CT Optimization for Diagnosis of Some Acute Abdomen Cases

American Journal of Roentgenology, 2000

American Journal of Roentgenology, 1997

The purpose of this study was to evaluate the effect of CT on the diagnosis and management of acute abdominal pain in patients who did not undergo surgery and to determine what population of patients would profit most from CT examination. MATERIALS AND METHODS. Clinical data and CT reports of 91 patients with acute abdomen (4 1 men and 50 women. 22-96 years old) were analyzed retrospectively. The accuracies

European …, 2003

The purpose of our study is to demonstrate the value of CT in the emergency department (ED) for patients with non-traumatic abdomi-nal pain. Between August 1998 and April 1999, 536 consecutive patients with non-traumatic abdominal pain were entered into our study. ...

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.

Seminars in Ultrasound, CT and MRI, 1999

Currently, CT plays a pivotal role in the evaluation of the patient with an acute abdomen. Several competing techniques have been described and investigated. Each appears to possess advantages and disadvantages which will be examined. Each imaging center needs to modify these protocols to satisfy local scanner availability, patient demographics, radiologic expertise, and economic considerations.

BMC Emergency Medicine, 2007

The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians. The OPTIMA study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominal pain at the ED.

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 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

American Journal of Roentgenology, 1994

An acute abdomen is a clinical condition characterized by severe abdominal pain that develops suddenly over several hours or less [1]. Abdominal tenderness and rigidity, either generalized or localized, usually are severe and indicate an urgent need for prompt diagnosis and treatment. The underlying cause of acute abdomen varies, and some cases require immediate surgical treatment, whereas for others, surgery is unnecessary or contraindicated. This need for prompt diagno

European Journal of Radiology, 2009

To evaluate routine use of CT Enterography (CTE) in patients presenting with non-traumatic acute abdominal pain with respect to patient tolerance, imaging of intestinal detail along with conventional abdominal evaluation. Modified CTE was performed in 165 consecutive patients with acute abdominal pain: ingestion, as tolerated, of 900-1200 ml of 2% barium suspension + 5 ml of Gastrografin over 45 min; 150 ml of iv contrast given in two boluses (50 and 100 ml) 3 min apart (split bolus injection protocol). Axial, coronal and sagittal reformats were reviewed by two radiologists and graded on a 5-point scale (5 best) in regard to GI tract luminal opacification and distension and abdominal organ and vascular enhancement. In 81 patients the cause of abdominal pain was identified (intestinal in 54 and extraintestinal in 27). Oral contrast reached cecum in 76% of the patients and the small bowel was well distended and opacified (medians=4). Mucosa detail was good (median=3) and there was significant (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) correlation between bowel opacification and distension for both jejunum and ileum. A combined nephrographic and excretory phase was achieved (medians 4 and 5, respectively), while the great vessels were well opacified, allowing for vascular evaluation (median=5). The rest of the abdominal structures were well visualized. Modified CTE is well tolerated by patients with acute non-traumatic abdominal pain, and can be used routinely as a non-invasive examination informative of bowel, vessel and organ pathology in Emergency Department patients.