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'''Washout''' is where tissue loads radiocontrast during arterial phase, but then returns to a rather hypodense state in venous or later phases. This is a property of for example [[hepatocellular carcinoma]] as compared to the rest of the liver parenchyma.<ref name="ChoiLee2014">{{cite journal|last1=Choi|first1=Jin-Young|last2=Lee|first2=Jeong-Min|last3=Sirlin|first3=Claude B.|title=CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma: Part II. Extracellular Agents, Hepatobiliary Agents, and Ancillary Imaging Features|journal=Radiology|volume=273|issue=1|year=2014|pages=30–50|issn=0033-8419|doi=10.1148/radiol.14132362|pmc=4263770|pmid=25247563}}</ref>
==Contrast-induced nephropathy==
===Risk factors===
The Roxana Mehran score predictor applies the following ten variables:<ref name=Modi2017>{{cite web|url=https://www.ncbi.nlm.nih.gov/books/NBK448066/|title=Contrast-Induced Nephropathy|website=StatPearls Publishing|year=2017|author=Kalgi Modi, Scott C. Dulebohn}} [http://creativecommons.org/licenses/by/4.0/ CC-BY-4.0]</ref>
*Age (4 points if older than 75 years old)
*Anemia (3 points)
*Use of an intra-aortic balloon pump (5 points)
*eGFR 60 to 40 (2 points)
*eGFR 40 to 20 (4 points)
*eGFR less than 20 (6 points)
*Hypotension (5 points, if systolic BP less than 80 mmHg for at least one hour requiring inotropic support)
*Contrast media volume (1 point per 100 ml)
*Congestive heart failure (5 points)
*Diabetes (3 points).
A risk score of less than 6 carries a risk of 7.5% to score more than 16 carries up to 57% risk.
===Alternatives===
{|class="wikitable"
! Iodine<br>concentration !! Maximum volume<ref name="KeaneyHannon2013"/>
|-
| 240 mg/ml || 4.2 ml *GFR<sub>ml/min</sub>
|-
| 350 mg/ml || 2.9 ml *GFR<sub>ml/min</sub>
In people with risk factors, the main alternatives are:
*'''Adjustment''' of the contrast dose. Evidence suggests that contrast doses should be limited to a ratio of grams of iodine to glomerular filtration rate (I<sub>gram</sub> / GFR<sub>ml/min</sub>) of a maximum of 1.<ref name="KeaneyHannon2013">{{cite journal|last1=Keaney|first1=J. J.|last2=Hannon|first2=C. M.|last3=Murray|first3=P. T.|title=Contrast-induced acute kidney injury: how much contrast is safe?|journal=Nephrology Dialysis Transplantation|volume=28|issue=6|year=2013|pages=1376–1383|issn=0931-0509|doi=10.1093/ndt/gfs602}}</ref> The local practice at NU Hospital Group has a I<sub>gram</sub>/GFR ratio of maximum 0.7 in patients with GFR ≥45 ml/min. It recommends a ratio of maximum 0.5 if GFR is lower, or in the presence of risk factors.
*Using ''no intravenous contrast''' for the investigation.
*Switching to '''another modality''' such as [[ultrasonography]] or [[MRI]]
*'''Treating or mitigating risk factors'''.
:*'''Hydration''' by drinking or intravenous volume expander, either before or after contract administration, decreases the risk of contrast-induced nephropathy.<ref name="YangHiremath2013">{{cite journal|last1=Yang|first1=Xiaoming|last2=Hiremath|first2=Swapnil|last3=Akbari|first3=Ayub|last4=Shabana|first4=Wael|last5=Fergusson|first5=Dean A.|last6=Knoll|first6=Greg A.|title=Prevention of Contrast-Induced Acute Kidney Injury: Is Simple Oral Hydration Similar To Intravenous? A Systematic Review of the Evidence|journal=PLoS ONE|volume=8|issue=3|year=2013|pages=e60009|issn=1932-6203|doi=10.1371/journal.pone.0060009}}</ref>
==Phases==
