Abdominal Computed Tomography In Patients Research Articles

Sacroiliitis in inflammatory bowel disease on abdominal computed tomography: prevalence, misses, and associated factors

Objective To evaluate the prevalence and rate of a missed diagnosis of sacroiliitis on abdominal computed tomography (CT) in patients with inflammatory bowel disease (IBD). Factors associated with sacroiliitis were also assessed. Method This retrospective study included 210 patients with IBD (mean age 31.1 years) who underwent abdominal CT. Based on a validated abdominal CT scoring tool, bilateral sacroiliac (SI) joints on abdominal CT in the whole study population were retrospectively reviewed. Subsequently, patients were classified into the ‘patients with sacroiliitis’ group and the ‘patients without sacroiliitis’ group. Univariate and multivariate regression analyses were used to clarify the factors associated with sacroiliitis. Results Sacroiliitis was identified in 26 out of 210 patients (12.4%). However, sacroiliitis was recognized on the primary reading in only five of these 26 patients (19.2%) and was missed on the initial report in the remaining 21 patients (80.8%). Among the 21 patients, 20 (95.2%) were finally diagnosed with axial spondyloarthritis (axSpA). There was a higher prevalence of female sex (p = 0.04), upper gastrointestinal involvement (p = 0.04), and back pain (p < 0.01) in patients with sacroiliitis than in those without sacroiliitis. However, on multivariate analysis, back pain was the only factor associated with sacroiliitis (p = 0.01). Conclusion Physicians should carefully evaluate SI joints on abdominal CT in patients with IBD to enable early detection of sacroiliitis, potentially leading to an early diagnosis of axSpA. In addition, if patients with IBD present with back pain, the possibility of sacroiliitis should be considered.

Effect of modified gastrointestinal decompression under abdominal CT in patients with intestinal obstruction.

We aimed to evaluate the effect of continuous quality improvement on modified gastrointestinal decompression under abdominal computed tomography (CT) in patients with intestinal obstruction. The CT images of 74 patients with intestinal obstruction who underwent gastrointestinal decompression in our hospital from 1 January 2018 to 31 December 2019 were analysed retrospectively (Control group). Factors influencing unsatisfactory decompression effects were analysed, and corresponding improvement measures were formulated and implemented. A total of 77 patients from 1 January 2020 to 31 March 2022 were enrolled prospectively (Study group). The position of the nasogastric tube end, the amount of gastric drainage within 24h and the degree of abdominal distension relief were compared before and after the improvement. After implementation of continuous quality improvement, the proportion of the end of the nasogastric tube reaching the antrum, the amount of gastric fluid drainage within 24h and the degree of abdominal distension relief were better than those before improvement (p<0.001, respectively). The execution rate and accuracy rate of CT interpretations by nurses reached 100% and 82%, respectively. Modified gastrointestinal decompression based on abdominal CT scans can increase the success of gastrointestinal decompression and effectively reduce the discomfort of patients.

Findings of Abdominal Imaging in Patients with COVID-19 - Part 1: Hollow Organs.

Since COVID-19 has spread worldwide, the role of imaging for early detection of the disease has become more prominent. Abdominal symptoms in COVID-19 are common in addition to respiratory manifestations. This review collected the available data about abdominal computed tomography (CT) and ultrasonography indications in hollow abdominal organs in patients with COVID-19 and their findings. Since abdominal imaging is less frequently used in COVID-19, there is limited information about the gastrointestinal findings. The most common indications for abdominal CT in patients with COVID-19 were abdominal pain and sepsis. Bowel wall thickening and fluid-filled colon were the most common findings in abdominal imaging. Acute mesenteric ischemia (AMI) was one of the COVID-19 presentations secondary to coagulation dysfunction. AMI manifests with sudden abdominal pain associated with high morbidity and mortality in admitted patients; therefore, CT angiography should be considered for early diagnosis of AMI. Ultrasonography is a practical modality because of its availability, safety, rapidity, and ability to be used at the bedside. Clinicians and radiologists should be alert to indications and findings of abdominal imaging modalities in COVID-19 to diagnose the disease and its potentially serious complications promptly.

Incidental Findings on Pediatric Abdominal Computed Tomography At A Pediatric Trauma Center

BackgroundThe increasing availability and use of computed tomography (CT) in pediatric abdominal trauma has increased the detection of incidental findings. While some of these findings are benign, others may require further evaluation for possible clinical importance. ObjectivesThis study aimed to identify the frequency and type of incidental findings and their need for follow-up on abdominal CT in patients at a pediatric trauma center. MethodsThis was a retrospective, observational study on trauma patients ≤21 years of age who presented to the emergency department between January 1, 2004 and July 31, 2016 and underwent CT scans of the abdomen and pelvis. Findings were classified as benign anatomic variants, benign pathologic lesions, and pathologic lesions requiring additional work-up. ResultsThere were 1073 patients included in the study population, with a mean age of 15.5 years; 707 (66%) were males. A total of 418 incidental findings were identified in 345 patients. Of these, 290 (69%) were benign and 60 (14%) were likely benign pathologic that required possible outpatient monitoring. Of those requiring additional evaluation, 5 (1%) patients warranted further evaluation before discharge. ConclusionsNearly one-third of patients had at least one radiographic finding unrelated to their injury. Of these, more than two-thirds did not require additional evaluation, but nearly one-third of patients required some form of further work-up.

Manual adjustment of tube voltage from 120 to 100 kVp during abdominal CT in patients with body weights ≤75 kg: assessment of image quality and radiation dose in a prospective, randomised trial

To assess image quality and radiation dose in patients with body weights ≤75 kg undergoing abdominal computed tomography (CT) with a tube voltage of either 120 or 100 kVp. Eighty patients weighing ≤75 kg were prospectively assigned to receive either 120 or 100 kVp abdominal CT in the portal-venous phase. Attenuation values of abdominal organs and image noise were measured, and the contrast-to-noise ratios (CNRs) were calculated. Subjective image quality was assessed by three independent radiologists. Radiation exposure was assessed by size-specific dose estimate (SSDE). The mean attenuation of the kidney increased by 20% at 100 kVp (p<0.0001), and the mean image noise was 27% higher in the 100 kVp (p=0.003). The CNR did not significantly differ between the groups (120 kVp, 6.6±2.8; 100 kVp, 7.4±3.6; p=0.26). Except for subjective image noise (p<0.001), no other subjective quality parameters (e.g., contrast, artefacts) were significantly different between the two groups (p between 0.094 and 0.761). The mean SSDE in the 100-kVp group (9.8±1.8 mGy) was reduced by 19% compared to the 120-kVp group (12.1±1.8 mGy; p<0.0001). Manual reduction of tube voltage from the standard 120 to 100 kVp for portal-venous phase CT in patients with body weights ≤75 kg resulted in a 19% dose reduction while maintaining objective and subjective image quality.

Frequency of hemorrhagic complications on abdominal CT in patients with warfarin therapy

ObjectiveTo evaluate the frequency of hemorrhagic complications on abdominal computed tomography (CT) in patients with warfarin therapy and its correlation with intensity of anticoagulation. Materials and methodsWe included 646 patients who received warfarin therapy with international normalized ratio (INR) greater than 3.0 and abdominal CT within 1month after INR measurement. ResultsSeventy-four patients (11.5%) showed hemorrhagic complications on abdominal CT. Frequency of hemorrhagic complications significantly correlated with intensity of anticoagulation (P<.001). ConclusionHemorrhagic complications on abdominal CT in patients with warfarin therapy were not rare, and it occurred more frequently in patients with higher INR.

Improvement of Image Quality at Low–Radiation Dose and Low–Contrast Material Dose Abdominal CT in Patients With Cirrhosis

To intraindividually compare a low-tube voltage, low-contrast material dose computed tomography (CT) reconstructed with iterative reconstruction (IR) algorithm at standard tube voltage reconstructed with filtered back projection (FBP) and standard-contrast material dose during liver dynamic CT. Twenty-five patients with liver cirrhosis underwent 64-section multidetector CT. One hundred twenty kilovolt (peak) (kV[p]) with standard contrast material dose of 600 mg of iodine per kilogram (protocol A) and 80 kV(p) with low-contrast material dose of 450 mg of iodine per kilogram (protocol B) CT image sets were reconstructed by using FBP algorithm and that of using IR algorithm with a 60%/40% blend of IR-FBP reconstruction at 80-kV(p) image set (protocol C). Scans obtained during 3 hepatic phases were subjected to quantitative and qualitative analysis. The mean radiation dose and the contrast medium dose were significantly lower under protocols B and C than under protocol A. In all hepatic phases, all signal-to-noise and contrast-to-noise ratios were greater under protocol C than under other protocols at all anatomic sites. Qualitative analysis showed that image noise and diagnostic acceptability were significantly higher under protocol C. In all hepatic phases, a low-tube voltage, low-contrast material dose CT with IR algorithm yielded better contrast enhancement and image quality than a standard tube voltage, standard contrast material dose CT with FBP in thin adult patients.

Evaluating the Accuracy of Emergency Medicine Resident Interpretations of Abdominal CTs in Patients with Non-Traumatic Abdominal Pain

Abdominal computed tomography (CT) is widely used as a diagnostic tool in emergency medicine (EM) to accurately diagnose abdominal pain. EM residents must be able to offer preliminary interpretations of CT imaging. In this study, we evaluated the preliminary interpretation ability of a sample of emergency residents presented with adult abdominal CT images, and compared their results with those of radiology residents. We conducted a prospective observational study from November 16, 2008 to June 30, 2009. During this time, we gathered preliminary interpretations of consecutive abdominal CT made by emergency and radiology residents. We assessed the discrepancy rates of both samples by comparing their findings to the final reports from attending radiologists. A total of 884 cases were enrolled in the present study. The discrepancy rates of emergency and radiology residents were 16.7% and 12.2%, respectively. When female genital organs, peritoneum, adrenal glands, or the musculoskeletal system were abnormal, we found that emergency residents' preliminary interpretations of CT images were insufficient compared to those of radiology residents. Therefore more formal education is needed to emergency residents. If possible, the preliminary interpretations of radiology attending physicians are ideal until improving the ability of interpretations of emergency residents in abdomen CT.

Incidental computed tomography sacroiliitis: clinical significance and inappropriateness of the New York radiological grading criteria for the diagnosis

The clinical implications of computed tomography (CT) detected sacroiliac joint (SIJ) changes compatible with sacroiliitis has been rarely discussed in the literature. The aim of the present study was to describe prevalence and clinical correlations of sacroiliitis, noted incidentally by abdominal CT in patients referred for non-musculoskeletal complaints, utilizing the New York radiological grading criteria for reference. Five hundred ninety-eight CT scans of the abdomen of patients 18–55 years old, performed at a community medical center, were prospectively examined for the presence of imaging changes consistent with sacroiliitis. Patients with the evidence of bilateral sacroiliitis of grade ≥2 were interviewed and underwent a rheumatologic examination. Twenty-two patients (13 females) were enrolled. Only eight patients (six males) had a history and clinical picture compatible with previously undiagnosed axial spondyloarthritis (SpA). Only the presence of erosions/joint space irregularity and/or inhomogeneous osseous sclerosis around SIJs on CT correlated with the clinical diagnosis of axial SpA. Dense homogenous osseous sclerosis was unrelated to axial SpA and was seen almost exclusively in females. The prevalence of incidental CT sacroiliitis is low, while the New York radiological grading criteria for diagnosing sacroiliitis may be inappropriate for CT imaging. CT noted erosions of the SIJ appear to be a reliable diagnostic sign of sacroiliitis, while the significance of the osseous sclerosis, seen on CT adjacent to SIJs requires better understanding.

The accuracy of focused abdominal CT in patients presenting to the emergency department

Focused computed tomography(CT) examination (FCT) is CT limited to a specific abdominal area in an attempt to reduce radiation exposure. We wanted to evaluate FCT on the basis of information from the request form and thus reduce radiation dose to the patient without missing relevant findings. We retrospectively analyzed 189 consecutive acute abdominal CT, dividing the findings as localized in the upper or lower abdomen. Another researcher blindly determined where the CT should be focused to, based only on information provided in the request form. The sensitivity and specificity of FCT in patients with symptoms from only upper abdomen was 100%. Sensitivity, specificity, and accuracy of FCT in patients with symptom from only lower abdomen were 79%, 100%, and 92%, respectively. Our study suggests that among patients with symptoms from the lower abdomen, not examining the upper abdomen would lead to missing relevant findings.

A randomized, controlled trial of routine early abdominal computed tomography in patients presenting with non-specific acute abdominal pain

To compare the effect of an initial early computed tomography (CT) examination versus standard practice (SP) on the length of hospital stay, diagnostic accuracy, and mortality of adults presenting with acute abdominal pain. Two hundred and five adults presenting with acute abdominal pain were randomized to undergo an early CT examination or current SP, which comprised supine abdominal and erect chest radiography. One hundred and ninety-eight patients (99 in each arm) were included in the analysis. The primary endpoint was the duration of inpatient stay; secondary endpoints were diagnostic certainty and mortality. There was no significant difference in the length of hospital stay between the two arms (p=0.20). At randomization 36% (35 of 96) of CT patients and 49% (48 of 98) of SP patients were correctly diagnosed; 24h after randomization the correct diagnosis had been established in 84% of CT patients and 73% of SP patients. This refinement in diagnostic certainty was significantly better in the CT group (p<0.001). There was no difference in mortality between the two trial arms (p=0.31). Early abdominal CT in patients with acute abdominal pain improves diagnostic certainty, but does not reduce the length of hospital stay and 6 month mortality.

Abdominal Computed Tomography Predicts Progression in Patients With Rai Stage 0 Chronic Lymphocytic Leukemia

Whether computed tomography (CT) should be routinely included in the diagnostic work-up in patients with chronic lymphocytic leukemia (CLL) has not yet been determined. The aim of this study was to analyze the prognostic significance of abdominal CT in patients with CLL in Rai clinical stage 0. Abdominal CT was performed at diagnosis in 140 patients consecutively diagnosed with CLL in Rai stage 0 disease. An abnormal abdominal CT was found in 38 patients (27%). Abnormal CT correlated with increased bone marrow infiltration (P = .024), high lymphocyte count (P = .001), increased ZAP-70 expression (P = .003), and short lymphocyte doubling time (LDT; P = .007). Patients with abnormal CT progressed more frequently and had a shorter time to progression than those with normal CT (median, 3.5 years v not reached, respectively; P < .001) and required earlier treatment intervention. In a multivariate analysis, only high ZAP-70 expression (relative risk = 3.60) and an abnormal abdominal CT (RR = 2.71) correlated with disease progression. In this series, an abnormal abdominal CT was a strong predictor of progression in patients with early-stage CLL. The inclusion of CT scans in the initial work-up of patients with early clinical stage on clinical grounds can, therefore, provide relevant clinical information.

Early Nonenhanced Abdominal Computed Tomography Can Predict Mortality in Severe Acute Pancreatitis

We wondered whether nonenhanced computed tomography (CT) within 48 hours of admission could identify individuals at risk for higher mortality from acute pancreatitis. Data from the international phase III study of the platelet-activating factor-inhibitor Lexipafant was used to analyze noncontrast CT versus acute pancreatitis mortality. Nonenhanced CT examinations of the abdomen from the trial were classified by disease severity (Balthazar grades A-E) and then correlated with patient survival. Among the 477 individuals who underwent CT within 48 hours of admission and 220 individuals who did so over the subsequent 6 days, higher CT grades were associated with increased mortality. Each unit increase in Balthazar grade during the initial 48 hours was associated with an estimated increase in the risk of mortality of 33%, and this trend increased to 50% if pancreatic enlargement and peripancreatic stranding (grades B and C) were combined (P<0.05). CT grade correlated minimally with Ranson, Glasgow, or APACHE II score during the initial 48 hours; however, this correlation improved over 3-8 days. Early nonenhanced abdominal CT in patients with acute pancreatitis is a valuable prognostic indicator of mortality in acute pancreatitis, even among patients without clinical features of severe acute pancreatitis.

Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma.

To evaluate the frequency and importance of transverse process fractures of lumbar vertebrae identified at helical computed tomography (CT) in patients with blunt abdominal trauma. Helical abdominal CT scans in 536 consecutive patients with a history of blunt abdominal trauma were prospectively evaluated for transverse process fractures of the lumbar spine. The number and level of fractures were categorized and correlated to the retrospective and initial interpretations of the radiographs obtained at original trauma examination. Number and type of associated abdominal injuries were recorded. CT scans showed transverse process fractures in 39 (7.3%) patients. Seventy-nine fractures were identified (single fractures in 12 patients, multiple fractures in 27). Fractures were right-sided in 13 patients, left-sided in 24, and bilateral in two. Transverse process fractures of the L3 vertebra were most common (n = 25). Fractures were not reported in 20 (61%) of 33 initial radiographic assessments. Even at retrospective review, only 30 (57%) of 53 fractures were correctly identified. Transverse process fractures were associated with abdominal injuries in 20 (51%) patients; this association was statistically significant (P <.001). Initial conventional radiography is relatively insensitive in the detection of transverse process fractures of the lumbar spine. There is a statistically significant association between transverse process fractures and abdominal injury.

Postadministration of oral contrast material for abdominal CT in patients with gastrectomy: modified drip ingestion method.

We introduce the modified drip ingestion method (MDIM) of administering oral contrast material for abdominal computed tomography (CT) in patients after gastrectomy. MDIM consists of the drip ingestion method, which we have recently reported, with additional ingestion of effervescent agent. MDIM in abdominal CT is a useful technique to improve the degree of distention of the gastrointestinal lumen including anastomotic sites in patients after gastrectomy.

AIDS and adenopathy: A computed tomographic pattern approach to diagnosis of acute abdominal complications in AIDS

Gastrointestinal disorders are common causes of acute disease in AIDS patients, second only to pulmonary pathology. Abdominal disorders are often evaluated by computed tomography (CT). The abnormalities encountered on CT are produced by a variety of opportunistic infections and neoplasms and can be confusing. This article describes a pattern approach to the interpretation of abdominal CT in patients with AIDS that relates pathophysiology to CT findings by emphasizing the appearance of lymph nodes. Nodes are analyzed for size, radiographic density, and location. A specific diagnosis or a short list of diagnostic possibilities is often suggested by the nodal appearance supplemented by extranodal findings.