MDCT and MR Imaging of Acute Abdomen

247 Pages·2018·17.89 MB·English

by  Michael Patlas

MDCT and MR
Imaging of
Acute Abdomen
New Technologies
and Emerging Issues
Michael Patlas
Douglas S. Katz
Mariano Scaglione
Editors
123
MDCT and MR Imaging of Acute
Abdomen
Michael Patlas • Douglas S. Katz
Mariano Scaglione
Editors
MDCT and MR Imaging
of Acute Abdomen
New Technologies
and Emerging Issues
Editors
Michael Patlas Douglas S. Katz
Hamilton General Hospital Department of Radiology
Department of Radiology Winthrop-University Hospital
McMaster University Mineola
Hamilton New York
Ontario USA
Canada
Mariano Scaglione
Department of Imaging
Pineta Grande Medical Center
Castel Volturno
Caserta
Italy
ISBN 978-3-319-70777-8 ISBN 978-3-319-70778-5 (eBook)
https://doi.org/10.1007/978-3-319-70778-5
Library of Congress Control Number: 2018935193
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To my parents, Dr. Natan and Ludmila Patlas, to my wife
Nataly, and my children Michal and Jessica.
Michael Patlas
To Darienne, my mate, my friend, my love, and my inspiration.
Douglas Katz
To Pietro and Ruben, my sons, the reason of my life.
Mariano Scaglione
Contents
1 Evidence-Based Imaging of the Acute Abdomen:
Where Is the Evidence? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ania Z. Kielar, Cynthia B. Walsh, and Matthew D. F. McInnes
2 Radiation Dose Reduction Strategies for Acute
Abdominal and Pelvic CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Samad Shah, Faisal Khosa, and Savvas Nicolaou
3 Dual-Energy CT in Patients with an Acute Abdomen. . . . . . . . 23
HeiShun Yu, David D. B. Bates, and Dushyant V. Sahani
4 Acute Hepatobiliary Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Marina C. Bernal Fernandez, Jorge A. Soto,
and Christina A. LeBedis
5 Advances in Acute Pancreatic Imaging . . . . . . . . . . . . . . . . . . . 77
Dan Van Roekel, Stephan Anderson, and Trevor Morrison
6 MDCT and MRI of Bowel Obstruction and Ischemia . . . . . . . 99
Daniel C. Oppenheimer, Constantine A. Raptis,
and Vincent M. Mellnick
7 MR Imaging of Acute Appendicitis . . . . . . . . . . . . . . . . . . . . . . . 123
Victoria Chernyak
8 Advances in MDCT and MRI of Renal Emergencies . . . . . . . . 137
Daniel Barkmeier and Suzanne Chong
9 Vascular Emergencies of the Retroperitoneum: Recent
Advances in MDCT and Interventional Radiology . . . . . . . . . . 151
Anna Maria Ierardi, Francesca Iacobellis,
Gianpaolo Carrafiello, Filippo Pesapane,
Refky Nicola, and Mariano Scaglione
10 Acute Abdominal Pain in Pregnant Patients . . . . . . . . . . . . . . . 179
Gabriele Masselli, Martina Derme, and Gianfranco Gualdi
11 MRI of the Acute Female Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . 193
Joseph W. Owen and Christine O. Menias
vii
viii Contents
12 Traumatic Abdominal Compartment Syndrome . . . . . . . . . . . . 217
Luigia Romano, Carlo Liguori, Ciro Acampora,
Nicola Gagliardi, Antonio Pinto, Sonia Fulciniti,
and Massimo Silva
13 Imaging of the Acute Abdomen in the Pediatric Patients . . . . . 229
Grazia Loretta Buquicchio, Margherita Trinci,
Riccardo Ferrari, Stefania Ianniello, Michele Galluzzo,
and Vittorio Miele
1
Evidence-Based Imaging
of the Acute Abdomen:
Where Is the Evidence?
Ania Z. Kielar, Cynthia B. Walsh,
and Matthew D. F. McInnes
Abstract in radiology and then specifically in the set-
Emergency radiology is still considered an ting of an acute abdomen. Tools available for
emerging subspecialty compared to more designing and reporting research are intro-
established areas such as neuroradiology and duced: This includes QUADAS-2 (Quality
abdominal-pelvic imaging. Although this sug- Assessment of Diagnostic Accuracy Studies),
gests that less time has passed to allow dedi- STARD (Standards for Reporting of Diagnostic
cated research in imaging associated with Accuracy), and PRISMA (Preferred Reporting
emergency medicine, it also implies that there Items for Systematic Reviews and Meta-
are opportunities for study in this field in the Analyses) [1, 2]. We also expand on commonly
future. accessed information currently used to help
In this introductory chapter, we emphasize guide radiologists in diagnosis and decision
the importance of evidence-based medicine making with regard to acute abdominal and pel-
vic conditions.
Perceived barriers to research in emergency
A. Z. Kielar, M.D., F.R.C.P.C. (*) radiology are reviewed. Tips and specific tools
Department of Medical Imaging, The Ottawa
to implement when designing an emergency
Hospital, Ottawa, Canada
radiology research study are provided; this
Department of Radiology Ottawa, University of
information may also be useful when critically
Ottawa, Ottawa, Canada
appraising published literature. Finally, an
Ottawa Hospital Research Institute, Ottawa, Canada
overview of emerging research opportunities
Department of Imaging, University of Toronto, and innovative areas in emergency radiology
Toronto, Canada
research is introduced, with focus on acute
C. B. Walsh, M.D., F.R.C.P.C. abdominal conditions, all of which will be
Department of Medical Imaging, The Ottawa
covered in more detail in subsequent chapters
Hospital, Ottawa, Canada
of this textbook.
Department of Radiology Ottawa, University
of Ottawa, Ottawa, Canada
Keywords
M. D. F. McInnes, M.D., F.R.C.P.C.
Evidence-based medicine · Levels of evidence
Department of Medical Imaging, The Ottawa
Cross-sectional imaging · Abdominal imaging
Hospital, Ottawa, Canada
Emergency radiology
Department of Radiology Ottawa, University of
Ottawa, Ottawa, Canada
Ottawa Hospital Research Institute, Ottawa, Canada
© Springer International Publishing AG, part of Springer Nature 2018 1
M. Patlas et al. (eds.), MDCT and MR Imaging of Acute Abdomen,
https://doi.org/10.1007/978-3-319-70778-5_1
2 A. Z. Kielar et al.
Abbreviations the type or modality of imaging chosen for eval-
uation by the radiologist [3].
ACR American College of Radiology Although establishing a final diagnosis is of
ALARA As low as reasonably achievable primary concern in an emergent setting, the con-
CT Computed tomography cept of ALARA (as low as reasonably achiev-
ED Emergency department able) principle should still be followed when
EPs Emergency physicians considering imaging of patients presenting to the
LLQ Left lower quadrant ED, especially those patients under 30 years of
LUQ Left upper quadrant age. Radiology-initiated campaigns of “Image
MRI Magnetic resonance imaging Wisely” in adults and “Image Gently” in chil-
NPV Negative predictive value dren have a substantial role in emergency radiol-
PICO Patient, intervention, comparison, ogy, although imaging algorithms for assessing
outcome this patient population vary depending on the
PPV Positive predictive value acuity of symptoms and patients’ underlying
PRISMA Preferred reporting items for sys- level of hemodynamic stability [4, 5]. Given
tematic reviews and meta-analyses these principles, imaging algorithms for assess-
QUADAS 2 Quality assessment of diagnostic ing abdomino-p elvic symptoms, and especially
accuracy studies in pregnant patients and young patients, should
RLQ Right lower quadrant begin with ultrasound, when appropriate, given
RUQ Right upper quadrant that this modality is relatively ubiquitous in
SAR Specific absorption rate terms of access, is less expensive, and gener-
STARD Standards for reporting of diag- ally has adequate sensitivity and specificity for
nostic accuracy the diagnosis of many common acute abdominal
US Ultrasound and pelvic conditions [6]. However, in equivocal
situations, in patients where ultrasound is not the
imaging modality of choice (e.g., ischemic bowel
evaluation), or when symptoms are discordant,
1.1 Background: Goals MRI or CT is important for establishing a clear
of Imaging Patients in the ED diagnosis.
with Abdominal and Pelvic Although there are many diagnostic tools and
Symptoms references available for emergency radiologists
(these will be covered in subsequent chapters of
Imaging of patients presenting to the emergency this book), there are still many research questions
department with abdominal symptoms has key waiting to be answered.
goals of providing safe, accurate, and timely
diagnoses of clinically significant abdomi-
nal and pelvic disorders. Patients with acute 1.2 Perceived Barriers
abdominal symptoms can have a wide range to Research
of underlying etiologies, including acute on in the Emergency
chronic conditions. With an aging population, Department
concomitant comorbidities may affect the emer-
gency physician’s ability to make a confident Patients present to the emergency department
diagnosis based on physical examination alone. (ED) with a wide range of symptoms, signs,
Increasing rates of obesity in North America and underlying medical conditions. The level of
and elsewhere also affect the accuracy of physi- acuity in this patient population varies: In many
cal examination and lead to greater reliance on patients, urgent or emergent imaging is required,
imaging. However, obesity can also negatively often reducing or eliminating the time needed
affect the quality of imaging, and may modify for obtaining consent. Some patients may not be
1 Evidence-Based Imaging of the Acute Abdomen: Where Is the Evidence? 3
able to give consent due to reduced level of con- 1.3 Evidence Currently Available
sciousness. For example, poly-trauma patients in Emergency Abdominal
may be unconscious or hemodynamically unsta- Radiology
ble, and therefore unable to provide consent.
This critical factor can be a barrier when design- Peer-reviewed articles can be identified on
ing research protocols, particularly for prospec- numerous topics through Internet searches
tive studies. including Google Scholar, as well as Pubmed
Emergency departments operate 24 h a day, and many others [8, 9]. Previously published
365 days a year, and patients with abdominal and research used as supporting evidence in emer-
pelvic symptoms present at all hours. This can be gency radiology has often dealt with diagnostic
a challenge to conducting prospective research, accuracy of various imaging modalities to make
as members of the research team, including a particular diagnosis. In some manuscripts the
nurses and specific physicians, who are required data included non-emergent patients, which can
to explain the prospective research protocols to lead to various biases. However, more recently,
potential study candidates, may not be present in “emergency- centered” or “emergency-specific”
the ED at the time consent needs to be obtained data is being published in various journals,
to enter a study. and more recently journals specific to the field
Another potential barrier to research in emer- of emergency radiology have been established
gency radiology is that patients who pass through [10]. These publications include various types
the ED are usually not followed long term in the of research, including systematic reviews and
ED as compared to family practices or with other single-center versus multicenter prospective
specialist physicians. The relationship between studies, as well as retrospective studies, in addi-
an emergency physician (EP) and patient is usu- tion to some topics which may include review
ally not as established as with other physicians. articles and opinion pieces. Becoming familiar
As a result, obtaining adequate follow-up of these with bias in imaging research when critically
patients can be difficult at times. This is particu- appraising published articles is important. Many
larly relevant for diagnostic accuracy research research efforts in emergency radiology are
regarding determination of false-n egative inter- directed at optimizing patient outcomes, creat-
pretations which often require rigorous clinical ing standardized imaging pathways, improving
follow-up [7]. communication between radiologists and other
Radiologists working in the ED may either be physicians, as well as increasing efficiency of
subspecialized or work part-time in other fields imaging in this patient population [10, 11].
and “pinch hit” in the ED. Those who work part- Several resources are available to assist in
time in the ED often have other areas of sub- assessing the completeness of research reporting
specialization to which they may dedicate the and risk of bias; the tool used will depend on the
majority of their research efforts. Even radiolo- study design. A large portion of imaging research
gists who are dedicated in the field of emergency is diagnostic accuracy. For this type of work,
radiology may find it challenging to perform STARD 2015 can be used to assess completeness
certain types of research due to the nature of of reporting, while QUADAS-2 can be used to
shift work associated with emergency radiology, assess risk of bias [2, 12]. This will be described
coupled with the pressures of turnaround time for in more detail in the next section of this chapter.
their final reports. Other forms of information and reference sup-
However, as we demonstrate later in this port can be accessed on the Internet. For exam-
chapter, there are opportunities for research in ple, the American College of Radiology (ACR)
the field of abdominal and pelvic emergency publishes Appropriateness Criteria related to
radiology which can help build upon already numerous topics pertinent to the field of radi-
existing data in this growing field of imaging and ology which are accessible to everyone free of
intervention. charge. They have organized, transparent, and