Rapid Sequence MRI Analysis of Acute Abdominal Pain

BMJ, 2009

Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. Design Fully paired multicentre diagnostic accuracy study with prospective data collection. Setting Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. Participants 1021 patients with non-traumatic abdominal pain of >2 hours' and <5 days' duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. Intervention All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. Main outcome measures Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. Results 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. Conclusion Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation.

Academic Radiology, 2017

Rationale and Objectives: This study aims to compare the diagnostic performance of abdominal computed tomography (CT) performed with and without oral contrast in patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain.

Clinical Imaging, 2002

Background: To determine whether intravenous contrast improves the ability of radiologists to establish the cause of acute abdominal pain after nondiagnostic or normal unenhanced CT. Methods: Out of 164 consecutive emergency department patients presenting with less than 48 h of nontraumatic, acute abdominal pain, a confident diagnosis for cause of pain was made prospectively in 71/164 (43%) patients on these unenhanced scans by the monitoring radiologist. In the other 93 patients, our study sample, intravenous contrast-enhanced CT was obtained. At a later date, retrospectively, two experienced abdominal CT radiologists independently evaluated unenhanced CT scans alone for potential causes of pain and diagnostic confidence level on a 1 -3 scale. At least 2 weeks later, intravenous enhanced and unenhanced scans were read side-by-side for the same assessment. Results: There was no significant difference in diagnostic confidence levels comparing unenhanced CT alone (2.59) vs. intravenous enhanced and unenhanced CT together (2.64). Chi-square analysis found no significant difference in finding a cause for pain when intravenous contrast was added compared to the initial unenhanced scan alone. Conclusions: Intravenous contrast did not significantly improve the ability of CT to establish a cause of abdominal pain after a negative or nondiagnostic unenhanced CT. D 0899-7071/02/$ -see front matter D 2002 Elsevier Science Inc. All rights reserved. PII: S 0 8 9 9 -7 0 7 1 ( 0 2 ) 0 0 5 3 5 -1

Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 2016

Introduction: In the present study, we aimed to evaluate concordance of imaging modalities of patients admitted to the emergency department (ED) with abdominal pain. Material and Methods: The study was conducted between the dates 01.06.2014-31.05.2015 after the local ethical committee approval. Patients admitted to the ED, with abdominal pain, whose multiple imaging were done (abdominal ultrasonography; USG and computed tomography; CT) were screened for 1 year retrospectively. Data analysis was performed using SPSS 15.0. Results: The study included a total of 413 patients of which 242 (58.6%) of women. The final diagnosis of the patients, 133 (32.2%) patients had nonspecific abdominal pain, the most commonly seen surgical diagnosis was acute appendicitis. When the sensitivities of USG and CT evaluated regarding the final diagnosis it was 38.9% and 86.1%, respectively for acute appendicitis, 0% and 30.4% respectively for acute pancreatitis, 65.4% and 98.1% respectively for ovarian pathology, 94.9% and 87.2% respectively for acute cholecystitis. There was detected concordance in 63.2% between USG and CT. While this rate was 61.7% among recent diagnosis with USG, for CT recent diagnoses it was found as 87.7%. Conclusion: In conclusion, when final diagnoses are compared with imaging methods in patients with abdominal pain, CT seems superior to USG. Especially in clinics where USG cannot be performed for 24 hours like in our clinic, CT may be preferred as the first imaging method. Giriş: Çalışmamızda, acil servise karın ağrısı nedeniyle başvuran hastaların görüntüleme yöntemleri uyumunun değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışma lokal etik kurul onayı alındıktan sonra 01.06.2014-31.05.2015 tarihleri arasında retrospektif olarak yapıldı. Acil Tıp Kliniğine karın ağrısı nedeniyle başvuran, birden fazla görüntüleme yöntemi (Batın ultrasonografisi; USG) ve Bilgisayarlı tomografisi; BT) yapılmış hastalar 1 yıl geriye yönelik tarandı. Verilerin analizi SPSS 15.0 kullanılarak yapıldı. Bulgular: Çalışmaya 242 (%58.6)'si kadın toplam 413 hasta dâhil edildi. Son tanılara bakıldığında, 133 (%32.2) hastanın son tanısı nonspesifik karın ağrısı, en sık görülen cerrahi tanı ise akut apandisit oldu. Son tanılara göre USG ve BT'nin duyarlılıkları değerlendirildiğinde, akut apandisit için USG %38.9, BT %86.1, akut pankreatit için USG %0, BT %30.4, over patolojisi için USG %65.4 BT %98.1, akut kolesistit için USG %94.9 BT %87.2 duyarlı bulundu. USG ile BT arasında %63.2 tanı uyumu saptandı. Bu oran USG ile son tanılar arasında %61.7 iken BT ile son tanılar arasında %87.7 olarak bulundu. Sonuç: Sonuç olarak çalışmamızda karın ağrılı hastalarda görüntüleme yöntemleri son tanılarla karşılaştırıldığında BT, USG'ye kıyasla, daha üstün görünmektedir. Özellikle bizim kliniğimiz gibi 24 saat USG yapılamayan kliniklerde BT ilk görüntüleme yöntemi olarak tercih edilebilir.

Clinical Gastroenterology and Hepatology, 2008

When assessing the use of an imaging study, historically 2 criteria were used, diagnostic accuracy and cost of the study. However, as the awareness of risk for radiationinduced cancer in the general population increases as a direct result of more computed tomography (CT) studies being performed, reevaluation of the approach to imaging studies is necessary. The new imaging paradigm considers patient safety as an important aspect of assessing the role of an imaging modality. The primary goals of the new imaging paradigm should be diagnostic accuracy and patient safety, with the secondary goal being more affordable cost of study. In formulating a plan for when to use body magnetic resonance imaging (MRI), one has to consider all of these criteria and should also consider the question of when CT has unmatched diagnostic accuracy. The advantages of the spatial resolution of CT are mainly realized when there is great contrast between what is being looked for and background tissue; examples include small lung nodules and renal calculi. The greater intrinsic soft tissue contrast resolution and greater sensitivity for the presence or absence of intravenous contrast are appreciated in MRI studies, circumstances in which lesions occur within an organ without altering its exterior contour. This is well-shown for liver lesions. Adding patient safety into the equation, MRI should be indicated in exams in which there is no greater difference in diagnostic accuracy between CT and MRI, in patients with greater concern for radiation safety such as pediatric patients, and in cases of multiple or serial exams.

International Journal of New Technology and Research, 2019

Acute abdominal pain can be evoked by a wide range of abdominal abnormalities, including acute appendicitis, diverticulitis, cholecystitis, and bowel obstruction. Imaging plays an important role in the treatment management of patients because clinical evaluation results can be inaccurate. Different radiological techniques vary in their sensitivity and accuracy for detecting each pain-caused abdominal disorder. To evaluate the diagnostic value of these radiological techniques in detecting the cause of abdominal pain, comparison between MRI and CT scan was made. The study was conducted at Tripoli Medical Center in 2016 on a group of fifteen patients, who diagnosed with an acute abdomen and had an erect and supine abdominal X-ray, were studied; including six females and nine males with their age range from thirty-one up to sixty-six years old. All of them recommended to have an abdominal CT examination, and then they recommended also by their doctors to have an abdominal MRI for the final diagnosis, because the abdominal X-ray result does not give them enough information about those cases as the result sometimes was looks like normal. In this study, we found: In eight cases (53.33%) of acute abdomen, magnetic resonance imaging (MRI) gave more information than computed tomography scans (CT), In three cases (20%) of acute abdomen, computed tomography scans (CT) gave more details than magnetic resonance imaging (MRI). In four cases (26.66) of acute abdomen, the magnetic resonance imaging (MRI) and computed tomography scans (CT), are gave the same information or details. In one case (6.66%), the abdominal X-ray result, and the computed tomography scan (CT) results were similar. Conclusion: MRI can find changes in the structure of organs or other tissues. It also can find tissue damage or disease, such as infection or a tumor. MRI scan can sometimes find a problem in a tissue or an organ that is not seen by X-ray, ultrasound, or CT scan, even when the size and shape of the tissue or organ looks normal. And sometimes MRI test results may be different than those from CT, ultrasound, or X-ray tests because the MRI scan is more specific.

2011

The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.

International Journal of Radiology and Diagnostic Imaging

Background: Acute abdomen is one of the most common emergencies presenting in the emergency room which requires immediate attention. Making an accurate diagnosis is of paramount importance in managing these patients, since most of these patients frequently require a surgical intervention. The divergence of patient population and the underlying pathology in acute abdomen calls for high quality imaging studies to make quick and precise diagnosis. Multi-detector computed tomography is an ideal tool in this regard. Materials and Methods: It is a prospective study conducted on 73 patients who presented with acute abdomen and subsequently underwent multi-detector computed tomography to ascertain the underlying pathology. The radiological findings in computed tomography were correlated with clinical, intraoperative and histopathological findings whenever available. Results: In our study the performance of multi-detector computed tomography, when compared with diagnosis made based on intra-operative findings, post-operative histopathology and clinical findings showed sensitivity of 97% and specificity of 75%. Overall Positive Predictive value of 98.5% and negative predictive value of 60% and accuracy of 96%. Conclusion: Since most of the patients presenting with acute abdomen have non-specific and overlapping clinical findings, making an accurate clinical diagnosis is challenging. In this scenario MDCT comes as a handy tool with high accuracy and good sensitivity and specificity. The results obtained in our study are comparable with other studies conducted worldwide.

Radiologia Brasileira, 2013

Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.

Radiologic Technology, 2011