Contrast opacification on thoracic CT angiography: challenges and solutions

Abhishek Chaturvedi, Daniel Oppenheimer, Prabhakar Rajiah, Katherine A. Kaproth-Joslin, Apeksha Chaturvedi

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Contrast flow and enhancement patterns seen on thoracic CT angiography (CTA) can often be challenging and may often reveal more than is immediately apparent. A non-diagnostic CTA following the initial contrast injection can be secondary to many causes; these include both extrinsic factors, such as injection technique/equipment failure (iv cannula, power injector), and intrinsic, patient-related factors. Contrast pressure and flow graphs often contain useful information regarding the etiology of a non-diagnostic scan. Understanding these graphs will help the radiologist plan a repeat contrast injection to overcome the deficiencies of the first injection and thus obtain a diagnostic scan. The current review article outlines normal and abnormal intravenous contrast dynamics, discusses how to recognize etiologies of non-diagnostic scans, and ultimately addresses techniques to overcome obstacles towards obtaining normal contrast opacification of the target vessel. In addition, there are some life-threatening findings, which unless sought for, may remain hidden in plain sight. Key Points • Using contrast enhancement and flow patterns to identify the cause of a non-diagnostic CTA. • Recognize life threatening causes of altered contrast dynamics such as cardiac asystole. • Non-target vessel opacification may hold key to underlying pathophysiology.

Original languageEnglish (US)
Pages (from-to)127-140
Number of pages14
JournalInsights into Imaging
Issue number1
StatePublished - Feb 1 2017


  • CT angiography
  • Cardiac asystole
  • Contrast dynamics
  • ECMO
  • Non-diagnostic CTA

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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