CLARIFICATION Re: CT with or without contrast

[jj337]

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I have heard and been taught conflicting information regarding the use of contrast with CT. I have also developed my own personal biases and need assistance from some of the more astute clinicians.

If a patient has a contraindication for MRI and has had previous back surgery, does the addition of contrast significantly help? What if it was a recent surgery versus an older one? What are scenarios where it would or would not be helpful?

Thanks for any input.

 

[101N]

I have heard and been taught conflicting information regarding the use of contrast with CT. I have also developed my own personal biases and need assistance from some of the more astute clinicians.

If a patient has a contraindication for MRI and has had previous back surgery, does the addition of contrast significantly help? What if it was a recent surgery versus an older one? What are scenarios where it would or would not be helpful?

Thanks for any input.

The short answer is yes, it does help. Contrast allows you to see disc protrusions in the sagittal reconstructions and root sleeve filling/trucation in the coronals. If they've had surgery and can't get an MRI, and you want to see the neural elements, then get contrast.

 

[PinchandBurn]

I have heard and been taught conflicting information regarding the use of contrast with CT. I have also developed my own personal biases and need assistance from some of the more astute clinicians.

If a patient has a contraindication for MRI and has had previous back surgery, does the addition of contrast significantly help? What if it was a recent surgery versus an older one? What are scenarios where it would or would not be helpful?

Thanks for any input.

Also what contrast are you talking about? IV versus intrathecal?

Typically, in patinets with hardware in their backs for which a MRI wont show much, a CT mylegram is reasonable.

I think IV contrast is good with a CT/MR if you are trying to r/o an abscess or infection.

 

[emd123]

I think IV contrast is good with a CT/MR if you are trying to r/o an abscess or infection.

Agree. Contrast definitely if looking for abscess/discitis, etc. Otherwise, you're still likely to see a big disc, unexpected mass, or other badness, without contrast as screening imaging, though.

Sometimes I'll do a non-con CT in the patient, who I want to do an injection on, I'm not really suspecting anything unusual, but it's been years since they've had any decent imaging and can't get an MRI for whatever reason. If you really are worried about something in particular, yes, do contrast, maybe even with/and without to increase your sensitivity. If you're not sure based on the situation call one of the radiologists and run it by them. Neurosurgery likes CT myelo's.

 

[embolize]

Post contrast only if you are concerned for infection.

Myelogram in postop pts if you can't get an MR.

 

[Tenesma]

i rarely ever use IV contrast for CTs - doesn't make that big of a difference... unless i am worried about infection, and even then i find that CT without contrast w/ ESR/CRP is just as good.

 

[jj337]

I hardly ever order contrast but did recently and the radiologist called questioning why I did...

84 year old S/P extension of L4-S1 fusion to L3 with significantly worsening pain 3 months prior. I have multiple concerns but radiologist said non-contrast would be fine. Has pacemaker.