CT for Acute Nontraumatic Abdominal Pain—Is Oral Contrast Really Required?

Kessner, Rivka; Barnes, Sophie; Halpern, Pinchas; Makrin, Vadim; Blachar, Arye

doi:10.1016/j.acra.2017.01.013

Cited by 39 publications

(24 citation statements)

References 24 publications

(28 reference statements)

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“…Use of Oral and Rectal Contrast Media for CT. A retrospective review of 661 patients found no significant difference in the ability to correctly diagnose a suspected acute abdominal process (including 199 cases of infectious/inflammatory findings) when CT imaging with oral contrast was compared with CT imaging performed without oral contrast [27]. Another study of 348 consecutive patients who presented to the emergency department for nontraumatic abdominal pain found no significant diagnostic benefit of oral contrast [28]. Although oral contrast practices for abdominal and pelvic CT vary nationally, rectal contrast is rarely used [29].…”

Section: Special Imaging Considerationsmentioning

confidence: 99%

ACR Appropriateness Criteria® Left Lower Quadrant Pain-Suspected Diverticulitis

Imaging¹,

Galgano

McNamara

et al. 2019

Journal of the American College of Radiology

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This review summarizes the relevant literature regarding imaging of suspected diverticulitis as an etiology for left lower quadrant pain, and imaging of complications of acute diverticulitis. The most common cause of left lower quadrant pain in adults is acute sigmoid or descending colonic diverticulitis. Appropriate imaging triage for patients with suspected diverticulitis should address the differential diagnostic possibilities and what information is necessary to make a definitive management decision. Patients with diverticulitis may require surgery or interventional radiology procedures because of associated complications, including abscesses, fistulas, obstruction, or perforation. As a result, there has been a trend toward greater use of imaging to confirm the diagnosis of diverticulitis, evaluate the extent of disease, and detect complications before deciding on appropriate treatment. Additionally, in the era of bundled payments and minimizing health care costs, patients with acute diverticulitis are being managed on an outpatient basis and rapid diagnostic imaging at the time of initial symptoms helps to streamline and triage patients to the appropriate treatment pathway.

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Section: Special Imaging Considerationsmentioning

confidence: 99%

ACR Appropriateness Criteria® Left Lower Quadrant Pain-Suspected Diverticulitis

Imaging¹,

Galgano

McNamara

et al. 2019

Journal of the American College of Radiology

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“…To the best of our knowledge, no study has compared CT with and without rectal contrast specifically for the clinical workup of DD. A few studies have compared the value of CT with and without rectal/enteric contrast in patients with appendicitis [21] and in patients with acute non-traumatic pain [22], concluding that enteric contrast does not improve the radiological diagnosis in most patients [23]. The diagnostic accuracy (94.8 %), sensitivity (91.7 %), and specificity (97.3 %) of CT with i. v. contrast alone in our study are comparable with previous studies in patients with DD who underwent CT with varying enteric contrast protocols.…”

Section: Discussionmentioning

confidence: 99%

To Fill or Not to Fill? – Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon

Meyer

Schmidbauer

Wacker

et al. 2021

Rofo

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Purpose To assess the value of the administration of positive rectal contrast at CT in patients referred for suspected diverticular disease (DD) of the colon. Materials and Methods 460 patients (253 male, 207 female; median age 62 years; interquartile range 24) with clinical suspicion of DD of the colon were included in this retrospective IRB-approved study. CT was performed with i. v. contrast only (n = 328, group M1), i. v. + positive rectal contrast (n = 82, group M2), neither i. v. nor rectal contrast (n = 32, group S1), or positive rectal contrast only (n = 19, group S2). Two readers in consensus evaluated all CT datasets concerning diagnosis of DD (yes/no) and categorized findings (classification of diverticular disease (CDD)). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of DD were calculated for all groups, using either clinical follow-up (n = 335) or intraoperative findings (n = 125) as the reference standard. In patients undergoing surgery, radiological staging of DD was correlated with the histopathology (weighted Cohen-k). Results 224 patients (48.7 %) were diagnosed with DD. The sensitivity, specificity, PPV, and NPV were as follows. Group M1 / M2: 92 %/92 %, 97 %/94 %, 96 %/96 %, 94 %/89 %, respectively; group S1 / S2: 94 %/86 %, 93 %/80 %, 94 %/92 %, 93 %/67 %, respectively. Radiological staging and histopathology correlated substantially in all groups (k = 0.748–0.861). Conclusion Abdominal CT had a high sensitivity and specificity for the diagnosis of DD. Disease staging correlated well with the findings at surgery. Additional positive rectal contrast administration did not have a significant advantage and may therefore be omitted in patients with suspected DD. Key Points: Citation Format

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“…CT protocol in patients with suspected bowel obstruction has been studied for years. It is well known that the oral administration of a high-attenuation contrast agent is no longer recommended for this diagnosis [7]. While there is a consensus on contrast-enhanced CT as the first-line examination for abdominal emergencies, the value of unenhanced CT - that is yet performed in many institutions - is more controversial [2, 3, 8–13].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Contrast Agent in Abdominal CT: Is It Really Needed to Identify the Cause of Bowel Obstruction? Proof of Concept

Vernuccio

Picone

Scerrino

et al. 2019

Gastroenterology Research and Practice

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Background. To compare sensitivity of unenhanced computed tomography (CT) and contrast-enhanced CT for the identification of the etiology of bowel obstruction. Materials and Methods. We retrospectively evaluated abdominal CT scans of patients operated for bowel obstruction from March 2013 to October 2017. Two radiologists evaluated CT scans before and after contrast agent in two reading sessions. Then, we calculated sensitivity of CT in the diagnosis of bowel obstruction and determined in which cases the etiology of bowel obstruction was detected on both unenhanced and enhanced CT or on enhanced CT only. The reference standard was defined as the final diagnosis obtained after surgery. Results. Eighteen patients (mean age 72±15 years, age range 37-88 years) were included in the study. Sensitivity of unenhanced CT and enhanced CT was not significantly different in either small bowel obstruction (64%, 7/11 patients vs. 73%, 8/11 patients; P=0.6547) or large bowel obstruction (71%, 5/7 patients vs. 100%, 7/7 patients; P=0.1410). Adhesions were identified on unenhanced CT as the etiology of small bowel obstruction in 80% (4/5) of patients. Tumors were identified on unenhanced CT as the etiology of large bowel obstruction in 67% (4/6) of patients. Conclusion. In the diagnosis of small bowel obstruction due to adhesions with normal bowel wall thickening and when a neoplasm is identified as the etiology of large bowel obstruction on unenhanced CT, an intravenous contrast agent may be avoided for the identification of the etiology. In remaining cases, contrast agent is still recommended.

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CT for Acute Nontraumatic Abdominal Pain—Is Oral Contrast Really Required?

Cited by 39 publications

References 24 publications

ACR Appropriateness Criteria® Left Lower Quadrant Pain-Suspected Diverticulitis

ACR Appropriateness Criteria® Left Lower Quadrant Pain-Suspected Diverticulitis

To Fill or Not to Fill? – Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon

Intravenous Contrast Agent in Abdominal CT: Is It Really Needed to Identify the Cause of Bowel Obstruction? Proof of Concept

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