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Role of Dual-Energy Computed Tomography (DECT) in Acute Abdomen

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Spectral Imaging

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Acute abdominal and pelvic pain can have a wide range of etiologies, from self-limiting conditions to acute pathologies requiring emergent surgery. Emergency radiology plays a pivotal role in the routine diagnosis and outcomes of patients with these disorders. Computed tomography (CT) with evolved protocols and technological advancements in particular with advent of dual-energy CT remains the first diagnostic modality of choice in patients with non-traumatic surgical abdomen, including appendicitis, cholecystitis, bowel ischemia, bowel obstruction, visceral perforation, bowel hemorrhage, and abdominal aortic aneurysm rupture. Renal calculi are also frequently encountered non-surgical causes of acute abdominal pain.

Conversely of the spectrum, abdominal trauma is one of the leading causes of death and morbidity. Mechanism of injury classifies abdominal trauma into blunt and penetrating. Blunt abdominal trauma usually results from falls from heights, motor vehicle collisions (MVC), and assaults. Penetrating abdominal trauma arises from stab wounds and gunshot wounds. In both blunt and abdominal trauma, imaging should exclude life-threatening injuries after careful examination and primary survey. Ultrasound is rapid and portable imaging modality making it a good option for abdominal trauma screening. However, fast scan is limited to look for hemoperitoneum, and evaluation of intra-abdominal organ injuries is dependent on MDCT. The hemodynamically stable patient should receive a multidetector computed tomography (MDCT) scan with IV contrast in the assessment of visceral and vascular injuries. DECT can increase the conspicuity of traumatic solid organ and hollow visceral damage by utilizing its post-processing applications like selective iodine imaging, virtual monoenergetic imaging.

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Abbreviations

CT:

Computed tomography

DECT:

Dual-energy computed tomography

ED:

Emergency department

GI:

Gastrointestinal

IV:

Intravenous

MDCT:

Multidetector computed tomography

MVC:

Motor vehicle collisions

VNC:

Virtual non- contrast

References

  • Ascenti G, Mileto A, Krauss B et al (2013) Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification versus standard enhancement measurements. Eur Radiol 23(8):2288–2295

    Article  PubMed  Google Scholar 

  • Brofman N, Atri M, Hanson JM, Grinblat L, Chughtai T, Brenneman F (2006) Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics 26(4):1119–1131

    Article  PubMed  Google Scholar 

  • Dinkel HP, Dansuer H, Triller J (2002) Blunt renal trauma: minimally invasive management with microcatheter embolization – experience in nine patients. Radiology 223(3):723–730

    Article  PubMed  Google Scholar 

  • Dreizin D, Munera F (2012) Blunt polytrauma: evaluation with 64-section whole-body CT angiography. Radiographics 32(3):609–631

    Article  PubMed  Google Scholar 

  • Elbanna KY, Mohammed MF, Chahal T, Khosa F, Ali IT, Berger FH, Nicolaou S (2018) Dual-energy CT in differentiating nonperforated gangrenous appendicitis from uncomplicated appendicitis. Am J Radiol 211:776–782

    Google Scholar 

  • Federle MP, Courcoulas AP, Powell M, Ferris JV, Peitzman AB (1998) Blunt splenic injury in adults: clinical and CT criteria for management, with emphasis on active extravasation. Radiology 206(1):137–142

    Article  CAS  PubMed  Google Scholar 

  • Glazer DI, Maturen KE, Kaza RK et al (2014) Adrenal incidentaloma triage with single-source (fast-kilovoltage switch) dual-energy CT. AJR Am J Roentgenol 203(2):329–335

    Article  PubMed  PubMed Central  Google Scholar 

  • Grajo JR, Patino M, Prochowski A, Sahani DV (2016) Dual energy CT in practice: basic principles and applications. Appl Radiol 2:6–12

    Article  Google Scholar 

  • Hamid S, Nicolaou S, Khosa F, Andrews G, Murray N, Abdellatif W, Qamar SR (2020) Dual-energy CT: a paradigm shift in acute traumatic abdomen. Can Assoc Radiol J 71(3):371–387. https://doi.org/10.1177/0846537120905301. Epub 2020 Mar 11.PMID: 32157893

    Article  PubMed  Google Scholar 

  • Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28(6):1603–1616

    Article  PubMed  Google Scholar 

  • Hidas G, Eliahou R, Duvdevani M, Coulon P, Lemaitre L, Gofrit ON, Pode D, Sosna J (2010) Determination of renal stone composition with dual-energy CT: in vivo analysis and comparison with X-ray diffraction. Radiology 257(2):394–401

    Article  PubMed  Google Scholar 

  • https://radiopaedia.org/articles/bowel-perforation-summary

  • Iochum S, Ludig T, Walter F’d’r, Sebbag H, Grosdidier G, Blum AG (2002) Imaging of diaphragmatic injury: a diagnostic challenge? Radiographics 22(1):S103–SS18

    Article  PubMed  Google Scholar 

  • Iraha Y, Okada M, Iraha R, Azama K, Yamashiro T, Tsubakimoto M, Aoki Y, Murayama S (2017) CT and MR imaging of gynecologic emergencies. Radiographics 37:1569–1586

    Article  PubMed  Google Scholar 

  • Jeremy R, Wortman JWU, Fulwadhva UP, Sodickson AD (2018) Dual-energy CT for abdominal and pelvic trauma. Radiographics 38(2):586–602

    Article  Google Scholar 

  • Joseph DK, Kunac A, Kinler RL et al (2013) Diagnosing blunt hollow viscus injury: is computed tomography the answer? Am J Surg 205(4):414–418

    Article  PubMed  Google Scholar 

  • Kamin RA, Nowicki TA, Courtney DS, Powers RD (2003) Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin North Am 21:61–72

    Article  PubMed  Google Scholar 

  • Kim JE, Lee JM, Baek JH, Han JK (2012) Initial assessment of dual-energy CT in patients with gallstones or bile duct stones: can virtual nonenhanced images replace true nonenhanced images? Am J Roentgenol 198(198):817–824. https://doi.org/10.2214/AJR.11.6972

    Article  Google Scholar 

  • Korn A, Bender B, Thomas C et al (2011) Dual energy CTA of the carotid bifurcation: advantage of plaque subtraction for assessment of grade of the stenosis and morphology. Eur J Radiol 80(2):e120–e1e5

    Article  CAS  PubMed  Google Scholar 

  • Landry BA, Patlas MN, Faidi S et al (2016) Are we missing traumatic bowel and mesenteric injuries? Can Assoc Radiol J 67(4):420–425

    Article  PubMed  Google Scholar 

  • Macari M, Spieler B, Kim D et al (2010) Dual-source dualenergy MDCT of pancreatic adenocarcinoma: initial observations with data generated at 80 kVp and at simulated weighted-average 120 kVp. AJR Am J Roentgenol 194(1):W27–W32

    Article  PubMed  Google Scholar 

  • Marin D, Nelson RC, Barnhart H et al (2010) Detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase: effect of a low-tube-voltage, high-tube-current CT technique – preliminary results. Radiology 256(2):450–459

    Article  PubMed  Google Scholar 

  • Marmery H, Shanmuganathan K, Alexander MT, Mirvis SE (2007) Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 189(6):1421–1427

    Article  PubMed  Google Scholar 

  • McGuire J, Bultitude MF, Davis P, Koukounaras J, Royce PL, Corcoran NM (2011) Predictors of outcome for blunt high grade renal injury treated with conservative intent. J Urol 185(1):187–191

    Article  PubMed  Google Scholar 

  • McNamara MM, Little MD, Alexander LF, Carroll LV, Beasley TM, Morgan DE (2015) Multireader evaluation of lesion conspicuity in small pancreatic adenocarcinomas: complimentary value of iodine material density and low keV simulated monoenergetic images using multiphasic rapid kVp-switching dual energy CT. Abdom Imaging 40(5):1230–1240

    Article  PubMed  Google Scholar 

  • Mirvis SE, Shanmuganathan K, Erb R (1994) Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR Am J Roentgenol 163(6):1375–1379

    Article  CAS  PubMed  Google Scholar 

  • Murray N, Darras KE, Walstra FE, Mohammed MF, McLaughlin PD, Nicolaou S (2019) Dual-energy CT in evaluation of the acute abdomen. Radiographics 39:264–286

    Article  PubMed  Google Scholar 

  • Navsaria PH, Nicol AJ, Krige JE et al (2009) Selective nonoperative management of liver gunshot injuries. Ann Surg 249(4):653–656

    Article  PubMed  Google Scholar 

  • Patel BN, Thomas JV, Lockhart ME, Berland LL, Morgan DE (2013) Single-source dual-energy spectral multidetector CT of pancreatic adenocarcinoma: optimization of energy level viewing significantly increases lesion contrast. Clin Radiol 68(2):148–154

    Article  CAS  PubMed  Google Scholar 

  • Potretzke TA, Brace CL, Lubner MG, Sampson LA, Willey BJ, Lee FT Jr (2015a) Early small-bowel ischemia: dal-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology 275:119–126

    Article  PubMed  Google Scholar 

  • Potretzke TA, Brace CL, Lubner MG, Sampson LA, Willey BJ, Lee FT Jr (2015b) Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology 25(1):119–126

    Article  Google Scholar 

  • Rakita D, Newatia A, Hines JJ, Siegel DN, Friedman B (2007) Spectrum of Ct findings in rupture and impending rupture of abdominal aortic aneurysms, impending rupture of abdominal aortic aneurysms. Radiographics 27:497–507

    Article  PubMed  Google Scholar 

  • Ratanaprasatporn L, Uyeda JW, Wortman JR, Richardson I, Sodickson AD (2018) Multimodality imaging, including dual-energy CT in the evaluation of gallbladder disease. Radiographics 38:75–89

    Article  PubMed  Google Scholar 

  • Rekhi S, Anderson SW, Rhea JT, Soto JA (2010) Imaging of blunt pancreatic trauma. Emerg Radiol 17(1):13–19

    Article  PubMed  Google Scholar 

  • Robinson E, Babb J, Chandarana H, Macari M (2010) Dual source dual energy MDCT: comparison of 80 kVp and weighted average 120 kVp data for conspicuity of hypo-vascular liver metastases. Investig Radiol 45(7):413–418

    Article  Google Scholar 

  • Shanmuganathan K, Mirvis SE, Boyd-Kranis R, Takada T, Scalea TM (2017) Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology 1:75–82

    Google Scholar 

  • Sivit CJ, Eichelberger MR, Taylor GA (1994) CT in children with rupture of the bowel caused by blunt trauma: diagnostic efficacy and comparison with hypoperfusion complex. AJR Am J Roentgenol 163(5):1195–1198

    Article  CAS  PubMed  Google Scholar 

  • Soto JA, Anderson SW (2012) Multidetector CT of blunt abdominal trauma. Radiology 265(3):678–693

    Article  PubMed  Google Scholar 

  • Sudarski S, Apfaltrer P, Nance JW Jr et al (2014) Objective and subjective image quality of liver parenchyma and hepatic metastases with virtual monoenergetic dual-source dual-energy CT reconstructions: an analysis in patients with gastrointestinal stromal tumor. Acad Radiol 21(4):514–522

    Article  PubMed  Google Scholar 

  • Sulu B, Günerhan Y, Palanci Y, Isler B, Caglayan K (2010) Epidemiological and demographic features of appendicitis and influences of several environment factors. Ulus Travma Acil Cerrahi Derg 16:38–42

    PubMed  Google Scholar 

  • Sun H, Xue H-D, Wang Y-N, Qian J-M, Yu J-C, Zhu F, Zhu H-D, Jin Z-Y, Li X-G (2013) Dual-source dual-energy computed tomography angiography for active gastrointestinal bleeding: a preliminary study. Clin Radiol 68(2):139–147

    Article  CAS  PubMed  Google Scholar 

  • Suzanne Albrecht P (2010) Management of diverticular disease. Gastroenterology 35:12

    Google Scholar 

  • Uyeda JW, LeBedis CA, Penn DR et al (2014) Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology 270(1):99–106

    Article  PubMed  Google Scholar 

  • Venkatesh SK, Wan JM (2008) CT of blunt pancreatic trauma: a pictorial essay. Eur J Radiol 67(2):311–320

    Article  PubMed  Google Scholar 

  • Vlahos I, Chung R, Nair A, Morgan R (2012) Dual-energy CT: vascular applications. AJR Am J Roentgenol 199:s87–s97

    Article  PubMed  Google Scholar 

  • Wallace AB, Raptis CA, Mellnick VM (2016) Imaging of bowel ischemis. Curr Radiol Rep 4:29

    Article  Google Scholar 

  • Wang CK, Tsai JM, Chuang MT, Wang MT, Huang KY, Lin RM (2013) Bone marrow edema in vertebral compression fractures: detection with dual-energy CT. Radiology 269(2):525–533

    Article  PubMed  Google Scholar 

  • White EM, Simeone JF, Mueller PR, Simeone JF, Butch RJ, Warshaw AL, Neff CC, Nardi GL, Ferrucci JT Jr (1986) Pancreatic necrosis: CT manifestations. Radiology 158(2):343

    Article  CAS  PubMed  Google Scholar 

  • Wortman JR, Bunch PM, Fulwadhva UP, Bonci GA, Sodickson AD (2016) Dual-energy CT of incidental findings in the abdomen: can we reduce the need for follow-up imaging? AJR Am J Roentgenol 6:W1–W11

    Google Scholar 

  • Yamada Y, Jinzaki M, Tanami Y, Abe T, Kuribayashi S (2012) Virtual monochromatic spectral imaging for the evaluation of hypovascular hepatic metastases: the optimal monochromatic level with fast kilovoltage switching dual-energy computed tomography. Investig Radiol 47(5):292–298

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada

    Saira Hamid, Muhammad Umer Nasir, Aneta Kecler-Pietrzyk, Adnan Sheikh, Nicolas Murray, Faisal Khosa & Savvas Nicolaou

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  1. Saira Hamid
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  2. Muhammad Umer Nasir
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  3. Aneta Kecler-Pietrzyk
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  4. Adnan Sheikh
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  5. Nicolas Murray
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  6. Faisal Khosa
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  7. Savvas Nicolaou
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Correspondence to Saira Hamid .

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Editors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland

    Hatem Alkadhi

  2. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland

    André Euler

  3. Department of Radiology, Universitätsklinikum Köln, Köln, Nordrhein-Westfalen, Germany

    David Maintz

  4. Department of Radiology, University of Washington, Seattle, WA, USA

    Dushyant Sahani

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Hamid, S. et al. (2022). Role of Dual-Energy Computed Tomography (DECT) in Acute Abdomen. In: Alkadhi, H., Euler, A., Maintz, D., Sahani, D. (eds) Spectral Imaging. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-96285-2_17

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  • DOI: https://doi.org/10.1007/978-3-030-96285-2_17

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