Kim KT, Kim YJ, Won Lee J, Kim YJ, Park SW, Lim MK, et al.. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Altogether findings are in line with preseptal cellulitis, with no signs of deeper . <> Cross-sectional schematic diagram through the right thigh demonstrating the various findings of necrotizing fasciitis. Lactic acidosis has never been documented in patients with normal renal function who are receiving metformin. Federal government websites often end in .gov or .mil. BMJ. Extensive streaky soft-tissue gas is seen extending along the fascial planes of the right thigh on radiograph. 70470 Metastases/Known cancer HIV Intracranial infection Note: CT can be used if there are contraindications for MRI. Patients with history of anaphylactic reaction should not receive contrast. Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Wall DB, Klein SR, Black S, de Virgilio C. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. Bookshelf Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review. Orbital cellulitis is an infectious process affecting the muscles and fat within the orbit, posterior or deep to the orbital septum, not involving the globe. Cellulitis (rare plural: cellulitides) is an acute infection of the dermis and subcutaneous tissues without deep fascial or muscular involvement. 2009;39(10):957-71. In B, the native left lung is small, with evidence of bronchiectasis, bronchiolectasis, and areas of honeycombing (black arrow). Turecki M, Taljanovic M, Stubbs A et al. The location and extent of the inflammatory process was accurately demonstrated with axial CT scans in all cases. Zacharias N, Velmahos GC, Salama A, Alam HB, de Moya M, King DR, et al.. Occasionally sepsis may result. 2019;10(1):47. The parapharyngeal space was the most commonly involved space. 6. Magnetic resonance imaging of musculoskeletal infections. This content is owned by the AAFP. 3 sonographic hallmarks of cellulitis include abnormal echogenicity and increased thickness of the dermis with indistinct "haziness" and increased echogenicity of the subcutaneous tissue, it is often helpful to compare the area in question to the (presumably normal)contralateral side, progressive accumulation of oedema in the subcutaneous tissue appears as branching, anechoic striations which impart a lobulated ("cobble-stone" appearance), presence of thickened and abnormally echogenic overlying skin will favour cellulitis over oedema, linear anechoic bands of fluid deep to the subcutaneous layer favour lymphoedema, ultrasound is more sensitive than MRI for the detection of a retained foreign body as the causative agent, especially if small and wooden 4,5. Saad A, Kho J, Almeer G, Azzopardi C, Botchu R. Br J Radiol. <>stream JAMES V. RAWSON, MD, AND ALLEN L. PELLETIER, MD. (ABRS) may develop orbital, intracranial, and vascular complications including orbital cellulitis, subperiosteal , abscess, intracranial abscess, cerebritis, cavernous sinus thrombosis and aneurysm. Created for people with ongoing healthcare needs but benefits everyone. Although classically a clinical diagnosis, imaging is a powerful adjunct to facilitate early diagnosis in equivocal cases. Epub 2017 Mar 30. MR Imaging in Acute Infectious Cellulitis. Alaia E, Chhabra A, Simpfendorfer C et al. A ct urogram uses IV contrast (dye) to better evaluate the renal pelvis and ureter (the "tube" connecting your kidneys t. Read More. DOI: https://doi.org/10.3949/ccjm.83a.15037, Computed tomography: revolutionizing the practice of medicine for 40 years, ACR-SCBT-MR-SPR practice parameter for the performance of thoracic computed tomography (CT), Screening for lung cancer: US Preventive Services Task Force recommendation statement, Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density, High-pitch ECG-synchronized pulmonary CT angiography versus standard CT pulmonary angiography: a prospective randomized study, Intravenous contrast medium administration and scan timing at CT: considerations and approaches, Emergency imaging assessment of acute, nontraumatic conditions of the head and neck, Iodinated contrast media and their adverse reactions, ACR Committee on Drugs and Contrast Media, ACR Manual on Contrast Media. A 35-year-old male with necrotizing fasciitis of the right calf. Rahmouni A, Chosidow O, Mathieu D et al. Computed tomography (CT) with and without contrast: indications and protocols. Intrathecal iodinated contrast is given during myelography to evaluate spinal or basal cisternal disease and cerebrospinal fluid leaks.11 Plain radiography of the spine is then obtained under fluoroscopic guidance. 2001 Mar;39(2):277-303. doi: 10.1016/s0033-8389(05)70278-5. Citation, DOI, disclosures and article data. Cellulitis. The risk of developing metabolic acidosis with metformin use is rare, but is higher in persons with chronic renal disease or transient impairment of renal function. . MRI Nomenclature for Musculoskeletal Infection. 7 0 obj PMC Inflammatory cellulitis is frequently confused with infectious cellulitis. 2009;39(10):957-71. Kirchgesner T, Tamigneaux C, Acid S et al. This absorption and scattering in turn results in higher CT attenuation values, or enhancement on CT images. HHS Vulnerability Disclosure, Help Contrast enhancement of the fascia can be variable depending on the stage of necrosis.1, 13,25 Enhancement of the affected fascia is thought to represent extravasated contrast from increased capillary permeability. These agents for enhancing the image created on CT may be delivered by a number of different routes, the most common of which are oral and intravenous. Radiologic Approach to Musculoskeletal Infections. Muscular fascia lies deep to the subcutaneous layer. endobj [ 16, 17, 18] On CT scans, a preseptal cellulitis may appear as. Kidney/ureteral stones With IV contrast 1. Sinus radiographs, which were also obtained, were not helpful in diagnosis or management. IV dye may cause a temporary alteration in kidney function. 3. In general, oral contrast is used for most abdominal and pelvic CT scans unless there is no suspicion of bowel pathology (e.g., noncontrast CT to detect kidney stones) or when administration. of 20 consecutive patients with necrotizing fasciitis, CT revealed fascial thickening and fat stranding in 80%, soft tissue gas in 55%, and abscesses in 35%.22, CT is helpful in guiding surgical debridement and drainage by evaluating the extent of soft tissue and osseous involvement, identifying the potential infectious source and identifying potential complications including vascular rupture or tissue necrosis.1, 2,13,22, MRI is the gold-standard for soft-tissue infections as it provides excellent soft-tissue contrast resolution with a sensitivity of 93% for the diagnosis for necrotizing fasciitis.1, 24 Essential sequences include T1 weighted imaging to assess anatomy, and T2 fat saturated or short tauinversion-recovery sequences to look for fascial thickening and edema.3, 25 Post gadolinium sequences are helpful to delineate the extent of infection, identify abscesses and areas of necrosis, but may not be feasible in patients with acute renal failure, which is common in this patient population.3, 26, Deep fascial thickening and subfascial fluid accumulation can be seen as high signal on fluid sensitive sequences (Figures 8 and 9).21 The deep intramuscular fascia is usually protected in the setting of cellulitis, but is involved in necrotizing fasciitis.1 Fascial thickening begins in the superficial fascia and extends along the deep intermuscular fascia, not just in areas contiguous to the deep peripheral fascia.1, 18 Hyperintensity and thickness of the fascia greater than or equal to 3 mm on fat saturated T2 weighted or short tauinversion-recovery images with involvement of three or more compartments is a sensitive finding to suggest necrotizing fasciitis.3, 8,13,25,27 The absence of T2 hyperintensity within the deep fascia can essentially exclude a diagnosis necrotizing fasciitis.3, 18,21. Prior to contrast administration, patients should be asked about previous allergy to CT contrast. 1994;192(2):493-6. It results in pain, erythema, oedema, and warmth. Unenhanced CT is also used in patients with spine and extremity trauma. Yu J & Habib P. MR Imaging of Urgent Inflammatory and Infectious Conditions Affecting the Soft Tissues of the Musculoskeletal System. CT pulmonary angiography with intravenous contrast in a patient being evaluated for arteriovenous malformation. In uncomplicated cellulitis, CT demonstrates skin thickening, septation of the subcutaneous fat, and thickening of the underlying superficial fascia. Assessment of interstitial lung disease does not require use of IV contrast; rather, a tailored protocol with thinner slices and non-contiguous expiratory images can be used to evaluate for air-trapping and dynamic airway compromise (Figure 4). The overall PPV for the prediction of deep neck abscess with contrast-enhanced CT was 79.6%. Radiographics. Use of this website is subject to the website terms of use and privacy policy. Even in osseous infection, CT and MRI can give better anatomic delineation of the extent of infection. Wysoki MG, Santora TA, Shah RM, Friedman AC. endobj Preparation: Please have only a clear liquid diet for 4 hours prior to exam. Although many radiology departments screen for shellfish allergy, there is no cross-reactivity between shellfish and iodinated contrast. dobrien 2. Necrotizing fasciitis: CT characteristics. Infect Dis Clin North Am. MeSH In cases of suspected arteriovenous malformation, a protocol similar to that used for suspected pulmonary embolus is used (Figure 3), although in some instances, the imaging features of arteriovenous malformation may be detectable without IV contrast. Musculoskeletal infection: role of CT in the emergency department. Miller TT, Randolph DA, Staron RB, Feldman F, Cushin S. Fat-suppressed MRI of musculoskeletal infection: fast T2-weighted techniques versus gadolinium-enhanced T1-weighted images, Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis, Differentiation of necrotizing fasciitis and cellulitis using MR imaging. Preparation: Please have only a clear liquid diet for 4 hours prior to exam. Additionally, systemic features such as fevers and rigors may also be present. CT Exams Contrast vs Non-Contrast Guide These suggestions are general guidelines that apply to the use of contrast for CT exams provided at Oregon Imaging Centers. Clear communication between the physician and radiologist is essential for obtaining the most appropriate study at the lowest cost and risk to the patient. Contrast-enhanced CT demonstrates air (arrows) and edema in the scrotum, surrounding the right testicle (a). AJR Am J Roentgenol. 2022 Jul 10;11(14):3998. doi: 10.3390/jcm11143998. High-resolution CT, which is used to evaluate diffuse lung disease, does not use IV contrast.17 Noncontrast imaging of the abdomen is routinely done to screen for renal stones in patients with flank pain.18 Common clinical scenarios in which noncontrast-enhanced CT is appropriate are summarized in Table 4,19 and common clinical scenarios in which contrast enhancement is recommended are summarized in Table 5.19 Indications for selection of imaging studies for specific clinical scenarios can be searched using the American College of Radiology Appropriateness Criteria at http://www.acr.org/ac.19. Insights Imaging. Soft-tissue infections and their imaging mimics: from cellulitis to necrotizing fasciitis, Necrotizing soft-tissue infection: diagnosis and management, Red flags for necrotizing fasciitis: a case control study, Sonographic detection of necrotizing fasciitis, Necrotizing soft tissue infections: a primary care review. The most common contrast agents used with CT imaging are barium- and iodine-based. Muscular fascia lies deep to the subcutaneous layer. It results in pain, erythema, edema, and warmth. CT with contrast can help to depict infection of the chest wall or mediastinum and in some instances can also delineate the route of spread.7, Contrast media used in CT contain iodine, which causes increased absorption and scattering of radiation in body tissues and blood. Cellulitis(rare plural: cellulitides) is an acute infection of the dermis and subcutaneous tissues without deep fascial or muscular involvement. Even in osseous infection, CT and MRI can give better anatomic delineation of the extent of infection. Sign In to Email Alerts with your Email Address. Emergency Medicine: Clinical Essentials. When is contrast needed for abdominal and pelvic CT? It is usually due to underlying bacterial sinusitis. Contrast agents are used to differentiate between organs and improve lesion detection and characterization. The American Academy of Radiology recommends the use of IV contrast only if care of the patient cannot be accomplished without it. While the plain film and nuclear medicine bone scan are still the traditional imaging modalities used in the evaluation of musculoskeletal infection, the cross-sectional imaging modalities, computed tomography (CT) and magnetic resonance imaging (MRI), have become critical in the delineation of many types of musculoskeletal infection. Bethesda, MD 20894, Web Policies 2017 Jun;31(2):299-324. doi: 10.1016/j.idc.2017.01.004. Scout film (a) and contrast-enhanced CT (b) shows intramuscular pockets of gas (arrows) in the left lateral thigh. N.p. Axial non-contrast. Different imaging modalities require different concentrations of contrast for optimal detection of pathology. [18F]Fluoride Positron-Emission Tomography (PET) and [18F]FDG PET for Assessment of Osteomyelitis of the Jaw in Comparison to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): A Prospective PET/CT and PET/MRI Pilot Study. Orbital cellulitis. Clinical presentations include skin erythema without a well-defined border, increased skin temperature, swelling of the affected area, and regional lymphadenopathy and lymphangitis. References. CT is used to accurately differentiate between superficial cellulitis and deep cellulitis. Normally the subcutaneous tissue is hypoechoic with few hyperechoic strands (representing connective tissue). The diagnostic algorithm for lung cancer screening is evolving. It is essential to know the types of contrast agents, their risks, contraindications, and common clinical scenarios in which contrast-enhanced computed tomography is appropriate. Become a Gold Supporter and see no third-party ads. The information provided is for educational purposes only. , Acuterecurrent rhinosinusitis Recent studies suggest that a combination of hydration, sodium bicarbonate, N-acetylcysteine, and decreased contrast volume may reduce this risk in high-risk populations.14,15, The question of whether this risk has been overstated has been raised in the medical literature. A 39-year-old male with necrotizing fasciitis of the right ankle. At the time the article was created The Radswiki had no recorded disclosures. It is injected through an intravenous line during the examination. This site needs JavaScript to work properly. Renal function should be assessed with a baseline creatinine level before administration as patients with impaired renal function are at risk for complications associated with IV contrast. CT is the most sensitive modality for soft-tissue gas detection, and compared with radiography, CT is superior to evaluate the extent of tissue or osseous involvement, show an underlying (and potentially more remote) infectious source, and reveal serious complications such as vascular rupture complicating tissue necrosis [ 10, 13 - 20 ]. Contrast: A plain ct looks for stones. The site is secure. Recent estimates place the number of computed tomography (CT) scans performed annually in the United States at approximately 70 million.1 Given the cost and radiation exposure, it is critical that CT is appropriate and performed with optimal technique. The PPV was 91.3% when more than one deep neck space was involved but only 50.0% in patients with isolated retropharyngeal abscesses. HHS Vulnerability Disclosure, Help That said, it is seldom required for diagnosing cellulitis and is therefore usually ordered for suspected complications or to rule out alternative diagnoses in cases of an atypical presentation. Fasciae of the Musculoskeletal System: MRI Findings in Trauma, Infection and Neoplastic Diseases. endstream ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2001 Oct;42(4-5):259-305. Potential Harms of Computed Tomography: The Role of Informed Consent. The type of contrast agent and route of administration can increase the diagnostic yield of the study ordered. During the injection you may feel flushed and get a metallic taste in your mouth. In particular, the evaluation of soft tissue infections, including cellulitus, myositis, fasciitis, abscess, and septic arthritis are often best evaluated by MRI or CT due to their excellent anatomic resolution and soft tissue contrast. 7. Creatinine cutoffs vary among institutions, but generally range between 1.5 and 2 mg per dL (132.6 to 176.8 mol per L) before alternative imaging strategies are considered.7 An increasing creatinine level that is still within normal limits is also concerning, and alternative imaging strategies should be considered. Above this, there is a narrow, relatively hyperechoic epidermal-dermal layer. Ultrasound is usually the first investigation to evaluate a clinical suspicion of cellulitis. 1998;170(3):615-20. Skeletal Radiol. 9. Speak with a Radiologist: 541-284-4016 If youre a nurse practitioner who struggles with the same question, check out the following guide to contrast and CT scans. Summary of imaging findings of necrotizing fasciitis. Iodinated contrast crosses the human placenta. These experts are usually happy to help select the correct test for your patient. Would you like email updates of new search results? AJR Am J Roentgenol. One of these questions that came up frequently related to CT scans was Do I need contrast?. Unable to process the form. Cross-sectional imaging findings include asymmetric thickening of fascia, soft tissue air, blurring of fascial planes, inflammatory fat stranding, reactive lymphadenopathy, and nonenhancement of muscular fascia. In B, the native left lung is small, with evidence of bronchiectasis, bronchiolectasis, and areas of honeycombing (black arrow). For the assessment of vascular disease, CT in most cases requires IV contrast to delineate the vessel lumen. 8. Water-soluble, iodine-based contrast agents can also be given orally. Before Contrast-enhanced CT demonstrates crescentic subfascial fluid (arrow) with fluid also seen superficial to the fascia (arrow head) and between muscle planes (a). Diffuse thickening of the superficial fascia, which can be seen in the early phase of necrotizing fasciitis (c). BMJ. What is the rationale for the laboratory workup for suspected pheochromocytomas and paragangliomas? Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-15554. Spinnato P, Patel DB, Di Carlo M, Bartoloni A, Cevolani L, Matcuk GR, Cromb A. Microorganisms. The https:// ensures that you are connecting to the Kirchgesner T, Tamigneaux C, Acid S et al. Ultrasound is helpful to rule out deep venous thrombosis, assess for possible foreign bodies, and guide potential diagnostic fluid aspiration.8, 13 Sensitivity of ultrasound for the diagnosis of necrotizing fasciitis is 88.2%, with a specificity of 93.3%.20, CT is the primary imaging modality in the work-up of necrotizing fasciitis given its wide availability and high spatial resolution compared to radiography or ultrasound.3 Soft-tissue gas is a pertinent CT finding, but absence of it should not exclude the diagnosis of necrotizing fasciitis if clinically suspected.1, 2,11,17 Gas within fluid collections along subfascial planes is the hallmark of necrotizing fasciitis (Figures 5 and 6).11, 21 The lack of soft-tissue gas on CT may be due to early disease, aerobic infections, or if the patient is diabetic.1, 16 The sensitivity of CT in diagnosing necrotizing fasciitis is 80%, but it lacks specificity as findings can also be seen in nonnecrotizing fasciitis.21, 22 Thickening and nonenhancement of the fascia on contrast-enhanced CT may be helpful to distinguish from nonnecrotizing fasciitis.2 Subfascial and intermuscular fluid accumulation can also be seen on CT, and may represent early findings of necrotizing fasciitis (Figure 7).21. Diagnosis of necrotizing soft tissue infections by computed tomography. Inflammatory cellulitis is frequently confused with infectious cellulitis. You'll need to take the antibiotic for the full course, usually 5 to 10 days, even if you start to feel better. Children have a lower incidence of reactions to IV contrast agents, and most of these are mild (0.18% for low-osmolality agents).7,8, Risk factors for contrast reactions include multiple drug allergies and asthma. Paz Maya S, Dualde Beltrn D, Lemercier P, Leiva-Salinas C. Necrotizing fasciitis: an urgent diagnosis. 2nd ed. Interstitial lung disease 2. Federal government websites often end in .gov or .mil. Patients with peripheral vascular disease or diabetes mellitusare particularly susceptible to cellulitis since minor injuries to the skin or cracked skin in the feet or toes can serve as a point of entry for infection. Oral contrast agents are barium- or iodine-based and are used for bowel opacification. Evaluation of chronic obstructive pulmonary disease also does not require IV contrast. Since the epidermis is not involved, cellulitis is not transmitted by person-to-person contact. 4. Metformin should be held for 48 hours after the administration of IV contrast, and resumed only after serum creatinine returns to baseline levels, according to the U.S. Food and Drug Administration. Yes neuro CTa HeaD Circle of Willis CTA Head with and without contrast Note: MRA Brain without contrast is preferred. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). E-mail: Received 2018 Jan 20; Revised 2018 Mar 2; Accepted 2018 Mar 8. and transmitted securely. All Rights Reserved. Skeletal Radiol. Yu J & Habib P. MR Imaging of Urgent Inflammatory and Infectious Conditions Affecting the Soft Tissues of the Musculoskeletal System. The American College of Radiology recommends using IV iodinated contrast in pregnant women when the information needed affects the care of the patient and fetus and cannot be obtained without contrast, and when the referring physician thinks that imaging should not wait until after the pregnancy.7, Iodinated contrast media can saturate the thyroid gland and significantly reduce uptake of iodine 131, rendering the treatment ineffective. FOIA Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-15554. The most common are baruim and iodine based. Clear communication between the physician and radiologist is essential for obtaining the most appropriate study at the lowest cost and risk to the patient. Working in the emergency department as a nurse practitioner, I order CT scans in my evaluation of patients every day. In uncomplicated cellulitis, CT demonstrates skin thickening, septation of the subcutaneous fat, and thickening of the underlying superficial fascia. Skin findings, pain out of proportion, and signs of systemic shock should alert the clinician to the possibility of necrotizing fasciitis. In general, oral contrast is used for most abdominal and pelvic CT scans unless there is no suspicion of bowel pathology (e.g., noncontrast CT to detect kidney stones) or when administration would delay a diagnosis in the trauma setting. If you have questions about ordering your patient's CT, we encourage you to speak with a radiologist about the study and the need for contrast. Patients with a mild allergy may be pre-medicated with an antihistamine or steroids before imaging. Some centers use oral contrast to evaluate for appendicitis; some do not use bowel contrast,3 and others use rectal contrast to avoid the delay associated with oral administration.4, Iodine-based intravenous (IV) contrast agents are used for opacification of vascular structures and solid abdominal and pelvic organs. Skeletal Radiol. 8600 Rockville Pike No mutagenic or teratogenic effects have been shown with nonionic, low-osmolality contrast in animal studies. Postoperative sternal wound infections are not uncommon and range from cellulitis to frank osteomyelitis. Search dates: November 2009 and April 27, 2010. Fascial thickening and involvement of multiple compartments is a sensitive finding on MRI. Cellulitis. The https:// ensures that you are connecting to the thickening of skin and superficial fascia, diffuse subcutaneous linear/reticular or ill-defined hyperintensity tending to collect at the hypodermis, contrast enhancement differentiates cellulitis from stasis oedema, areas of necrotising cellulitis do not enhance, degree of enhancement depends on the post contrast delay. As with barium agents, they must be diluted for CT compared with the concentrations used in fluoroscopy. 07/16 RH /MF ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. When I was newer to my role, I had a lot of questions about diagnostic imaging, when it was indicated, and what test to order. no financial relationships to ineligible companies to disclose. % Although it is a clinical diagnosis, imaging is a powerful adjunct to facilitate early diagnosis in equivocal cases. Fluid tracking along deep and intermuscular fascia, which can be seen in advanced cases (d). endobj In the emergency setting, CT of the neck is often performed to investigate symptoms of acute infection or inflammation or symptoms of aerodigestive tract compromise referable to the neck. That said, it is seldom required for diagnosing cellulitis and is therefore usually ordered for suspected complications or to rule out alternative diagnoses in cases of an atypical presentation. Emerg Radiol. MRI Nomenclature for Musculoskeletal Infection. 8600 Rockville Pike A 53-year-old male with necrotizing fasciitis of the left knee. At the time the article was last revised David Carroll had Possible reactions are listed in Table 1.7 If a patient has had a previous minor reaction to an IV iodinated contrast agent, precontrast administration of oral or IV corticosteroids and diphenhydramine (Benadryl) may decrease their risk (Table 27 ). It is important to tell the technician and your doctor if you have had a previous allergic reaction to iodinated contrast. In a patient with colon cancer undergoing a workup for metastases, axial CT without contrast (A) shows prominence of the right hilar region (arrow). Required fields are marked *. Unable to process the form. MR Imaging in Acute Infectious Cellulitis. One study showed similar increases in serum creatinine levels between inpatient populations who received IV iodinated contrast and those who did not.16, Noncontrast-enhanced CT is used in patients with head trauma and acute stroke. An official website of the United States government. Given that metformin is excreted through the kidneys, IV contrast may impair metformin clearance from the body putting the patient at risk for metabolic acidosis. Initial radiographs show soft tissue gas (without puncture wound) or are normal with high clinical suspicion of necrotizing fasciitis. Radiology. Contrast may also be avoided when the suspected pathology is likely to be visible on noncontrast-enhanced CT. A history should be obtained to determine if the reaction was mild (which typically requires observation but not treatment), moderate (which requires prompt treatment), or severe (which requires rapid intervention and, often, hospitalization). The .gov means its official. Unauthorized use of these marks is strictly prohibited. Here is an overview of the indications for contrasted CT: CT Angiography, or CTA, is a type of contrasted CT scan used to evaluate the blood vessels. N/A No CT WRIST LEFT WO CONTRAST (IMG3906) CT WRIST RIGHT WO CONTRAST(IMG3909) CT HAND LEFT WO CONTRAST (IMG3794) CT HAND RIGHT WO CONTRAST (IMG3797) 73200 Biomed Res Int. The specific agent and route of administration are based on clinical indications and patient factors.
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