Multi-Detector Row CT of Acute Non-traumatic Abdominal Pain: Contrast and Protocol Considerations
Section snippets
Oral contrast
The use of oral contrast agents in the imaging evaluation of abdominal pain has served to yield a high diagnostic accuracy using CT for the common etiologies of abdominal pain, even with previous generations of CT scanners. For instance, reported accuracy for diagnosing diverticulitis using rectally administered contrast approaches 100% (overall diagnostic accuracy, 99%) using single-detector CT technology.1 Similarly, excellent diagnostic accuracy for the diagnosis of appendicitis has been
Intravenous contrast
While not associated with a similar potential for a significant decrease in emergency department throughput as in the case of oral contrast, the administration of intravenous contrast carries downsides of risks to the patient, including both nephrotoxicity as well the possibility for allergic reactions. As mentioned previously, in the author’s institution, including many others, intravenous contrast is often administered in patients with abdominal pain. The projected benefits include improved
Image reconstruction and post-processing
An additional factor in optimizing CT protocols in abdominal pain imaging includes image reconstruction, specifically reconstruction slice thickness. In the case of the appendix, the impact of slice thickness on several factors, including visualization of the appendix, confidence in appendiceal visualization, diagnostic accuracy, and diagnostic confidence in diagnosing appendicitis has been reported for varying CT slice thicknesses.23 The authors found that the correctness of the diagnosis of
Radiation dose
As is the general case with the use of CT, radiation dose is of significant concern in the imaging evaluation of patients with abdominal pain in the emergency department. To date, several studies have evaluated the applications of low-dose imaging protocols to the evaluation of patients with abdominal pain. In a recent study, standard (8.0 mSv) and low-dose (4.2 mSv) protocols were compared, and no differences in diagnostic accuracy for appendicitis, appendiceal visualization rates, or
Summary
In summary, given mounting evidence of the untoward effects of oral and intravenous contrast, many long-held practices in abdominal CT imaging deserve further scrutiny. These negative effects include, among others, increased emergency department throughput time, possible delays in diagnosis and management, potential radiation dose increases associated with positive oral contrast agents, and the known risks associated with intravenous contrast, primarily related to nephrotoxicity. In addition,
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Cited by (10)
The utility of CT scan for the diagnostic evaluation of acute abdominal pain
2019, American Journal of SurgeryCitation Excerpt :They identified three situations, however, where repeat CT scans are common and where the benefit may not outweigh the risks: rule out pulmonary embolism, renal colic, and recurrent abdominal pain. CT technology has improved greatly over the past decades with higher resolution images possible with less radiation.61 The typical radiation dose for AbdCT has dropped from 23 mSv in the 1980's to 6–10 mSv most recently.62
CT for Acute Nontraumatic Abdominal Pain—Is Oral Contrast Really Required?
2017, Academic RadiologyCitation Excerpt :The introduction of helical and multidetector CT scanners has made the utility of oral contrast uncertain. The use of both oral and IV contrast materials is remarkably sensitive and specific for the diagnosis of bowel-related pathologies, but is not necessarily the most efficient and safe protocol (4,5). There are no formal definite guidelines regarding the optimal use of oral contrast in patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain, and this has led to a wide variation in clinical practice (6).
Evidence-Based Medicine Approach to Abdominal Pain
2016, Emergency Medicine Clinics of North AmericaCitation Excerpt :A specificity of greater than 94% and sensitivity of greater than 96% can be found regarding the appearance of the bowel wall in addition to the vascular findings in patients with mesenteric ischemia. Ordering the wrong protocol, such as a noncontrast CT, in acute mesenteric ischemia has lower sensitivity and specificity.89 To further complicate matters, contrast can be provided orally, rectally, or intravenously.
Evaluating Patients with Left Upper Quadrant Pain
2015, Radiologic Clinics of North AmericaCitation Excerpt :Patient preparation and scan protocols can be tailored to optimize the evaluation of a specific suspected diagnosis, although frequently the initial clinical diagnosis is incorrect, and the imaging protocol used should not be too narrow.2,20 Intravenous contrast is necessary for the optimal evaluation of many of the acute LUQ diseases.22 Contrast-enhanced dual-phase MDCT is advocated for suspected pancreatitis or left pyelonephritis and for the evaluation of splenic pathology.1,23,24
Positive oral contrast material for abdominal CT: Current clinical indications and areas of controversy
2020, American Journal of Roentgenology