CECT
Definition:
Contrast-Enhanced Computed Tomography (CECT) is a CT imaging technique that uses
intravenous (IV) iodinated contrast agents to improve visualization of internal organs, blood
vessels, and pathological lesions. The contrast enhances differences in tissue density,
improving diagnostic accuracy.
Types of CECT:
Based on timing and phase of contrast enhancement, CECT is classified into:
1. Non-contrast Phase: Baseline scan before contrast administration.
2. Arterial Phase (20–30 seconds post-injection):
o Best for evaluating arteries, hypervascular tumors (e.g., hepatocellular
carcinoma).
3. Venous/Portal Venous Phase (60–70 seconds post-injection):
o Best for liver parenchyma, abdominal organs.
4. Delayed Phase (5–10 minutes or more post-injection):
o For evaluating urinary tract, fibrotic tissues, or contrast washout.
Other categorizations include:
• Single-phase vs. multiphase CECT (depending on clinical indication).
• CT Angiography (CTA): Specialized CECT to visualize vessels.
Common Indications:
CECT is widely used in various fields:
Abdominal Imaging:
• Suspected abdominal masses or malignancies
• Liver lesions (e.g., HCC, metastases)
• Pancreatic pathologies (e.g., pancreatitis, tumors)
• Appendicitis, diverticulitis, abscesses
Chest Imaging:
• Pulmonary embolism (CTPA)
• Lung masses, infections, or metastases
• Aortic dissection or aneurysm
Head & Neck:
• Trauma, stroke, brain tumors (with delayed contrast for BBB penetration)
• Orbital or sinus pathologies
• Neck masses or lymphadenopathy
Vascular Imaging:
• Aneurysms, dissections
• Thrombosis or embolism
• Pre-operative vascular mapping
Trauma Evaluation:
• Polytrauma protocol: Head, chest, abdomen, pelvis
Oncologic Staging & Follow-up:
• Tumor extent, metastases, and treatment response
Contraindications:
Absolute Contraindications:
• Severe allergy to iodinated contrast not manageable with premedication
• Anaphylactic reaction to iodinated contrast in the past
• Pregnancy (relative but usually avoided unless benefits outweigh risks,
especially with contrast)
• Severe renal failure (eGFR <30 ml/min/1.73m²) without dialysis support
Relative Contraindications:
• Moderate renal impairment (eGFR 30–59)
• Multiple myeloma (risk of contrast-induced nephropathy, especially if
dehydrated)
• Dehydration
• Use of nephrotoxic drugs (e.g., NSAIDs, aminoglycosides)
• Thyroid disorders (iodine load may precipitate thyrotoxicosis)
Potential Complications:
Early (Immediate to Hours):
1. Allergic Reactions:
o Mild: Nausea, rash, itching
o Moderate: Vomiting, bronchospasm
o Severe: Anaphylaxis, hypotension
2. Contrast-Induced Nephropathy (CIN):
o Acute kidney injury (usually within 48–72 hrs)
3. Extravasation of contrast:
o Pain, swelling, risk of tissue damage
4. Nausea, vomiting, flushing, metallic taste
Late (Days to Weeks):
1. Delayed allergic reactions:
o Rash, urticaria (up to 7 days later)
2. Thyroid dysfunction:
o Iodine-induced hyperthyroidism, especially in elderly or with underlying
thyroid disease
3. Persistent renal dysfunction in susceptible patients
Precautions & Preparations:
• Check renal function (eGFR)
• Allergy history and premedication if needed (steroids/antihistamines)
• Hydration pre- and post-procedure to minimize CIN risk
• Informed consent
• Avoid metformin 48 hours after contrast if at risk for renal impairment
