As with conventional angiography, intravascular contrast is required for CT evaluation of vascular structures. In the emergency department, such an examination is most commonly done to evaluate the aorta for trauma, dissection, or aneurysm. If the clinical suspicion is high, initial evaluation with conventional aortography should be considered instead of CT because, in such cases, aortography (requiring additional doses of contrast) would probably be performed whether or not the CT findings are positive.
Helical CT (a form of high-speed CT) has been used in conjunction with rapid contrast injection to perform CT pulmonary arteriography as an alternative to conventional arteriography for the detection of pulmonary embolism. A scintigraphic ventilation-perfusion scan is usually performed as a screening study prior to either type of pulmonary arteriography. If results of the ventilation-perfusion scan are normal or near normal, pulmonary embolism is ruled out and in most cases further evaluation with a contrast study is unnecessary.
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