Is measurement of renal function necessary for all trauma patients before iodinated contrast administration?

Pantel, Haddon; Stensland, Kristian; Hashim, Jeffrey; Rosenblatt, Michael S.

doi:10.1007/s10140-017-1513-7

Cited by 1 publication

(1 citation statement)

References 15 publications

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“…95% confidence of the estimation equation is shown indicated in light blue It needs to be acknowledged that most patients undergoing contrast-enhanced CT will undergo laboratory testing for glomerular filtration rate, and in routine practice, these tests frequently go in hand with a blood count [29][30][31]. However, not every patient requires a laboratory test and thus analytical data may not be available at the time point of imaging, e.g., in trauma patients [30,32]. Of note, a general need for a laboratory workup for every patient before intravenous contrast media is not supported by current guidelines, e.g., the manual on contrast media by the American College of Radiology and guidelines by the European Society for Urogenital Radiology [33,34].…”

Section: Discussionmentioning

confidence: 99%

Evaluating anemia using contrast-enhanced spectral detector CT of the chest in a large cohort of 522 patients

et al. 2020

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Objectives The blood of patients with anemia demonstrates distinctly lower attenuation in unenhanced CT images. However, the frequent usage of intravenous contrast hampers evaluation of anemia. Spectral detector computed tomography (SDCT) allows for reconstruction of virtual non-contrast images (VNC) from contrast-enhanced data (CE). The purpose of this study was to evaluate whether VNC allow for prediction of anemia. Methods Five hundred twenty-two patients with CE-SDCT of the chest and accessible serum hemoglobin (HbS) were retrospectively included. Patients were assigned to three groups (severe anemia, moderate/mild anemia, and healthy) based on recent lab tests (≤ 7 days) for HbS following gender and the WHO definition of anemia. CT attenuation was determined using two ROI in the left ventricular lumen and one ROI in the descending thoracic aorta. ROI were placed on CE and copied to VNC. ANOVA, linear regression, and receiver operating characteristics were used for statistic evaluation. Results Average HbS was 11.6 ± 2.4 g/dl. Attenuation on VNC showed significant differences between healthy patients, patients with mild/moderate anemia, and severely anemic patients (all p ≤ 0.05). Applying cutoffs of 39.2/37.6 HU and 33.6/32.7 HU allowed to differentiate between healthy, mild/moderately, and severely anemic men/women (AUC 0.857/0.833 and 0.879/0.932). A linear relationship between HbS and attenuation on VNC was established (r2 = 0.54, HbS = − 0.875 + 0.329 × HU). Conclusions An approximation of HbS and presence of anemia can be conducted based on simple attenuation measurements in contrast-enhanced SDCT examinations enabled by VNC imaging. Key Points • While the attenuation of blood is a previously described biomarker for anemia in non-contrast images, virtual non-contrast images from spectral detector CT circumvent this limitation and allow for diagnosis of anemia in contrast-enhanced scans. • Attenuation of blood in virtual non-contrast images derived from spectral detector CT shows a moderate correlation to serum hemoglobin levels. • Presence of anemia be estimated in virtual non-contrast images using proposed cutoffs of 39.2 HU and 37.6 HU for men and women, respectively, to differentiate between healthy and anemic patients.

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