see [[CT with IV contrast in low renal function]])
 ===Low renal function===

@@ Line 51: / Line 51: @@
 ===Pregnancy===
-Iodinated contrast in pregnancy, when orally administered, is harmless.<ref name=acog>{{cite web|url=https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Guidelines-for-Diagnostic-Imaging-During-Pregnancy-and-Lactation|title=Guidelines for Diagnostic Imaging During Pregnancy and Lactation|website=[[American Congress of Obstetricians and Gynecologists]]}} February 2016</ref> Intravenous administration of iodinated radiocontrast agents can cross the placenta and enter the fetal circulation, but animal studies have reported no teratogenic or mutagenic effects from its use. There have been theoretical concerns about potential harm of free iodide on the fetal [[thyroid gland]],<ref name=acog/> but multiple studies have shown that a single dose of intravenously administered iodinated contrast medium to a pregnant mother has no effect on neonatal thyroid function.<ref>{{cite web|url=https://www.acr.org/~/media/37D84428BF1D4E1B9A3A2918DA9E27A3.pdf|title=ACR Manual on Contrast Media. Version 10.3|year=2017|website=American College of Radiology|publisher=American College of Radiology Committee on Drugs and Contrast Media|accessdate=2017-07-30}}</ref> Nevertheless, it generally is recommended that radiocontrast only be used if absolutely required to obtain additional diagnostic information that will improve the care of the fetus or mother.<ref name=acog/>
+Iodinated contrast in pregnancy, when orally administered, is harmless.<ref name=acog>{{cite web|url=https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Guidelines-for-Diagnostic-Imaging-During-Pregnancy-and-Lactation|title=Guidelines for Diagnostic Imaging During Pregnancy and Lactation|website=[[American Congress of Obstetricians and Gynecologists]]}} February 2016</ref> Intravenous administration of iodinated radiocontrast agents can cross the placenta and enter the fetal circulation, but animal studies have reported no teratogenic or mutagenic effects from its use. There have been theoretical concerns about potential harm of free iodide on the fetal thyroid gland,<ref name=acog/> but multiple studies have shown that a single dose of intravenously administered iodinated contrast medium to a pregnant mother has no effect on neonatal thyroid function.<ref>{{cite web|url=https://www.acr.org/~/media/37D84428BF1D4E1B9A3A2918DA9E27A3.pdf|title=ACR Manual on Contrast Media. Version 10.3|year=2017|website=American College of Radiology|publisher=American College of Radiology Committee on Drugs and Contrast Media|accessdate=2017-07-30}}</ref> Nevertheless, it generally is recommended that radiocontrast only be used if absolutely required to obtain additional diagnostic information that will improve the care of the fetus or mother.<ref name=acog/>
 ===Breastfeeding===

@@ Line 15: / Line 15: @@
 *Renal or urinary disease
 *Thyroid disorders
-*Myasthenia gravis
+*Myasthenia gravis: Older forms of iodinated contrast have caused an increased risk of exacerbation of the disease, but modern forms have no immediate increased risk.<ref name="MehriziPascuzzi2014">{{cite journal|last1=Mehrizi|first1=Mehyar|last2=Pascuzzi|first2=Robert M.|title=Complications of radiologic contrast in patients with myasthenia gravis|journal=Muscle & Nerve|volume=50|issue=3|year=2014|pages=443–444|issn=0148639X|doi=10.1002/mus.24254|pmid=24677227}}</ref>
-*Diabetes and heart disease. These are aggravating factor in low renal function (see [[CT with IV contrast in low renal function]])
+*Diabetes and heart disease: These are aggravating factor in low renal function (see [[CT with IV contrast in low renal function]])
 ===Low renal function===
@@ Line 49: / Line 49: @@
 In older patients with multinodular goiter and borderline low or subnormal TSH concentrations, a suggested measure is measurement of thyroid function tests three to four weeks after contrast administration.<ref name=UpToDate-thyr/> Limited evidence suggests that antithyroid agents before the investigation may blunt or prevent hyperthyroidism.<ref name=UpToDate-thyr/>
 ==Phases==

@@ Line 11: / Line 11: @@
 '''Washout''' is where tissue loads radiocontrast during arterial phase, but then returns to a rather hypodense state in venous or later phases. This is a property of for example [[hepatocellular carcinoma]] as compared to the rest of the liver parenchyma.<ref name="ChoiLee2014">{{cite journal|last1=Choi|first1=Jin-Young|last2=Lee|first2=Jeong-Min|last3=Sirlin|first3=Claude B.|title=CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma: Part II. Extracellular Agents, Hepatobiliary Agents, and Ancillary Imaging Features|journal=Radiology|volume=273|issue=1|year=2014|pages=30–50|issn=0033-8419|doi=10.1148/radiol.14132362|pmc=4263770|pmid=25247563}}</ref>
-==Low renal function==
+==Risk factors==
 {{Main|CT with IV contrast in low renal function}}
 Decreased renal function and several other conditions increase the risk of '''contrast-induced nephropathy''', which is a potentially lethal renal injury to the kidney following intravenous radiocontrast.<ref name="RudnickFeldman2008">{{cite journal|last1=Rudnick|first1=M.|last2=Feldman|first2=H.|title=Contrast-Induced Nephropathy: What Are the True Clinical Consequences?|journal=Clinical Journal of the American Society of Nephrology|volume=3|issue=1|year=2008|pages=263–272|issn=1555-9041|doi=10.2215/CJN.03690907}}</ref>
-===When it matters===
+;When it matters
 According to European guidelines, the main risk factors of ''contrast-induced nephropathy'':<ref name="NymanAhlkvist2018">{{cite journal|last1=Nyman|first1=Ulf|last2=Ahlkvist|first2=Joanna|last3=Aspelin|first3=Peter|last4=Brismar|first4=Torkel|last5=Frid|first5=Anders|last6=Hellström|first6=Mikael|last7=Liss|first7=Per|last8=Sterner|first8=Gunnar|last9=Leander|first9=Peter|title=Preventing contrast medium-induced acute kidney injury|journal=European Radiology|year=2018|issn=0938-7994|doi=10.1007/s00330-018-5678-6}}</ref>
 *Estimated glomerular filtration rate (eGFR) of less than '''30 ml/min'''/1.73 m2 before intra-venous or intra-arterial radiocontrast administration with second-pass renal exposure (passing lungs or other tissues before the kidneys).
@@ Line 27: / Line 35: @@
 ''Further reading: [[CT with IV contrast in low renal function]]''
-==Allergy==
+===Allergy===
 [[File:Intramuscular site of adrenaline.jpg|150px|thumb]]
 {{Main|Contrast medium reaction}}
@@ Line 34: / Line 42: @@
 *Summon an '''anesthesiologist'''
-===Prevention===
+;Prevention
 {{Main|Prevention of contrast medium reaction}}
 Before a contrast CT of a patient with known allergic-like or unknown-type of contrast reaction to the same class of contrast medium (such as iodinated), the American College of of Radiology recommends premedication with a glucocorticoid, preferably starting 12 or 13 hours before contrast administration.<ref>{{cite web|url=https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf#page=11|title=Page 9 in: ACR Manual On Contrast Media|website=American College of Radiology, Committee on Drugs and Contrast Media|accessdate=2018-08-25}} Version 10.3. 2018. ACR </ref>
 ==Phases==
@@ Line 97: / Line 110: @@
 *Disappearance of contrast in all abdominal structures except for tissue with [[fibrosis]], which appears more radiodense.
 |}
 ==Locations==