In Reply to: Re: Case 0298_02 -- CT arterial portography posted by Al Nemcek on February 04, 1998 at 12:09:27:
We have all but stopped doing CTAP since it is the feeling of the abdominal imaging section, notably Ken Kopecky, that a dual pass spiral CT (done on an Elscint twin) is as good as or better than CTAP (very carefully done) since there are many artifacts genered by CTAP which have proved problematic even to a well recognized expert tike Ken. The surgeons are using intraoperative US done by Ken and the correlation with the spiral alone has been excellent. Further, the vascular MIPs obtained from the scan are to die for. Though I love doing SMA/celiacs (the "Hopkins runoff") I do a lot fewer now.
As for the contrast, we collected data looking at densities in the liver using Al's technique of placing the catheter, little or no contrast, then angio after the CTAP, and compared that to the practice of doing the whole angio first, at that time using a total of 160 cc of contrast for cut film (aside-we now do digitals which are beautiful on the Toshiba). There was no detectable difference in the baseline density nor the peak enhancement. We did about ten patients in each group but due to the above the study never got completed. It was enough to quell the abdominal imaging service's fears about doing the angio first however.
If I were still doing these I would a digital angio (50 cc total) then send the patient to CT.