Non-Enhanced CT Rarely Aids Haemorrhage Detection

TOPLINE:

Non-enhanced CT scans were deemed helpful in only 4% of haemorrhage cases, primarily in gastrointestinal bleeding, while contributing substantially to the overall radiation exposure. An analysis of 75 patients revealed that non-enhanced CT series accounted for more than 37% of the total radiation dose.

METHODOLOGY:

• Researchers conducted a retrospective analysis of patients who underwent a triphasic CT scan for suspected bleeding and interventional angiography within 6 hours of active bleeding confirmation between 2014 and 2020.
• A total of 75 participants (median age, 64 years; 59% men) were included, with gastrointestinal bleedings accounting for 44% of cases.
• Two experienced observers re-evaluated all CT scans to indicate whether a non-enhanced scan was needed for each CT. Data on radiation exposure were also recorded.

TAKEAWAY:

• After consensus reading, non-enhanced CT scans provided additional value in only three cases (4%) of haemorrhage detection, all involving gastrointestinal bleeding.
• Non-enhanced series contributed significantly to the overall radiation exposure, with a mean dose length product of 927.9 mGy × cm vs 631.3 mGy × cm for the arterial phase and 915.0 mGy × cm for the portal venous phase.
• The arterial phase scan had a significantly lower radiation dose than both non-enhanced and portal venous phase scans (P < .001), whereas non-enhanced and portal venous phase scans had comparable radiation doses (P = .98).

IN PRACTICE:

“Our findings suggest that a non-contrast CT scan as part of routine protocol for suspected bleeding can be safely omitted in most cases without compromising confident diagnosis of haemorrhage. Omission of the non-contrast scan results in a notable reduction of radiation exposure, which is therefore particularly desirable for young patients. However, it is important to acknowledge that in some cases non-contrast scan can be helpful, especially in suspected GI [gastrointestinal] bleeding or if oral contrast has been applied,” the authors wrote.

SOURCE:

This study was led by Johannes Bremm, Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany. It was published online on April 11, 2025, in the European Journal of Radiology.

LIMITATIONS:

The retrospective study design and the moderate number of patients were some of the limitations. The inclusion of only cases with confirmed bleeding in interventional angiography could have resulted in selection bias.

DISCLOSURES:

No funding information was provided for this study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.