Computed Tomography

Justifying multidetector CT in abdominal sepsis: time for review?

 S Meeson, CM Alvey and SJ Golding

Radiology Group, Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.

The further development of multidetector row CT (MDCT) has led to changes in the application and examination technique, leading to a need to justify the level and frequency of radiation exposure associated with MDCT. A literature review of how the use of modern scanners has affected diagnosis was undertaken, followed by a year-long retrospective study of MDCT scans of patients presenting with symptoms of abdominal sepsis. The diagnostic accuracy of detecting causes of abdominal sepsis using this technology was sought. Scans were performed using a LightSpeed 16 system (GE Healthcare Medical Systems, Slough, UK and Milwaukee, WI). Clinical diagnoses were based upon surgical and histopathological findings, treatment outcome and follow-up scans. System dose parameters recorded were the dose–length product (DLP) and volume CT dose index. The literature on investigating suspected abdominal sepsis has not been updated significantly since the time of conventional CT. 94 patients were included in the study; causes of abdominal sepsis could be detected with a sensitivity of 0.95 and a specificity of 0.91. Repeat examination and cumulative exposure was a key finding. Patients with abscesses and acute pancreatitis had the highest number of scanner visits; patients with diverticular disease had the lowest number of visits, lowest cumulative DLP and shortest stay in hospital. Cumulative DLP was affected by scan length, number of scans and patient size. In conclusion, diagnostic accuracy data for MDCT scans using 16 slices confirm that CT remains a suitable modality for imaging abdominal sepsis but scope for dose constraint exists.

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