CT Abdomen and Pelvis CT can be performed without and/or with IV contrast and with or without oral contrast, depending on localizing symptoms and/or laboratory findings. In general, a single-phase IV contrast-enhanced examination is performed as additional precontrast and postcontrast images are not required for diagnosis. Abdominal CT without the use of oral or IV contrast has been advocated as an alternative to abdominal radiographs for evaluating appendicitis [17,24]. However, the use of IV contrast increases the spectrum of detectable pathology [25,26]. Unless otherwise specified, the subsequent discussion of CT refers to IV contrast-enhanced CT. Contraindications are not considered in the appropriateness assessment. Many institutions no longer routinely use oral contrast because of the associated delay in scan acquisition and departmental and ED throughput balanced against questionable diagnostic advantage [27-30]. Positive oral contrast may help improve confidence in identifying bowel-related pathology; however, advances in CT technology with multiplanar reformations can also improve diagnostic confidence in patients with abdominal pain [61-63]. Several studies have shown that CT improves the final diagnosis and management of patients who present with abdominal pain [5,24,31,64-67]. A prospective trial of 547 patients presenting to the ED with abdominal pain demonstrated that CT altered the diagnosis in 54% of patients and frequently changed disposition patterns, with a greater proportion of patients discharged in lieu of admission for observation [68]. Other studies have shown that CT outperforms clinical diagnosis [69,70]. Additionally, the use of CT in patients with acute abdominal pain In a prospective study of 584 ED patients presenting with nontraumatic abdominal pain, CT was shown to change the diagnosis, improve diagnostic certainty, and affect potential patient management decisions [31].
Acute Nonlocalized Abdominal Pain. CT Abdomen and Pelvis CT can be performed without and/or with IV contrast and with or without oral contrast, depending on localizing symptoms and/or laboratory findings. In general, a single-phase IV contrast-enhanced examination is performed as additional precontrast and postcontrast images are not required for diagnosis. Abdominal CT without the use of oral or IV contrast has been advocated as an alternative to abdominal radiographs for evaluating appendicitis [17,24]. However, the use of IV contrast increases the spectrum of detectable pathology [25,26]. Unless otherwise specified, the subsequent discussion of CT refers to IV contrast-enhanced CT. Contraindications are not considered in the appropriateness assessment. Many institutions no longer routinely use oral contrast because of the associated delay in scan acquisition and departmental and ED throughput balanced against questionable diagnostic advantage [27-30]. Positive oral contrast may help improve confidence in identifying bowel-related pathology; however, advances in CT technology with multiplanar reformations can also improve diagnostic confidence in patients with abdominal pain [61-63]. Several studies have shown that CT improves the final diagnosis and management of patients who present with abdominal pain [5,24,31,64-67]. A prospective trial of 547 patients presenting to the ED with abdominal pain demonstrated that CT altered the diagnosis in 54% of patients and frequently changed disposition patterns, with a greater proportion of patients discharged in lieu of admission for observation [68]. Other studies have shown that CT outperforms clinical diagnosis [69,70]. Additionally, the use of CT in patients with acute abdominal pain In a prospective study of 584 ED patients presenting with nontraumatic abdominal pain, CT was shown to change the diagnosis, improve diagnostic certainty, and affect potential patient management decisions [31].