With the advancement of technology, the vast majority of CT examinations can be reformatted to the resolution of the previously ordered HRCT, and there is rarely an added benefit of HRCT to a routine CT. Khalil et al [33] subsequently published a study retrospectively evaluating patient outcomes comparing a cohort of patients who had a CT without IV contrast with a cohort of patients who underwent CTA. There was a statistically significant difference in the number of emergent surgical resections following embolization in patients who did not have a CTA preceding the BAE (10% CT without cohort versus 4.5% CTA cohort). IV contrast is also well established as an agent that significantly improves the visualization of mediastinal structures. As discussed above, IV contrast shows an added benefit to preprocedural embolization planning. Therefore, CT chest without IV contrast is only warranted in the diagnosis of massive hemoptysis in patients with poor renal function or life-threatening contrast allergy. CT Chest without and with IV Contrast Although early studies used CT chest protocols without IV contrast followed by with IV contrast, there are no data to support any added value of a CT chest without IV contrast prior to administering contrast in the diagnosis of hemoptysis or in preprocedural planning for BAE. CTA Chest CTA has also proven to be beneficial in detecting bronchial and nonbronchial arteries in preprocedural planning. Remy-Jardin et al [34] documented the utility of CTA for BAE preprocedural planning, demonstrating an 86% concordance rate between the 58 abnormal arteries identified on CTA compared with the gold standard of conventional arteriography. Hartmann et al [35] retrospectively reviewed 251 patients (with varying severity of hemoptysis) who were imaged by CTA. Of these 251 patients, 214 had CTAs that were of diagnostic quality without confounding central mediastinal pathology.
Hemoptysis. With the advancement of technology, the vast majority of CT examinations can be reformatted to the resolution of the previously ordered HRCT, and there is rarely an added benefit of HRCT to a routine CT. Khalil et al [33] subsequently published a study retrospectively evaluating patient outcomes comparing a cohort of patients who had a CT without IV contrast with a cohort of patients who underwent CTA. There was a statistically significant difference in the number of emergent surgical resections following embolization in patients who did not have a CTA preceding the BAE (10% CT without cohort versus 4.5% CTA cohort). IV contrast is also well established as an agent that significantly improves the visualization of mediastinal structures. As discussed above, IV contrast shows an added benefit to preprocedural embolization planning. Therefore, CT chest without IV contrast is only warranted in the diagnosis of massive hemoptysis in patients with poor renal function or life-threatening contrast allergy. CT Chest without and with IV Contrast Although early studies used CT chest protocols without IV contrast followed by with IV contrast, there are no data to support any added value of a CT chest without IV contrast prior to administering contrast in the diagnosis of hemoptysis or in preprocedural planning for BAE. CTA Chest CTA has also proven to be beneficial in detecting bronchial and nonbronchial arteries in preprocedural planning. Remy-Jardin et al [34] documented the utility of CTA for BAE preprocedural planning, demonstrating an 86% concordance rate between the 58 abnormal arteries identified on CTA compared with the gold standard of conventional arteriography. Hartmann et al [35] retrospectively reviewed 251 patients (with varying severity of hemoptysis) who were imaged by CTA. Of these 251 patients, 214 had CTAs that were of diagnostic quality without confounding central mediastinal pathology.