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. 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. . Unable to process the form. official website and that any information you provide is encrypted A ct urogram uses IV contrast (dye) to better evaluate the renal pelvis and ureter (the "tube" connecting your kidneys t. Read More. There is subcutaneous emphysema (arrows) overlying the right ankle with plate and screw fixation seen (a). 7. In pleural effusion, CT assessment for the presence, location, and extent of the effusion does not require contrast. Compared to plain radiography, ultrasound, CT and MR provide higher sensitivity and specificity for the diagnosis of necrotizing fasciitis. Radiographics. HHS Vulnerability Disclosure, Help CT pulmonary angiography with intravenous contrast in a patient being evaluated for arteriovenous malformation. The parapharyngeal space was the most commonly involved space. AJR Am J Roentgenol. The overall PPV for the prediction of deep neck abscess with contrast-enhanced CT was 79.6%. Created for people with ongoing healthcare needs but benefits everyone. 2 0 obj Oral contrast agents are barium- or iodine-based and are used for bowel opacification. <>/Metadata 2 0 R/ViewerPreferences 6 0 R>> Prior to contrast administration, patients should be asked about previous allergy to CT contrast. However, CT scanning with contrast involves exposure to ionizing radiation, which may increase the risk of malignancy and eye lens damage. Abdominal and/or pelvic pain-acute or chronic 2. Below is an overview of the following CTA studies and their indications: Abdominal Aorta (CTA Abdomen) - Aneurysm, dissection, post stent grafting, renal artery stenosis, metastatic stenosis In cases of question, Computed tomography (CT) with and without contrast of the orbits and sinuses should be ordered to look for evidence of post-septal involvement. Measure serum creatinine before ordering CT studies with IV dye to assess for baseline renal insufficiency. 7 0 obj If youre ever stuck when it comes to the correct diagnostic imaging method for your patient, pick up the phone and call the radiologist or imaging facility with whom you work. 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. endobj CT may also be ordered for cross-sectional images of the spine with contrast in the thecal sac. 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. For the assessment of vascular disease, CT in most cases requires IV contrast to delineate the vessel lumen. Different imaging modalities require different concentrations of contrast for optimal detection of pathology. Extensive streaky soft-tissue gas is seen extending along the fascial planes of the right thigh on radiograph. 2019;10(1):47. 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. Contrast is not used in patients with head, extremity or spine trauma. Rahmouni A, Chosidow O, Mathieu D et al. Case 1: orbital and periorbital cellulitis, see full revision history and disclosures. 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? Normally the subcutaneous tissue is hypoechoic with few hyperechoic strands (representing connective tissue). When the neoplasm has CT attenuation similar to that of adjacent structures (lymph nodes in the hilum, masses in the mediasti-num or chest wall), IV contrast can improve identification of the lesion and delineation of its margins and the relationship with adjacent structures (eg, vascular structures) (Figure 1). Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine. They are used for bowel opacification and are not nephrotoxic. 2021 Feb 1;94(1118):20200648. doi: 10.1259/bjr.20200648. Epub 2015 Apr 29. 2001;176(5):1155-9. An official website of the United States government. It is injected through an intravenous line during the examination. 1998 Aug;6(3):537-59. Altogether findings are in line with preseptal cellulitis, with no signs of deeper . Diffuse high signal can also be seen in the muscle and subcutaneous fat.13 If subcutaneous edema is not the predominant feature, one should consider necrotizing fasciitis rather than cellulitis.1, 13 A summary of spectrum of findings for necrotizing fasciitis is summarized in Figure 10 and Table 2. Large volume of gas seen within the scrotum wall and scrotum sac on the scout image (curved black arrow), consistent with Fourniers gangrene. Necrotizing fasciitis: contribution and limitations of diagnostic imaging. Contrast-enhanced CT demonstrates crescentic subfascial fluid (arrow) with fluid also seen superficial to the fascia (arrow head) and between muscle planes (a). A 53-year-old male with necrotizing fasciitis of the left knee. 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). Fortunately, orbital fat provides intrinsic background contrast, and most orbital pathologies can be easily visualised without infusion of a contrast medium. 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. Federal government websites often end in .gov or .mil. Search dates: November 2009 and April 27, 2010. Your email address will not be published. Cellulitis occurs after disruption of the skin and invasion of the subcutaneous tissues by microorganisms that may be skin flora, such as beta-haemolytic streptococci (most often),Staphylococcus aureus(including methycillin-resistant), or other bacteria 9. If a diagnosis of orbital cellulitis is made, the patient needs to be immediately assessed monitored for signs of compartment syndrome and optic neuropathy which would warrant an . Gothner M, Dudda M, Kruppa C, Schildhauer TA, Swol J. Fulminant necrotizing fasciitis of the thigh, following an infection of the sacro-iliac joint in an immunosuppressed, young woman, MRI in necrotizing fasciitis of the extremities. Preparation: Please have only a clear liquid diet for 4 hours prior to exam. Dr. Amy Levine answered. With respect to employing CT as an imaging modality, first one should be aware of the different ty. Cellulitis. Your email address will not be published. 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. No mutagenic or teratogenic effects have been shown with nonionic, low-osmolality contrast in animal studies. CT head without IV contrast Usually Not Appropriate . Kidney/ureteral stones With IV contrast 1. Even in osseous infection, CT and MRI can give better anatomic delineation of the extent of infection. 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. 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. Detailed protocols for premedication and management of contrast adverse reactions are beyond the scope of this review and the reader is advised to refer to dedicated manuals.10. Before Struk DW, Munk PL, Lee MJ, Ho SG, Worsley DF. Case 1: orbital and periorbital cellulitis, see full revision history and disclosures. 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 MAGNETIC RESONANCE IMAGING Brothers TE, Tagge DU, Stutley JE, Conway WF, Del Schutte H, Byrne TK. Iodinated contrast agents can cause reversible acute renal failure. 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. MR Imaging in Acute Infectious Cellulitis. 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. Thirteen orbital computed tomographic (CT) scans were obtained in 12 patients with postseptal (orbital) cellulitis. 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. 2022 Mar 5;87:e141-e162. endobj It results in pain, erythema, edema, and warmth. BMJ. Other CT findings include increase soft-tissue attenuation, subcutaneous edema and inflammatory fat stranding, which can also be seen in cellulitis.2,2123 In a study by Wysoki et al. Patients with a mild allergy may be pre-medicated with an antihistamine or steroids before imaging. Enter multiple addresses on separate lines or separate them with commas. Cellulitis. Clinical presentations include skin erythema without a well-defined border, increased skin temperature, swelling of the affected area, and regional lymphadenopathy and lymphangitis. 2020;368:m710. Horton L, Jacobson J, Powell A, Fessell D, Hayes C. Sonography and Radiography of Soft-Tissue Foreign Bodies. The most common are baruim and iodine based. Spinnato P, Patel DB, Di Carlo M, Bartoloni A, Cevolani L, Matcuk GR, Cromb A. Microorganisms. Concerns for using IV contrast during CT include a history of reactions to contrast agents, pregnancy, treatment of thyroid disease with radioactive iodine, use of metformin (Glucophage), and chronic or acutely worsening renal disease. 5. 4. Fundic gland polyps: Should my patient stop taking PPIs? What is the rationale for the laboratory workup for suspected pheochromocytomas and paragangliomas? 6. Crit Rev Diagn Imaging. 07/16 RH /MF Kirchgesner T, Tamigneaux C, Acid S et al. Signs of cellulitis are easy to appreciate on CT and MRI and include thickening of the fat, best appreciated on the preseptal space, fat infiltration, and contrast enhancement. 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 ). Barium suspension from fluoroscopy or CT will not produce an artifact on abdominal magnetic resonance imaging. Within three days of starting an antibiotic, let your health care provider know whether the infection is responding to treatment. Bethesda, MD 20894, Web Policies 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. Mitchell C, Dolan N, Drsteler K. Management of Dependent Use of Illicit Opioids. Bakleh M, Wold LE, Mandrekar JN, Harmsen WS, Dimashkieh HH, Baddour LM. At the time the article was last revised David Carroll had Lactic acidosis has never been documented in patients with normal renal function who are receiving metformin. Scout film (a) and contrast-enhanced CT (b) shows intramuscular pockets of gas (arrows) in the left lateral thigh. A CT can help determine the underlying cause of orbital cellulitis. Unenhanced CT is also used in patients with spine and extremity trauma. <>stream No circumscribed collection, or signs of bulbar or intraconal involvement (note the preservation of the normal intraorbital fat density). Maximum-intensity projection images reconstructed in the axial (A) and coronal (B) planes show bilateral arteriovenous malformations with corresponding feeding arteries (white arrows) and draining veins (black arrows). Imaging of Musculoskeletal Soft Tissue Infections. In B, the native left lung is small, with evidence of bronchiectasis, bronchiolectasis, and areas of honeycombing (black arrow). 8600 Rockville Pike An official website of the United States government. Axial non-contrast. In patients with elevated creatinine, withholding IV dye may be necessary. Related editorial: Potential Harms of Computed Tomography: The Role of Informed Consent. Speak with a Radiologist: 541-284-4016 2017 Jun;31(2):299-324. doi: 10.1016/j.idc.2017.01.004. Patients with history of anaphylactic reaction should not receive contrast. Contrast-enhanced CT demonstrates a horse-shoe shaped perirectal air collection (arrows), extending into the subcutaneous tissues of the ischiorectal fossa and medial gluteal region (b). Marked preseptal edema and discrete contrast enhancement in the area of the affected left upper eyelid. Many practices have their own protocols for IV dye administration in patients using metformin so nurse practitioners must familiarize themselves with these policies. The type of contrast agent and route of administration can increase the diagnostic yield of the study ordered. Since the epidermis is not involved, cellulitis is not transmitted by person-to-person contact. When is contrast needed for abdominal and pelvic CT? All rights reserved. 3. In the false-positive group, cellulitis was the most . MRI's visualization of the bone marrow allows for the sensitive detection of osteomyelitis, although specificity for the diagnosis of osteomyelitis is aided by other findings, including cortical destruction. without access to clinical information or CT results. Evaluation of chronic obstructive pulmonary disease also does not require IV contrast. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, organs, and blood vessels. CT without contrast in a patient with a history of interstitial lung disease and right lung transplant shows the patent but partially narrowed anastomotic site of the right bronchus (A) (red arrow). Order "WRIST" if only carpal area. Musculoskeletal infection: role of CT in the emergency department. Ultrasound is usually the first investigation to evaluate a clinical suspicion of cellulitis. Skeletal Radiol. the contents by NLM or the National Institutes of Health. The major families of contrast agents are ionic and nonionic. 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. The information provided is for educational purposes only. T2 weighted image with fat saturation of the left thigh demonstrates a large area of myonecrosis within the proximal rectus femoris muscle, with extensive muscular, fascial, and subcutaneous enhancement and edema, with crescentic fascial fluid collections, predominantly around the rectus femoris and sartorius, suggestive of necrotizing fasciitis. no financial relationships to ineligible companies to disclose. This site needs JavaScript to work properly. Despite its limitations, radiographs can be more sensitive than physical exam for the detection of soft-tissue gas, with radiographic findings present before clinical crepitus is detected.17 Radiographs can also be helpful in identifying other causes of infection including the presence of a foreign body or underlying fracture.3, 13, The role of ultrasound is limited in the work-up of necrotizing fasciitis given that the lack of resolution of deeper structures.8 The presence of soft-tissue gas can be more apparent on ultrasound compared to radiographs.17, 18 Findings include an echogenic layer of gas above the deep fascia with posterior dirty acoustic shadowing (Figure 4).19 Other nonspecific findings include hyperechogenicity of the overlying fat, with cobblestone appearance indicating subcutaneous edema, but these findings can also be seen in cellulitis or anasarca.8, 19 Color Doppler evaluation may not reveal hypervascularity.8 Specific signs that are helpful to differentiate necrotizing fasciitis from cellulitis include irregularity of the fascia, abnormal fluid collection along fascial planes, and diffuse fascia thickening when compared to the contralateral unaffected side.8. 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. These agents are not used for imaging of the abdomen and/or pelvis if bowel pathology is not suspected, or if doing so will delay scanning as in the case of acute trauma. and transmitted securely. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 2009;16(4):267-76. doi: 10.5114/pjr.2022.113825. Radiol Clin North Am. 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. 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. 3. 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. 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. Below is an overview of the following CTA studies and their indications: Regardless of the pathology youre looking for, contrast isnt right for everyone. 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 Infect Dis Clin North Am. 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. On MRI, the signal on T2-WI is variable depending on the etiology. HHS Vulnerability Disclosure, Help endobj If the infection spreads to deeper tissues, soft-tissue abscess, infectious myositis, necrotizing fasciitis, and osteomyelitis can all be detected with CT. MRI is sensitive for distinguishing cellulitis alone from necrotizing fasciitis and infectious myositis and for showing subcutaneous fluid collections and abscesses. Epub 2017 Mar 30. This absorption and scattering in turn results in higher CT attenuation values, or enhancement on CT images. While adverse effects to the fetus have not been demonstrated with IV dye, contract does cross the placenta. Disease processes that involve calcifications may benefit from noncontrast-enhanced images because contrast may mask the appearance of calcifications. Clinical presentations include skin erythema without a well-defined border, increased skin temperature, swelling of the affected area, and regional lymphadenopathy and lymphangitis. Sign In to Email Alerts with your Email Address. Citation, DOI, disclosures and article data. CT is commonly used to diagnose, stage, and plan treatment for lung cancer, other primary neoplastic processes involving the chest, and metastatic disease.2 The need for contrast varies on a case-by-case basis, and the benefits of contrast should be weighed against the potential risks in each patient. 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. Copyright2022 ThriveAP Inc., All Rights Reserved, Key Advice for NPs & PAs with Angela Golden, DNP, FNP-C, FAANP, FOMA, Evidence-Based Wound Care for Advanced Practice Providers, Featured ThriveAP Faculty: Benjamin Smith, DMSc, PA-C, DFAAPA, Finding Your Why with ThriveAP Speaker Steven Wei, EdD, MPH, MS, PA-C, DFAAPA. {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, Carroll D, Knipe H, et al. Weaver JS, Omar IM, Mar WA, Klauser AS, Winegar BA, Mlady GW, McCurdy WE, Taljanovic MS. Pol J Radiol. However, contrast enhancement is used to evaluate suspected or known exudative effusions and empyema.6 It also aids the evaluation of metastatic or primary malignancy of the pleura, particularly in cases of occult disease, as enhancement and thickening of the pleura are of diagnostic interest. Radiology. Alaia E, Chhabra A, Simpfendorfer C et al. Cellulitis can affect any region of the body, and commonly affects a lower limb. Even in osseous infection, CT and MRI can give better anatomic delineation of the extent of infection. Skeletal Radiol. Hydration can decrease these risks. A paranasal sinus pathology is . Ultrasound is usually the first investigation to evaluate a clinical suspicion of cellulitis. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The US Preventive Services Task Force currently recommends low-dose CT without contrast, along with appropriate patient counseling, for patients with a history of smoking and an age range as detailed in the Task Force statement.3. no financial relationships to ineligible companies to disclose. CT is used to accurately differentiate between superficial cellulitis and deep cellulitis. sharing sensitive information, make sure youre on a federal Next imaging study. Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot) The site is secure. 70470 Metastases/Known cancer HIV Intracranial infection Note: CT can be used if there are contraindications for MRI. Most centers use nonionic contrast agents (which are generally low osmolality) for IV contrast studies.5 The rate of major reactions (e.g., anaphylaxis, death) is the same for ionic and nonionic IV contrast agentsan estimated one in 170,000 administrationsbut nonionic contrast has a lower rate of minor reactions.6 Approximately 5% to 12% of patients who receive high-osmolality contrast have adverse reactions, most of which are mild or moderate.7 Use of low-osmolality contrast has been associated with a reduction in adverse effects. Follow-up of a solitary pulmonary nodule also typically does not require contrast enhancement, though some investigators have reported high sensitivity with dynamic contrast enhancement of pulmonary nodules.4 This rep resents a rare clinical application of chest CT with and without contrast. It results in pain, erythema, oedema, and warmth. Careers. Disclaimer. Epidemiology Risk factors trauma foreign bodies 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. However, IV radiologic contrast may cause transient alteration in renal function, which could impair metformin clearance, leading to a higher risk of metabolic acidosis. Federal government websites often end in .gov or .mil. Fasciae of the Musculoskeletal System: MRI Findings in Trauma, Infection and Neoplastic Diseases. sharing sensitive information, make sure youre on a federal The concentration of barium used for fluoroscopy is more than 20 times that of the typical oral contrast suspension for CT. For example, the barium concentration from an upper gastrointestinal series or an enema will produce an artifact on abdominal CT because it is significantly more concentrated than bowel contrast agents used for CT. Barium enemas are also given after abdominal CT to allow time for the less-dense barium to leave the colon.
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