A new European survey has highlighted broad agreement—but also notable differences—among radiologists and clinicians regarding the use of contrast-enhanced CT (CECT) in patients with suspected sepsis. While all specialties recognize the diagnostic value of CECT, perspectives diverge on contraindications, acceptable imaging time windows, and repeat imaging in clinically deteriorating patients.

The survey, led by Dr. Ann-Christine Stahl, PhD, postdoctoral research fellow and registrar at the Department of Radiology, Charité – Universitätsmedizin Berlin, along with Kerstin Rubarth, PhD, Prof. Dr. Marc Dewey, PhD, and an international research team, gathered responses from 719 participants in 2023. The findings were published on 26 January 2026 in European Radiology.

Strong Consensus on Diagnostic Value, Variation in Clinical Application

Participants included 144 emergency radiologists, 518 clinicians, and 57 general radiologists, with 297 respondents affiliated with the European Society of Emergency Radiology (ESER). Across all groups, respondents agreed that CECT plays a crucial role in identifying infection sources and complications in sepsis.

However, emergency radiologists were more likely than clinicians or general radiologists to accept clinical reasoning in complex scenarios—particularly in cases of clinical deterioration, where additional or repeat imaging may influence management.

Disagreement on Optimal Timing for CECT

Although most respondents agreed that CECT should be performed promptly, opinions varied on what constitutes an acceptable time window:

57.1% of all respondents favored imaging within six hours

45.8% of emergency radiologists supported this timeframe

No emergency radiologists selected a less-than-one-hour window

35.9% of emergency radiologists considered imaging after 12 hours acceptable

By comparison, only 14.3% of general radiologists and 3.2% of clinicians supported such extended timing

These findings suggest emergency radiologists may be more flexible in balancing urgency with patient stability and logistics.

Repeat Imaging: A Point of Divergence

Repeat CECT imaging was another area of differing perspectives. While radiation exposure typically limits repeat scans, the authors noted that in high-mortality conditions such as sepsis, the diagnostic benefits may outweigh the risks.

Emergency radiologists were most supportive of repeat imaging

Clinicians were the most hesitant

General radiologists held intermediate views

This variation reflects differing risk–benefit assessments across specialties.

Contraindications: Kidney Function, Thyroid Disease, and Prior Reactions

Views also diverged on CECT use in patients with potential contraindications, provided appropriate preparation was undertaken:

Latent hyperthyroidism:

Supported by 85.3% of general radiologists

66.4% of clinicians

70.7% of emergency radiologists considered it acceptable or not a contraindication

Manifest hyperthyroidism:

63.9% of clinicians supported CECT after preparation

50% of general radiologists and 36.9% of emergency radiologists considered it a relative contraindication

Impaired kidney function:

Emergency radiologists more frequently viewed this as a relative or absolute contraindication

General radiologists and clinicians were less likely to classify it as absolute

Opinions varied widely for patients with end-stage kidney disease on dialysis, though many emphasized the importance of adequate preparation

Radiation Exposure Less Often Seen as a Contraindication

Most respondents across all specialties disagreed that radiation exposure alone should preclude CECT in sepsis. However:

22.1% of emergency radiologists viewed radiation as a relevant contraindication

Compared with 17.1% of general radiologists and 8% of clinicians

Call for Greater Interdisciplinary Alignment

The authors concluded that emergency radiologists may be more inclined to prioritize clinical context—especially in unstable patients—when deciding on imaging. While this interpretation remains speculative, the findings underscore the need for greater interdisciplinary alignment in sepsis imaging protocols.

Despite strong consensus on the importance of timely CECT, the observed differences between emergency radiologists, general radiologists, and clinicians suggest opportunities for improved collaboration, shared guidelines, and unified decision-making to optimize care for patients with sepsis.

Source : https://www.auntminnieeurope.com/clinical-news/ct/article/15815852/european-survey-sheds-light-on-imaging-of-sepsis#:~:text=A%20new%20European%20survey%20has,acceptable%20time%20windows%20for%20imaging.