Clinical Significance of CT scans

CT scans provide information close to real-time that allows for proper management of multiple diseases. Before the invention of the CT scan, patients with abdominal pain, fever, and elevated white blood cell count would have been taken to the operating room for an exploratory laparotomy to find the cause. CT's invention has provided physicians and surgeons information to avoid unnecessary laparotomies and saved millions in healthcare costs. Ultimately, the patient benefit outweighs the risk of radiation and has remained a mainstay in the clinical diagnosis of disease. Technological advancements to the CT scan significantly augmented patient care by making it more efficient and cost-effective.

The CT scan was the mainstay instrument to detect and follow-up tumours until the advent of the MRI and PET scans. Tumours avidly enhance with the use of iodine contrast. The combined PET CT scan can detect and stage cancer patients.

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Brain: for patients with hydrocephalus, the CT scan is the principal study to evaluate ventricle size and compare the size in cases of shunt malfunction. For pediatric patients with headaches, loss of consciousness, or seizures, the CT scan is usually normal; thus, judicious use is encouraged to avoid radiation exposure. For a patient involved in a traumatic scenario, the CT scan can show skull fractures, traumatic hematomas (epidural, subdural, and intracerebral), and oedema in a fast way to obtain rapid management. CT scan can be used to detect spontaneous subarachnoid hemorrhage, hematomas, and stroke. Cerebral vascular lesions like arteriovenous malformations and aneurysms can be suggested due to the presence of calcifications. CT-perfusion is used to determine the cerebral blood flow to specific brain areas using color-coded maps. CT angiography identifies adequate blood flow within respective organs such as the brain, heart, lung, kidney, or extremities.  

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Intraoperative CT scan has been used for neurosurgery, breast cancer, and lung cancer, to provide real-time images during a procedure or immediately follow it. During spine surgery, its use permits correct screw placement. For intracranial pathology, the intraoperative CT scan helps for the proper placement of a ventricular catheter or drainage of a cyst. However, the CT can help rectify the amount of resection, which sometimes is underestimated by the surgeon.

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CT-myelography can be used for those patients in whom MRI can not be performed to evaluate the spinal cord for thecal sac compression and leaks.

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Abdomen: used for tumors, ascites, effusion, cholecystitis, and obstruction. For abdominal pain, a CT scan can address the cause for pain in most patients; however, its use is more limited in oncologic pain.

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Neck: used for tumors, benign masses, thyroid nodules, and lymphadenopathy. For head and neck pathology, the CT scan is the first-line imaging examination. If an adult patient presents with a neck mass, the study localizes and characterizes it and shows if adenopathy is present.

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Spine: to evaluate fractures, degenerative changes, stability, and osteomyelitis. At the emergency department, the entire cervical spine can be assessed with a cervical CT scan. In severe trauma, the whole spine can be adequately visualized.

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Lung: to detect pulmonary embolisms, hemothorax, pneumothorax, excess fluid, emphysema, fibrosis, and pneumonia that may be missed on traditional X-ray. With the surge in Covid-19 cases, the use of chest CT scans has increased for diagnostic purposes. An abdominal CT rarely adds more information in Covid-19 cases

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Bone: to identify complex bone fractures, eroded joints, knee, tumors, and osteomyelitis. The CT scan has a higher sensitivity over X-ray imaging in identifying elbow fractures, especially those involving the growth plate. Intraoperative CT is used for complicated surgeries such as resection of a talocalcaneal coalition.

Gyn: to identify cysts, fibromas, and tumors. Ultrasound is the primary diagnostic tool in gynaecological pathology; however, CT plays an essential role in those cases where the sonogram is inconclusive.

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Biopsy: CT guided biopsy to different organs for tumour diagnosis and pathogen identification.

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Abscess: CT guided aspiration of deeper abscesses that would previously require surgical exploration and removal.

Ref: https://www.statpearls.com/articlelibrary/viewarticle/127218/

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