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Table 13 Section 6: Whole Body CT – Protocol, key issue 4: contrast phase

From: European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version)

Key question: What is the optimal phase for contrast enhanced emergency polytrauma imaging?
No Statement(s) Cons Grade Cons
6.4.1 The choice of the injection protocol should be individually adapted to the patient and their clinical condition, in particular with regard to dose aspects and required diagnostic significance 86%
normal
GPP
A
86%
normal
6.4.2 An unenhanced phase may be considered to be performed in case of question of blood components outside a vascular lumen 57%
weak
GoR
0
57%
weak
6.4.3 For a given indication, it may be considered to calculate an unenhanced phase using the dual-energy technique 100%
strong
GoR
0
100%
strong
6.4.4 Purely unenhanced CT imaging should not be performed on the trunk of the body 100%
strong
GoR
A
86%
normal
6.4.5 A split bolus protocol ought to be part of a dose-optimised protocol 71%
weak
GPP
B
57%
weak
6.4.6 Where a split bolus protocol identifies questionable relevant findings, the region in question ought to be supplemented with an additional appropriate further phase 100%
strong
GPP
B
100%
strong
6.4.7 For a protocol with a focus on highest diagnostic precision, at least the upper abdomen should be depicted in both the arterial and venous phases 86%
normal
GoR
A
100%
strong
6.4.8 For image findings suspicious of active bleeding, at least two temporally separated contrast phases ought to be present to estimate the activity 100%
strong
GoR
B
86%
normal
Literature: detected = 2518, excluded = 2450, full-text: rated = 68, excluded = 22, included = 46 (guideline: [15, 19, 24, 48, 79, 90,91,92,93,94,95,96,97,98]; level 1: [99]; level 2: [25, 26, 28, 55, 56, 65, 89, 100,101,102,103]; level 3: [16, 27, 29, 51, 52, 54, 57, 58, 61,62,63, 70, 72, 74, 75, 104,105,106,107,108])
Comments: The section deals with intravenous contrast media. Mainly for time reasons oral or rectal filling is inappropriate / obsolete