When screening for malignancy, do you order CT with contrast (or) both with and without contrast?

I think the best way to think about this is to assess what each scan shows. A CT with oral and IV contrast is very good for assessing details between soft tissues and blood vessels. A CT without contrast is better for assessing for renal stones and for fractures, especially small insufficiency fractures (in bone). A CT with contrast can obscure detection of some pathology such as renal stones. The CT with and without contrast is giving you the best opportunity to assess the tissue in two states - the IV contrast will highlight the areas with blood vessels after injection. You and the radiologist will have a more complete view of the anatomy and to some extent the physiology of the chest-abdomen-pelvis if the study is ordered with and withou...

First, I would recommend a good intake and a thorough physical examination. Depending on the rheumatology symptoms, various cancer diagnoses could be targeted. For example, for dermatomyositis, one would look for ovarian cancer. Then imaging directed toward such cancers, first.

In the absence of any suspicion for a specific cancer, review screening tests (mammogram, colonoscopies, PAP-smears, lung CT, perhaps PSA, etc) done in the recent past to look for suspicious cancer features.

If all is normal, there is a blood ctDNA test to look for potential cancers. If negative, could observe. This is in its infancy. Pons-Belda et al., PMID 34943407

If all these fail, a PET-CT might be the most comprehensive screening, but very expensive, and some tum...