CT Abdomen and Pelvis CT with IV contrast is extremely useful in the evaluation of the neutropenic patient with abdominal pain secondary to its high spatial resolution and ability to display key imaging features [57]. Infectious and inflammatory processes of the small bowel and colon are well depicted by CT with IV contrast, which offers the additional advantage of depicting abscesses or perforations. Given the frequency of neutropenic enterocolitis (28%) and SBO (12%) in this setting, and as neutropenic enterocolitis is largely managed nonsurgically, an early and accurate diagnosis with CT can avoid unnecessary surgery and initiate appropriate medical management [8]. In addition, other abdominal infections, chemotherapeutic-related mucosal injury, and visceral tumors may be depicted by CT. CT without IV but with positive oral contrast can be used as an alternative if patients have severe renal insufficiency or a history of iodinated contrast allergies. Contraindications are not considered in the appropriateness assessment. Multiphasic CT imaging offers little additional benefit in absence of specific clinical indications related to liver or kidneys. MRI Abdomen and Pelvis There are no recent studies available to evaluate the use of MRI in acute nonlocalized or diffuse abdominal pain in the neutropenic patient. Although MRI with contrast may be used to evaluate SBO [58], there are no studies available to evaluate its diagnostic accuracy for neutropenic enterocolitis or other common colitidies or enteritidies in the neutropenic patient. MRI with contrast offers high soft-tissue contrast and the ability to administer gadolinium in patients with a history of allergic reaction to iodinated contrast material [58]. Specialized protocols (MR enterography or colonography) exist to interrogate the small bowel and colon and are mostly designed for use in patients with history of inflammatory bowel disease in the nonemergent setting.
Acute Nonlocalized Abdominal Pain. CT Abdomen and Pelvis CT with IV contrast is extremely useful in the evaluation of the neutropenic patient with abdominal pain secondary to its high spatial resolution and ability to display key imaging features [57]. Infectious and inflammatory processes of the small bowel and colon are well depicted by CT with IV contrast, which offers the additional advantage of depicting abscesses or perforations. Given the frequency of neutropenic enterocolitis (28%) and SBO (12%) in this setting, and as neutropenic enterocolitis is largely managed nonsurgically, an early and accurate diagnosis with CT can avoid unnecessary surgery and initiate appropriate medical management [8]. In addition, other abdominal infections, chemotherapeutic-related mucosal injury, and visceral tumors may be depicted by CT. CT without IV but with positive oral contrast can be used as an alternative if patients have severe renal insufficiency or a history of iodinated contrast allergies. Contraindications are not considered in the appropriateness assessment. Multiphasic CT imaging offers little additional benefit in absence of specific clinical indications related to liver or kidneys. MRI Abdomen and Pelvis There are no recent studies available to evaluate the use of MRI in acute nonlocalized or diffuse abdominal pain in the neutropenic patient. Although MRI with contrast may be used to evaluate SBO [58], there are no studies available to evaluate its diagnostic accuracy for neutropenic enterocolitis or other common colitidies or enteritidies in the neutropenic patient. MRI with contrast offers high soft-tissue contrast and the ability to administer gadolinium in patients with a history of allergic reaction to iodinated contrast material [58]. Specialized protocols (MR enterography or colonography) exist to interrogate the small bowel and colon and are mostly designed for use in patients with history of inflammatory bowel disease in the nonemergent setting.