Slip-ring and conventional dynamic hepatic CT: contrast material and timing considerations

The major conclusions and recommendations of this review of contrast material use are summarized as follows: 1. Our recommendations for routine administration of contrast material are summarized in the Table. 2. Patient factors, such as weight, and liver and cardiovascular disorders may be taken into account when the above recommendations are modified. 3. Unenhanced scanning should be performed selectively. It is unnecessary for routine examinations performed with modern scanners and good contrast material injection techniques. 4. Although conclusive evidence is lacking regarding efficacy, reduced doses of contrast material may be given to patients with an elevated serum creatinine level. A full dose of low-osmolar contrast material may be given to functionally anephric patients if otherwise medically appropriate. 5. Differences in enhancement patterns produced by low-osmolar contrast agents and by high-osmolar contrast agents are small. Choice of contrast material should be based on other factors. 6. The dose of low-osmolar contrast material may be lower than the dose of high-osmolar contrast material so the examination cost may be reduced. 7. Low-osmolar contrast material is not satisfactory to use with delayed iodine scanning. 8. With use of slip-ring scanners and either helical or incremented scanning and recommended techniques, scanning should begin by the end of the injection of contrast material for biphasic techniques and within about 5-15 seconds after the end of injection for monophasic techniques. 9. Section thicknesses no greater than 8 mm should be used for helical or nonhelical scanning. 10. With helical scanning, a 1:1 pitch is preferred with a thickness of 5-8 mm. Overlapping sections may be used selectively to help identify and characterize small lesions. 11. Multiple-pass scanning is helpful to identify hepatocellular carcinoma in cirrhotic livers. This technique may also prove helpful in other conditions. As with any new technology, considerable advantages have come with new challenges, which can be overcome by knowing underlying principles and by attending to detail. Although we have learned much over the past 15 years about proper performance of abdominal CT examinations, we have much yet to learn about the effects of such examinations on the improved health of our patients and on the economic costs to society of providing this form of health care. Opinions on techniques have converged recently, as summarized herein. Therefore, we hope that some centers will now redirect their CT research toward the profoundly difficult, timely, and important issues of examination appropriateness, the value of quality improvement programs, clinical outcomes, and cost-effectiveness.