Non-enhanced abdominal Computed tomography( CT) for demonstration of painful abdominal conditions in patients not candidates for contrast-enhanced study, how does it help?

Abstract

Background: There is a wide variety of abdominal painful conditions that necessitate computed tomography (CT) imaging; our study was  aimed to demonstrate the utility of non-enhanced computed tomography (NECT) of the abdomen as a standalone study to detect  the cause of abdominal pain in patients who are not candidates for iodinated contrast administration.

Methods: Nonenhanced CT was  performed to one hundred and seventy patients who presented with abdomino-pelvic pain that necessitates abdominal imaging by CT in conjunction with inability to use iodinated contrast media.

Results: There was 134/170 patients (~79%) showed clinically relevant  radiologic diagnosis. The gastrointestinal system was the most commonly affected system (n= 81/170 ~ 48%). Of the total, 22 patients  were presented with right lower quadrant pain and clinically suspected to have appendicitis; 14 of them were diagnosed with acute appendicitis on NECT with sensitivity, specificity and accuracy of 73.6%, 100% and 86.3% respectively. About 20% of patients required  urgent management. Final diagnostic confirmation was made operatively in 20/134 cases whereas in remaining cases was based on the  presence of specific imaging features, the response to specific therapy, and long-term follow-up. The percent agreement in the study was  excellent between the readers; the inter-reader reliability was calculated at 97%.

Conclusion: Non-enhanced computed tomography  has the potential to detect the cause of abdominal pain in the setting of contra indication to iodinated contrast media in most situations.  Using an appropriate checklist, a wide spectrum of clinically-relevant diagnoses could be identified with a significant impact on patient  management.