Does delayed phase imaging in CT angiography provide additional information in patients with suspected active
Mihran Khdhir1, Youssef Ghosn2, Yara Jabbour2
1Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA.
Insights
Delayed phase imaging in CT angiography for active bleeding offers minimal diagnostic value. This adds time and radiation exposure without significant clinical benefit, questioning its routine use in bleeding evaluations.
Area of Science:
- Radiology
- Medical Imaging
- Diagnostic Imaging
Background:
- Multiphasic CT angiography (CTA) is crucial for diagnosing active bleeding.
- The utility of delayed phase imaging in this context requires further investigation.
Purpose of the Study:
- To determine if delayed phase imaging provides additional diagnostic information in multiphasic CTA for suspected active bleeding.
- To assess the impact of delayed phase imaging on examination time and radiation exposure.
Main Methods:
- Retrospective analysis of 104 patients undergoing multiphasic CTA for suspected acute bleeding.
- Independent review of CTA images by general, interventional, and body imaging radiologists.
- Evaluation of whether delayed phase images altered the final impression and assessment of additional findings, time, and radiation dose.
Main Results:
- Delayed phase imaging provided no significant additional diagnostic information in 96.1% of cases.
- The mean additional time for delayed phase acquisition was 3.61 minutes.
- Delayed imaging increased radiation dose by a mean of 847.75 mGy.cm.
Conclusions:
- Delayed phase imaging in multiphasic CTA for suspected active bleeding offers minimal additional diagnostic value.
- Routine use of delayed phase imaging in this setting is not supported due to increased time and radiation exposure.
- Further research may explore specific select cases where delayed imaging could be beneficial.
Purpose:
We hypothesize that delayed phase imaging does not provide additional diagnostic information in patients who undergo multi-phasic CTA for suspected active bleeding.
Methods:
Data on patients who underwent multiphasic CTA (pre-contrast, arterial, porto-venous, and delayed phases) for suspected acute bleed were retrospectively collected between January 2019 and November 2021. CTA images were reviewed by a general radiologist, an interventional radiologist, and a body imaging radiologist independently. Each reader evaluated if delayed phase images provided additional information that would change the final impression of the CTA report. Additional information regarding bleeding location, time needed for delayed image acquisition, and radiation exposure were also obtained.
Results:
A total of 104 patients with CTAs were analyzed with an average age of 58 years ± 22. Studies rated with absent additional findings on delayed images were 102 (98.1%) by the interventional radiologist, 101 (97.1%) by the body imaging radiologist, and 100 (96.1%) by the general radiologist with percent agreement of 96.15% (kappa 0.54, p < 0.001). All the findings were characterized as unlikely to be clinically significant. Mean time added to complete a delayed phase images was 3.61 ± 3.4 min. The average CT dose length product (DLP) for the total exam was 3621.78 ± 2129.57 mGy.cm with delayed acquisition adding a mean DLP of 847.75 ± 508.8 mGy.cm.
Conclusion:
Delayed phase imaging does not provide significant additional diagnostic information in evaluating patients with suspected active bleeding but is associated with increased examination time and radiation exposure.
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