Role of dual energy CT to improve diagnosis of non-traumatic abdominal vascular emergencies

Due to a contrast shortage crisis resulting from the decreased supply of iodinated contrast agents, the American College of Radiology (ACR) has issued a guidance statement followed by memoranda from various hospitals to preserve and prioritize the limited supply of contrast. The vast majority of iodinated contrast is used by CT, with a minority used by vascular and intervention radiology, fluoroscopy, and other services. A direct consequence is a paradigm shift to large volume unenhanced CT scans being utilized for acute and post traumatic patients in EDs, an uncharted territory for most radiologists and trainees. This article provides radiological diagnostic guidance and a pictorial example through systematic review of common unenhanced CT findings in the acute setting.

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“…3 ). Acute thrombosis (particularly of veins) can lead to vessel enlargement [ 39 , 40 ] and perivenous fat stranding (Fig. 4 ).…”

Section: Discussionmentioning

confidence: 99%

Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists

et al. 2022

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“…Seventy-five percent patients of BAT are associated with the motor vehicle collision. 6,7 Abdomen blows and falls are accountable for 15.0% and 6.0% to 9.0% patients respectively. 8 BAT due to occult BAT may happen in a result of child abuse and violence in domestic activities.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of FAST (Focused Abdominal Sonography in Trauma) scan in diagnosis of significant abdominal trauma using CT abdomen as gold standard.

Hanif

Bibi²,

Raja

et al. 2020

TPMJ

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Objectives: The aim of this research work is to find out the precision of FAST scan in detection of the significant abdominal trauma with the utilization of the CT abdomen considering it as a gold standard. Study Design: Cross Sectional study. Setting: Department of Radiology and Department of Emergency in Holy Family Hospital, Rawalpindi. Period: Six months from March, 2019 to September 2019. Material & Methods: Total 120 patients of both genders having age from 16 to 65 years who were presented in the Department of Trauma emergency. Both were the participants of this research work. We carried out CT of abdomen and FAST scan for every patient. We also calculated the sensitivity, PPV, NPV, specificity and overall accuracy rate of the FAST scan. Results: There were 80.80% (n: 97) male patients and 19.20% (n: 23) patients were females. We found 28.30% (n: 34) patients as positive in FAST scan and 22.50% (n: 27) patients as positive on CT of abdomen. FAST scan’s accuracy, NPV, PPV, sensitivity and specificity were present as 84.20%, 93%, 61.80%, 77.8% and 86% respectively. Conclusion: FAST scan permits the identification of the free fluid gathered in various regions of the abdomen cavity because of the BAT with high rate of sensitivity, PPV, NPV and specificity.

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“…In pancreatic CT, the monochromatic images at low keV (<65 keV) improved lesion detection and conspicuity of PDAC, in particular when compared to standard 120 kVp images (Figure 1) (43)(44)(45). Similarly low-voltage acquisitions, the visualization of pancreatic duct is improved with monochromatic images at low keV (Figure 2); this is valuable in chronic pancreatitis (46). Another application of monochromatic images at low keV is the optimization of contrast enhancement, with the possibility of post-processing in case of inadequate contrast bolus injection or with the aim of contrast dose reduction in patients with impaired renal function (47,48).…”

Section: Dual Energy Ct: Qualitative and Quantitative Evaluationsmentioning

confidence: 97%

New advances in CT imaging of pancreas diseases: a narrative review

et al. 2020

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Computed tomography (CT) plays a pivotal role as a diagnostic tool in many diagnostic and diffuse pancreatic diseases. One of the major limits of CT is related to the radiation exposure of young patients undergoing repeated examinations. Besides the standard CT protocol, the most recent technological advances, such as low-voltage acquisitions with high performance X-ray tubes and iterative reconstructions, allow for significant optimization of the protocol with dose reduction. The variety of CT tools are further expanded by the introduction of dual energy: the production of energy-selective images (i.e., virtual monochromatic images) improves the image contrast and lesion detection while the materialselective images (e.g., iodine maps or virtual unenhanced images) are valuable for lesion detection and dose reduction. The perfusion techniques provide diagnostic and prognostic information lesion and parenchymal vascularization and interstitium. Both dual energy and perfusion CT have the potential for pushing the limits of conventional CT from morphological evaluation to quantitative imaging applied to inflammatory and oncological diseases. Advances in post-processing of CT images, such as pancreatic volumetry, texture analysis and radiomics provide relevant information for pancreatic function but also for the diagnosis, management and prognosis of pancreatic neoplasms. Artificial intelligence is promising for optimization of the workflow in qualitative and quantitative analyses. Finally, basic concepts on the role of imaging on screening of pancreatic diseases will be provided.

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Role of dual energy CT to improve diagnosis of non-traumatic abdominal vascular emergencies

Cited by 20 publications

References 73 publications

Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists

Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists

Accuracy of FAST (Focused Abdominal Sonography in Trauma) scan in diagnosis of significant abdominal trauma using CT abdomen as gold standard.

New advances in CT imaging of pancreas diseases: a narrative review

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