Eye Socket, Pituitary or Ear CT Scan (with and without contrast)

This is a CT scan aimed at a small, crowded part of the head — the eye sockets, the bony pocket that holds the pituitary gland, or the back compartment of the skull — scanned twice, once plain and again after iodine contrast is injected. Comparing the two sets is what shows which tissue takes up contrast and which does not.

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What it is

A CT scanner rotates an X-ray source around the head and reconstructs the readings into thin cross-sectional pictures that can be reformatted in any plane. This code covers a study targeted at one of three small regions rather than the brain as a whole: the orbits, meaning the bony sockets and the contents around each eye; the sella, the hollow in the skull base that houses the pituitary gland; or the posterior fossa, the compartment at the back and bottom of the skull holding the cerebellum and brainstem. The distinguishing feature here is that the region is scanned both before and after an iodine-based contrast agent is given by vein. The plain pass establishes what things look like on their own — including calcium and fresh blood, which contrast can mimic — and the second pass shows what lights up.

Why it is done

  • To investigate a mass, an infection, or an inflammatory process in or around the eye socket, where tumor and inflammation can look alike without contrast
  • To examine the pituitary region when a hormone abnormality or a visual field problem points there
  • To look at the back of the skull for a lesion, bleeding, or a structural abnormality
  • To evaluate injury to the bones of the orbit after facial trauma

What to expect

Because contrast is part of this study, there is usually some preparation: questions about kidney function, previous reactions to contrast, and medications, and often instructions not to eat for a period beforehand. An intravenous line goes in. The patient lies on a table that slides through the scanner's ring and holds still; the first set of images is taken, the contrast is injected, and a second set follows. The injection commonly causes a warm flush and a metallic taste that pass in under a minute. The scanning itself is painless and quick — the appointment is longer than the scan. A radiologist reads both sets and reports; MRI, not CT, is often the preferred test for some of these regions, and which one was ordered is worth knowing.

Questions worth asking

  • Is the with-and-without study a single combined charge, or are the plain and contrast passes billed as two scans?
  • Is the contrast material itself billed separately from the scan, and at what price?
  • Was an MRI considered for this question, and how do the two compare on cost at this facility?
  • Does the estimate include both the facility's technical charge and the radiologist's professional fee for reading it?

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