Role of Dual-Energy Computed Tomography (DECT) in Acute Abdomen

Abstract

Acute abdominal and pelvic pain can have a wide range of etiologies, from self-limiting conditions to acute pathologies requiring emergent surgery. Emergency radiology plays a pivotal role in the routine diagnosis and outcomes of patients with these disorders. Computed tomography (CT) with evolved protocols and technological advancements in particular with advent of dual-energy CT remains the first diagnostic modality of choice in patients with non-traumatic surgical abdomen, including appendicitis, cholecystitis, bowel ischemia, bowel obstruction, visceral perforation, bowel hemorrhage, and abdominal aortic aneurysm rupture. Renal calculi are also frequently encountered non-surgical causes of acute abdominal pain.Conversely of the spectrum, abdominal trauma is one of the leading causes of death and morbidity. Mechanism of injury classifies abdominal trauma into blunt and penetrating. Blunt abdominal trauma usually results from falls from heights, motor vehicle collisions (MVC), and assaults. Penetrating abdominal trauma arises from stab wounds and gunshot wounds. In both blunt and abdominal trauma, imaging should exclude life-threatening injuries after careful examination and primary survey. Ultrasound is rapid and portable imaging modality making it a good option for abdominal trauma screening. However, fast scan is limited to look for hemoperitoneum, and evaluation of intra-abdominal organ injuries is dependent on MDCT. The hemodynamically stable patient should receive a multidetector computed tomography (MDCT) scan with IV contrast in the assessment of visceral and vascular injuries. DECT can increase the conspicuity of traumatic solid organ and hollow visceral damage by utilizing its post-processing applications like selective iodine imaging, virtual monoenergetic imaging.KeywordsBlunt abdominal traumaPenetrating abdominal traumaSplenic injuryLiver injuryMesenteric injuryPneumoperitoneumHemoperitoneumDiaphragmatic injuriesVascular injuriesAcute nontraumatic abdominal painGangrenous cholecystitisGangrenous appendicitisSmall bowel ischemiaSmall bowel perforationPancreatitisUrinary colic