Contrast use in extremity sarcoma CTs raises concerns

Significant deviation from American College of Radiology (ACR) guidelines regarding the use of contrast in chest computed tomography (CT) for pulmonary staging and surveillance in extremity sarcoma patients not only raises concerns about the potential medical implications but also highlights a substantial additional cost burden, according to a retrospective chart review.

Despite ACR recommendations since 2015 favoring CT without contrast, the study found that at the authors institution, contrast-enhanced CTs are routinely ordered and performed.

The study, spanning the years 2005 to 2023, included a total of 1916 CT studies. Results indicated a notable prevalence of CT scans ordered and performed with contrast, both before and after the ACR’s 2015 guidelines. Surprisingly, even after the guidelines were established, 79.2% of patients’ final surveillance CTs were performed with contrast, contrary to the recommended practice.

In addition to the medical implications, the study conducted a cost analysis comparing CT modalities. The contrast-enhanced CTs incurred an additional $297,704 in both patient and institutional costs.

Reference
Priester JI, Simister SK, Sario M, et al. Scrutinizing the use of contrasted chest CTs in extremity sarcoma staging and surveillance. J Surg Oncol. 2023;doi: 10.1002/jso.27510. Epub ahead of print. PMID: 37997294.