Does delayed phase imaging in CT angiography provide additional information in patients with suspected active bleeding?

• Published in: Emergency radiology Vol. 31; no. 4; pp. 439 - 446
• Main Authors: Khdhir, Mihran, Ghosn, Youssef, Jabbour, Yara, Abbas, Nada, Tarcha, Ziad, Kayali, Mohamad, Khouzami, Riad, Natout, Mustafa, Muallem, Nadim
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2024; Springer Nature B.V
• Subjects: Aged; Angiography; Bleeding; Computed tomography; Computed Tomography Angiography - methods; Contrast Media; Diagnostic systems; Emergency Medicine; Female; Hemorrhage - diagnostic imaging; Humans; Image acquisition; Image contrast; Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Original Article; Radiation; Radiation effects; Radiology; Retrospective Studies; Radiation dose; Delayed phase imaging; CT protocol; Trauma; Active bleed
• ISSN: 1438-1435; 1070-3004; 1438-1435
• DOI: 10.1007/s10140-024-02239-9

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.