Acute Abdomen: Rational Use of us, MDCT, and MRI

  • Vittorio Miele
  • Antonio Pinto
  • Antonio Rotondo
Part of the Medical Radiology book series (MEDRAD)


The term "acute abdomen" defines a clinical syndrome characterized by the sudden onset of severe abdominal pain, requiring early medical or surgical treatment. The acute abdominal pain may be due to trauma or non-trauma diseases and it is a frequent condition in patients presenting to the hospital emergency department. Computed Tomography is universally considered the key imaging modality for the evaluation of severe trauma patients and patients with non-traumatic acute abdominal disease. In case of acute abdomen unenhanced CT scan is not performed routinely. The contrast enhanced CT study is performed with a two-phase protocol, in arterial and portal venous phases; in trauma patients excretory phase is done only in cases of suspected urinary track lesions (renal pelvis, ureter and bladder). Multiplanar reconstruction (MPRs) are useful for interpretation of abdominal diseases as they allow the scanned volume to be viewed in any arbitrary plane interactively determined by the viewer. These reconstructions are especially useful when tubular structures, such as vessels, ureters, and bowel, are followed. Maximum intensity projections (MIPs) are useful for CT angiography and CT urography. The reconstruction of volume rendered (VR) images is particularly helpful for visualization of complex anatomy and pathology of visceral vasculature and best delineates a tortuous course of vessels and small branches.


Acute Pancreatitis Acute Abdominal Pain Bowel Ischemia Unenhanced Compute Tomography Acute Mesenteric Ischemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Birnbaum BA, Jeffrey RB (1998) CT and sonographic evaluation of acute right lower quadrant abdominal pain. Am J Roentgenol 170:361–371Google Scholar
  2. Boudiaf M, Soyer P, Terem C et al (2001) CT evaluation of small bowel obstruction. Radiographics 21:613–624PubMedGoogle Scholar
  3. Bree RL, Ralls PW, Balfe DM et al (2000) Evaluation of patients with acute right upper quadrant pain: American College of Radiology—ACR appropriateness criteria. Radiology 215 (suppl):153–157PubMedGoogle Scholar
  4. Caoili EM, Paulson EK (2000) CT of small-bowel obstruction: another perspective using multiplanar reformations. Am J Roentgenol 174:993–998Google Scholar
  5. Cho KC, Baker SR (1994) Extraluminal air: diagnosis and significance. Radiol Clin North Am 32:829–844PubMedGoogle Scholar
  6. DeStigter KK, Keating DP (2009) Imaging update: acute colonic diverticulitis. Clin Colon Rectal Surg 22:147–155PubMedCrossRefGoogle Scholar
  7. Fanucci E, Fiaschetti V, Rotili A et al (2007) Whole-body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure. Emerg Radiol 13:251–257PubMedCrossRefGoogle Scholar
  8. Frush DP (2002) Pediatric CT: practical approach to diminish the radiation dose. Pediatr Radiol 32:714–717PubMedCrossRefGoogle Scholar
  9. Fulcher AS, Turner MA (1999) Magnetic resonance pancreatography (MRP). Crit Rev Diagn Imaging 40:285–322PubMedGoogle Scholar
  10. Furukawa A, Yamasaki M, Furuichi K et al (2001) Helical CT in the diagnosis of small bowel obstruction. Radiographics 21:341–355PubMedGoogle Scholar
  11. Gore RM, Miller FH, Scott Pereles F et al (2000) Helical CT in the evaluation of the acute abdomen. Am J Roentgenol 174:901–913Google Scholar
  12. Grassi R, Di Mizio R, Pinto Pinto A et al (1996) Comparative adequacy of conventional radiography, ultrasonography and computed tomography in sixty-one consecutive patients with gastrointestinal perforation. Radiol Med 91:747–755PubMedGoogle Scholar
  13. Grassi R, Pinto A, Rossi G et al (1998) Conventional plain-film radiology, ultrasonography and CT in jejuno-ileal perforation. Acta Radiol 39:52–56PubMedGoogle Scholar
  14. Grassi R, Romano S, Pinto A et al (2004) Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol 50:30–36PubMedCrossRefGoogle Scholar
  15. Ha HK, Kim JS, Lee MS et al (1997) Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology 204:507–512PubMedGoogle Scholar
  16. Hagtvedt T, Aalokken TM, Notthellen J et al (2003) A new low-dose CT examination compared with standard-dose CT in the diagnosis of acute sinusitis. Eur Radiol 13:976–980PubMedGoogle Scholar
  17. Hedrick TL, Sawyer RG, Young JS (2005) MRI for the diagnosis of blunt abdominal trauma: a case report. Emerg Radiol 11:309–311PubMedCrossRefGoogle Scholar
  18. Heverhagen JT, Klose KJ (2009) MR imaging for acute lower abdominal and pelvic pain. RadioGraphics 29:1781–1796PubMedCrossRefGoogle Scholar
  19. Imuta M, Awai K, Nakayama Y et al (2007) Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients. Radiat Med 25:113–118PubMedCrossRefGoogle Scholar
  20. Kalra MK, Prasad S, Saini S et al (2002) Clinical comparison of standard-dose and 50% reduced-dose abdominal CT: effect on image quality. AJR Am J Roentgenol 179:1101–1106PubMedGoogle Scholar
  21. Kalra MK, Maher MM, Prasad SR et al (2003) Correlation of patient weight and cross-sectional dimensions with subjective image quality at standard dose abdominal CT. Korean J Radiol 4:234–238PubMedCrossRefGoogle Scholar
  22. Kalra MK, Rizzo SMR, Novelline RA (2005) Reducing radiation dose in emergency computed tomography with automatic exposure control techniques. Emerg Radiol 11:267–274PubMedCrossRefGoogle Scholar
  23. Kellow ZS, MacInnes M, Kurzencwyg D et al (2008) The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology 248:887–893PubMedCrossRefGoogle Scholar
  24. Lazarus DE, Slywotsky C, Bennett GL et al (2004) Frequency and relevance of the “small-bowel feces” sign on CT in patients with small-bowel obstruction. Am J Roentgenol 183:1361–1366Google Scholar
  25. Leschka S, Alkadhi H, Wildermuth S et al (2005) Multi-detector computed tomography of acute abdomen. Eur Radiol 15:2435–2447PubMedCrossRefGoogle Scholar
  26. Levine MS, Scheiner JD, Rubesin SE et al (1991) Diagnosis of pneumoperitoneum on supine abdominal radiographs. Am J Roentgenol 156:731–735Google Scholar
  27. Marincek B (2002) Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. Eur Radiol 12:2136–2150PubMedGoogle Scholar
  28. Milia DJ, Brasil K (2011) Current use of CT in the evaluation and management of injured patients. Surg Clin N Am 91:233–248PubMedCrossRefGoogle Scholar
  29. Miller F, Bree R, Rosen M, et al. ACR Appropriateness Criteria® October (2008) American College of Radiology Web site. Accessed 10 Apr 2009
  30. Mindelzun RE, Jeffrey RB (1997) Unenhanced helical CT for evaluating acute abdominal pain: a little more cost, a lot more information. Radiology 205:43–45PubMedGoogle Scholar
  31. Novelline RA, Rhea JT, Rao PM et al (1999) Helical CT in emergency radiology. Radiology 213:321–339PubMedGoogle Scholar
  32. Patel SJ, Reede DL, Katz DS et al (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. RadioGraphics 27:1705–172PubMedCrossRefGoogle Scholar
  33. Pinto A, Scaglione M, Pinto F et al (2000) Helical computed tomography diagnosis of gastrointestinal perforation in the elderly patient. Emerg Radiol 7:259–262CrossRefGoogle Scholar
  34. Pinto A, Scaglione M, Giovine S et al (2004) Comparison between the site of multislice CT signs of gastrointestinal perforation and the site of perforation detected at surgery in forty perforated patients. Radiol Med 108:208–217PubMedGoogle Scholar
  35. Poletti P-A, Platon A, Becker CD (2007) Role of imaging in the management of trauma victims. In: Marincek B, Dondelinger RF (eds) Emergency radiology. Imaging and Intervention, Chap. 1.1. Springer, Berlin, pp 3–23Google Scholar
  36. Pradel JA, Adell JF, Taourel P et al (1997) Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology 205:503–512PubMedGoogle Scholar
  37. Prasad SR, Wittram C, Shepard JA et al (2002) Standard-dose and 50%-reduced-dose chest CT: comparing the effect on image quality. Am J Roentgenol 179:461–465Google Scholar
  38. Ptak T, Rhea JT, Novelline RA (2003) Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method: initial experience. Radiology 229:902–905PubMedCrossRefGoogle Scholar
  39. Rao PM, Rhea JT, Novelline RA et al (1998) Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. Am J Roentgenol 170:1445–1449Google Scholar
  40. Rogalla P, Kloeters C, Hein P (2009) CT technology overview: 64-slice and beyond. Radiol Clin North Am 47:1–11PubMedCrossRefGoogle Scholar
  41. Rosen MP, Sands DZ, Esterbrook Longmaid H et al (2000) Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. Am J Roentgenol 174:1391–1396Google Scholar
  42. Shackford SR (1993) Focused ultrasound examinations by surgeons: the time is now. J Trauma 35:181–182PubMedCrossRefGoogle Scholar
  43. Silen W (1996) Cope’s early diagnosis of the acute abdomen, 19th edn. Oxford University Press, New YorkGoogle Scholar
  44. Smith RC, Rosenfield AT, Choe KA et al (1995) Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology 194:789–794PubMedGoogle Scholar
  45. Smith RC, Verga M, McCarthy S et al (1996) Diagnosis of acute flank pain: value of unenhanced helical CT. Am J Roentgenol 166:97–101Google Scholar
  46. Stoker J, van Randen A, Lameris W et al (2009) Imaging patients with acute abdominal pain. Radiology 253:31–46PubMedCrossRefGoogle Scholar
  47. Urban BA, Fishman EK (2000) Tailored helical CT evaluation of acute abdomen. Radiographics 20:725–749PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Vittorio Miele
    • 1
  • Antonio Pinto
    • 2
  • Antonio Rotondo
    • 3
  1. 1.Department of Emergency Radiology S. Camillo HospitalRomeItaly
  2. 2.Department of RadiologyCardarelli HospitalNaplesItaly
  3. 3.Department of RadiologySecond UniversityNaplesItaly

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