TRIPLE PHASE CT SCAN

                 TRIPLE PHASE CT SCAN

A Triple Phase CT Scan is a specialized imaging technique primarily used to evaluate vascular structures and organ perfusion, especially in the liver, pancreas, kidneys, and certain tumors. It involves acquiring CT images in three different phases of contrast enhancement after intravenous contrast injection.

🔹 Definition:

A Triple Phase CT scan is a contrast-enhanced CT examination that captures images in three time-based phases following contrast injection:

  1. Arterial Phase (~20–30 sec)
  2. Portal Venous Phase (~60–70 sec)
  3. Delayed Phase (~5–15 mins)

It provides detailed vascular and parenchymal evaluation, particularly useful for detecting hypervascular and hypovascular lesions.

🔹 Indications:

Triple phase CT is commonly indicated in:

  • Liver lesion characterization (e.g., HCC, metastases, hemangiomas)
  • Preoperative liver surgery planning
  • Hepatic arterial mapping
  • Pancreatic masses
  • Renal tumors (e.g., RCC)
  • Adrenal mass evaluation
  • Gastrointestinal bleeding
  • Trauma assessment
  • Abdominal aortic aneurysm or dissection
  • Oncological staging

🔹 Contraindications:

  • Allergy to iodinated contrast media
  • Renal insufficiency or failure (eGFR <30 ml/min/1.73m²)
  • Pregnancy (unless benefits outweigh the risk)
  • Uncontrolled hyperthyroidism (risk of thyroid storm)
  • Severe cardiac failure (in contrast bolus injection)
  • Dehydrated patients (risk of contrast nephropathy)

🔹 Patient Preparation:

  • Fasting: 4–6 hours before scan (to reduce GI tract artifacts)
  • IV access: 18–20G cannula in antecubital vein
  • Consent: Inform patient about contrast risks
  • Hydration: Ensure adequate hydration before and after scan
  • Renal function test: Check serum creatinine / eGFR
  • Remove metallic items (artifacts)
  • Allergy history: Rule out iodine or contrast allergy

🔹 Contrast & Radiographer Technique:

  • Contrast agent: Non-ionic iodinated contrast (e.g., Iohexol)
  • Volume: 100–120 ml (adjusted per body weight)
  • Injection rate: 3–5 ml/sec using power injector
  • Saline chaser: 30–40 ml to ensure full contrast bolus
  • Bolus tracking or timing bolus technique used to time arterial phase

🔹 Scanning Method (Triple Phase Protocol):

Phase Timing Purpose
Arterial Phase 20–30 sec post-injection Detect hypervascular lesions, arterial anatomy
Venous Phase 60–70 sec post-injection Evaluate portal veins, liver parenchyma, hypovascular lesions
Delayed Phase 5–15 minutes post-injection Washout pattern, fibrotic tissue, late enhancement


Scan coverage: Diaphragm to pubic symphysis (or organ-specific)

Reconstruction: Axial, coronal, sagittal, and 3D reformats

🔹 After Care:

  • Monitor for allergic reactions (observe for 15–30 minutes post-contrast)
  • Encourage oral hydration
  • Check urine output (especially in renal patients)
  • Report any symptoms like rash, nausea, breathlessness
  • Resume normal diet after scan if no adverse effects

🔹 Diseases Commonly Diagnosed:

  • Hepatocellular carcinoma (HCC) – arterial enhancement, venous washout
  • Liver metastases – various enhancement patterns
  • Pancreatic adenocarcinoma – hypovascular in arterial phase
  • Renal cell carcinoma (RCC) – hypervascular in arterial phase
  • Hemangioma – peripheral nodular enhancement with centripetal fill-in
  • Adrenal adenoma vs pheochromocytoma
  • Aneurysms, dissections, vascular malformations
  • GI bleeding source
  • Traumatic injuries to solid organs
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