CT Abdomen &pelvis Protocols

CT ABDOMEN &PELVIS
PROTOCOLS
 Trauma Protocol
Blunt injury
A relatively simple protocol can be used for
patients with blunt trauma based on scanning the
entire abdomen in the portal venous phase and a
subsequent delayed excretory scan 3-5 minutes
later if injury is detected on the initial scan.
No oral contrast is administered.
•Spleen
•Liver
Classification grade I grade II grade III grade IV grade V
• Of trauma injuries • subcapsular haem • subcapsular haem • subcapsular haem • any injury in the • shattered spleen
atoma atoma atoma presence of a
<10% of surface 10-50% of surface >50% of surface splenic vascular
area area area injury* or active
• parenchymal • intraparenchymal • ruptured bleeding confined
laceration <1 cm haematoma <5 cm subcapsular or within splenic
depth • parenchymal intraparenchymal capsule
• capsular tear laceration 1-3 cm haematoma ≥5 cm • parenchymal
in depth • parenchymal laceration
laceration >3 cm involving
in depth segmental or hilar
vessels producing
>25%
devascularisation
•Pancreas
Oral contrast
• In routine abdominal scanning patients are given oral
contrast to opacify the bowel and allow differentiation
from adjacent pathological lesions.
• In most instances patients are given 800 ml of positive
oral contrast 3% solution of Gastrografin
(sodium/meglumine diatrizoate. or similar water-
soluble contrasts given 30–40 minutes before the scan
to opacify the small bowel
Although positive contrast is used in routine scanning,
if the stomach is the primary organ of interest, for
instance in the staging of gastric cancer, water can be
used as a negative contrast to improve visualization of
the gastric wall,
Stomach wall well visualized
when water is used as negative
contrast water filled gastric
lumen gastric wall
Basics of contrast-enhancement
 Phases of enhancement
 The purpose of contrast-enhanced CT (CECT) is to
find pathology by enhancing the contrast between a
lesion and the normal surrounding structures
Sometimes a lesion will be hypovascular compared to
the normal tissue and in some cases a lesion will be
hyper vascular to the surrounding tissue in a certain
phase of enhancement.
So it is important to know in which phase a CT should
be performed depending on the pathology that you
are looking for.
•Non-enhanced CT (NECT)
Helpful in detecting calcifications, fat in tumors,
fat-stranding as seen in inflammation like
appendicitis, diverticulitis, omental infarction etc.
•Early arterial phase - 15-25 sec or immediately
after bolus tracking
This is the phase when the contrast is still in the
arteries and has not enhanced the organs and
other soft tissues
 Late arterial phase - 35-40 sec. early venous portal
phase", because some enhancement of the portal vein
can be seen. All structures that get their blood supply
from the arteries will show optimal enhancement.
 Late portal phase 65 - 70 sec hepatic phase is the
most accurate term, most people use the term "late
portal phase". In this phase the liver parenchyma
enhances through blood supply by the portal vein and
you should see already some enhancement of the
hepatic veins.
 Hypervascular lesion is best seen in late arterial phase
 Nephrogenic phase - 100 sec or 80 sec after bolus
tracking. This is when all of the renal parenchyma including
the medulla enhances. Only in this phase you will be able to
detect small renal cell carcinomas.
 Delayed phase - 6-10 minutes 6-10 minutes after bolus
tracking. Sometimes called "wash out phase" or "equilibrium
phase". There is wash out of contrast in all abdominal
structures except for fibrotic tissue, because fibrotic tissue has
a poor late wash out and will become relatively dense
compared to normal tissue. This is comparable to late
enhancement of infarcted scar tissue in cardiac MR
CECT ABDOMEN & PELVIS
Flow Rate: 2.5ml/s
Pressure: 250PSI
Contrast volume: 65-70ml
Cannula : 18G or 20G
Start time: 65 sec
Liver Tri-Phasic
The purpose of contrast-enhanced CT (CECT) is to find
pathology by enhancing the contrast between a lesion and the
normal surrounding structures.
Pressure: 300psi
Flow Rate: 4.5ml/s
Contrast volume: 100ml
Liver Tri-Phasic
NON-ENHANCED CT (NECT)
Helpful in detecting calcifications, fat in tumors, fat-stranding as seen in
inflammation like appendicitis, diverticulitis, omental infarction etc.
EARLY ARTERIAL PHASE - 15-25 sec
LATE ARTERIAL PHASE - 30-35 sec Sometimes also called "arterial phase" or
"early venous portal phase",
PORTAL VENOUS PHASE- 65 sec In this phase the liver parenchyma enhances
through blood supply by the portal vein and you should see already some
enhancement of the hepatic veins.
DELAYED PHASE - 3-5 minutes Sometimes called "wash out phase" or
"equilibrium phase".
Liver Bi-Phasic
NON-ENHANCED CT (NECT):
Helpful in detecting calcifications, fat in tumors, fat-stranding as seen
in inflammation like appendicitis, diverticulitis, omental infarction etc.
ARTERIAL PHASE:15 to 25 sec Sometimes also called "arterial
phase" or "early venous portal phase",
PORTAL VENOUS PHASE: 65 sec In this phase the liver
parenchyma enhances through blood supply by the portal vein and you
should see already some enhancement of the hepatic veins.
PANCREATIC
ACUTE PANCREATITIS: CHRONIC PANCREATITIS:

Flow Rate: Flow Rate:
2.5ml/s 4.0/4.5 /2.5ml/s
Pressure: Pressure: 250PSI
250PSI Contrast volume: 65-70ml
Contrast volume: 80 ml Cannula :
18G or 20G Early Arterial Phase: 15 - 25Sec
Portal venous Phase: 65sec Late Arterial Phase: 35 -40 sec
Delay Phase Phase: 90 sec or 3-
5 min
Acute pancreatitis
Chronic pancreatitis
CT UROGRAM
CT Urogram Is Diagnose Of Renal Cell Carcinoma
• Flow Rate: 4.5ml/s
Pressure: 300 PSI
Contrast volume: 100ml
Plain scan
Early Arterial phase: 15-25 sec
Corticomedullary phase: 35sec
Nephrogenic Phase: 90 sec
Excretory Phase: 8min
AORTOGRAM
PROTOCOLS:
• ROI: Arch of Aorta
• Flow Rate: 4.5-5.0
• Pressure: 300PSI
• Contrast volume: 100ml
• Normal Saline: 45-50ml
• Cannula : 18G
• Field of View: Arch of aorta to bifurcation of aorta.
RENAL ANGIOGRAPHY
PROTOCOLS:
• ROI: Thoracic Aorta
• Flow Rate: 4.5-5.0
• Pressure: 300PSI
• Contrast volume: 100ml
• Normal Saline: 45-50ml
• Cannula : 18G

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ACUTE PANCREATITIS: CHRONIC PANCREATITIS:

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