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Introduction: Undifferentiated abdominal pain in the emergency setting is frequently investigated with an intravenous contrast enhanced CT as a first line diagnostic test. However, global contrast shortages restricted the use of contrast for a period in 2022, altering standard practice with many scans performed without intravenous contrast. Whilst IV contrast can be useful to assist with interpretation, its necessity in the setting of acute undifferentiated abdominal pain is not well described, and its use comes with its own risks. This study aimed to assess the shortcomings of omitting IV contrast in an emergency setting, by comparing the rate of CT scans with "indeterminate" findings with and without the use of IV contrast. Methods: Data from presentations to a single centre emergency department for undifferentiated abdominal pain prior to and during contrast shortages in June 2022 were retrospectively compared. The primary outcome was the rate of diagnostic uncertainty, where the presence or absence of intra‐abdominal pathology could not be ascertained. Results: 12/85 (14.1%) of the unenhanced abdominal CT scans provided an uncertain result, compared with 14/101 (13.9%) of control cases performed with intravenous contrast (P = 0.96). There were also similar rates of positive and negative findings between the groups. Conclusion: Omitting intravenous contrast for abdominal CT in the setting of undifferentiated abdominal pain demonstrated no significant difference in the rate of diagnostic uncertainty. There are significant potential patient, fiscal and societal benefits as well as potential improvements to emergency department efficiency with the reduction of unnecessary intravenous contrast administration. [ABSTRACT FROM AUTHOR]

Despite the advances in the medical care, tuberculosis (TB) still remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11-12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings. [ABSTRACT FROM AUTHOR]

Introduction: Computed tomography colonography (CTC) for the detection of colorectal disease is gaining popularity as an alternative to colonoscopy. This has been associated with an increase in incidental extra-colonic findings such as abdominal aortic aneurysms. However, due to the patient selection process of obtaining a CTC, it was hypothesised that this patient cohort might represent a high-risk group. The primary aim of this study was to determine the impact that CTC had on small aneurysm referrals. Owing to the potential selection bias, the secondary aim was to compare baseline characteristics referred by CTC to the cohort referred by other radiological modalities.Methods: Consecutive patients attending the small aneurysm clinic at a single tertiary centre were included. Baseline patient comorbidities were collected and recorded on a prospective database. The characteristics of patients who had a CTC-detected aneurysm were compared to patients referred by other radiological modalities.Results: There were 566 patients with small aneurysms included. Of these, 96 (17.0%) had their aneurysm detected from CTC and the remaining aneurysms were detected by other radiological modalities. These patients were on average 2 years older and were less likely to have a smoking history. There was no difference in other patient characteristics.Conclusion: Computed tomography colonography contributed to the initial diagnosis of one in five patients with small aneurysms. Despite a potential selection bias for patients undergoing CTC, there were no major baseline differences between the CTC cohort and patients referred by other radiological modalities. Routine assessment of the aorta during a CTC may aid in aneurysm detection. [ABSTRACT FROM AUTHOR]

Introduction Duodenojejunal flexure ( DJF) orientation is often examined routinely during contrast swallow studies, including those performed for purely oesophageal queries. We examine the radiation burden and the incidence of malrotation in patients undergoing contrast swallow, without clinical suspicion for malrotation. Methods Two hundred eighteen consecutive contrast swallow studies were reviewed. Patients whose history may potentially suggest malrotation were identified ( n = 90), and remaining children were grouped based on whether DJF was examined (Group 1; n = 88) or not (Group 2; n = 40). Data extracted include demographics, radiographic parameters (dosage, screening time, number of images obtained) and examination findings. Outcome measures comprised: (i) prevalence of clinically incidental malrotation; and (ii) influence of additional evaluation of DJF on patient dosage (mean ± SEM). Results Malrotation was identified in 2 of 90 patients (2.2%) examined with clinical indications for possible malrotation, but none in Group 1 (13% already had normal DJF confirmed on previous examinations). Groups 1 and 2 were comparable with respect to age and gender ( P = ns). Additional evaluation of DJF (Group 1) meant that 54% more images were acquired (48.5 ± 2.9 vs. 31.4 ± 3.4 images in group 2; P = 0.0002) and 24.9% increased screening time (130.8 ± 9.3 vs. 104.7 ± 13.0 seconds in group 2; P = 0.089), resulting in 32.6% increased patient dosage (1.36 ± 0.21 vs. 1.02 ± 0.16 microGym2/kg in group 2; P = 0.19). Conclusions This study highlights the increased radiation exposures involved with routine screening for DJF position in those patients without clinical suspicion of malrotation, and raises questions about the validity of this practice; however, further research is needed. [ABSTRACT FROM AUTHOR]

Aim To determine the sensitivity of computed tomographic colonography ( CTC) in the detection of colorectal cancer in our population and evaluate the reasons why these lesions may be missed on CTC. Methods All patients who underwent CTC in the 65-month period from 1 January 2004 to 1 July 2009 were included in the analysis. Demographic data and CTC findings were recorded, according to the CT Colonography Reporting and Data System. Data were cross-matched with the National Cancer Registry results for colorectal cancer cases between 1 January 2004 and 1 October 2009, 3 months longer to include any delayed diagnoses. Results There were 2026 consecutive CTC patients, comprising 52.6% female, average age of 60 years; range 19-87. Approximately 84% were symptomatic. There were 45 confirmed colorectal cancers among this patient group in the National Cancer Registry during the relevant time period compared with 43 suspected cancers on CTC, giving a miss rate of 2 of 45, or 4.4%. Conclusion The sensitivity of 95% for CTC in the detection of colorectal cancer compares favourably with the published national and international data. [ABSTRACT FROM AUTHOR]

Despite the high diagnostic accuracy of CT for appendicitis, numerous pitfalls exist that may result in a misdiagnosis. This pictorial review outlines the potential pitfalls in the CT diagnosis of appendicitis that includes atypical position of the appendix and coexisting pathologies. Various mimickers of appendicitis and clinical dilemmas will be highlighted. Upon completion, the reviewer should have an improved ability to recognise appendicitis mimickers and identify equivocal or atypical findings. [ABSTRACT FROM AUTHOR]

Introduction This study aims to determine the diagnostic accuracy of Primovist-enhanced MRI in the detection of hepatocellular carcinoma ( HCC) in cirrhosis, using liver explant histopathology correlation. Methods Thirty patients underwent a Primovist-enhanced MRI prior to liver transplantation for cirrhosis at the Princess Alexandra Hospital from 2006 to June 2012. Pre-contrast T1, T2 and post-Primovist arterial, portal venous and delayed hepatobiliary phase sequences were routinely obtained. A retrospective audit of MRI reports determined whether HCCs was identified on pre-transplantation imaging. Results were correlated to the explant liver histopathology. Specificity and sensitivity of Primovist in HCC identification in cirrhosis was determined. Results The time interval between preoperative MRI and transplantation ranged from the day of transplantation to 112 weeks pre-transplantation. Thirty-nine HCCs were identified histologically in explants. Fifteen HCCs were identified on pre-transplant MRI in 11 patients, ranging from 11 to 43 mm, all confirmed on histopathology. Fourteen MRI studies identified no lesion, concordant on histology. Twenty-four either well or moderately differentiated HCCs were identified on histopathology, all of which were less than 17 mm, were not depicted on MRI. No poorly differentiated HCCs were present in the explants. Two regenerative nodules were correctly identified on MRI. This correlated to a sensitivity of 42.5%, specificity of 100% and a positive predictive value of 100% and negative predictive value of 39.5%. Conclusion Primovist-enhanced MRI is very accurate in the identification of HCC in cirrhosis, especially if the tumour is greater than 17 mm and undifferentiated. However, sensitivity is reduced for well- and moderately differentiated HCC less than 17 mm. [ABSTRACT FROM AUTHOR]

Summary This essay illustrates the usefulness of MRI in evaluating perianal fistulas, a common disease, notorious for recurrence if not assessed and treated adequately. MRI exquisitely depicts the perianal anatomy and shows the fistulous tracks and their associated ramifications and abscesses. It thus provides an excellent preoperative understanding of the disease, enabling selection of the most appropriate surgical treatment and therefore minimising all chances of recurrence. [ABSTRACT FROM AUTHOR]

This study was carried out to review our experience with 3-T MRI in the assessment of Crohn disease in a paediatric population. Twenty-four patients with biopsy proven Crohn disease identified on the radiology information system underwent abdominal MRI, with or without pelvic MRI. Twenty-eight studies were carried out on a 3-T scanner at a tertiary paediatric hospital. Eight of 24 of these (30%) had a gastrointestinal barium study, 2 of 24 (8%) a CT and 9 of 24 (38%) an abdominal ultrasound. The different MRI sequences were rated for observation of the bowel wall and abnormalities (0–5). The findings were correlated to relevant findings on endoscopy, examination under anaesthesia (EUA) and where available surgery, barium studies, CT and ultrasound. In this study, the colon was involved in 5 of 28 (18%), small bowel in 7 of 28 (25%), terminal ileum in 5 of 28 (18%). All the perineal studies (9 of 9) showed abnormalities. Sinus tracts or fistulas were identified in 7 of 28 (25%) studies. The mean rating of the different MRI sequences in showing bowel wall and changes of Crohn disease was T2 TSE 3.6, T2 half fourier aquisition single shot turbo spin echo (HASTE) with a long TE 3.6, T2 HASTE with short TE 3.4, true fast imaging with steady state precession (FISP) 2.7, T1 4.1 and Post-contrast T1 4.3. The T2 HASTE sequences with thinner slices improved observation. Detection of superficial abnormalities was similar on the 3D VIBE images and on the post-contrast T1 spin-echo (SE) sequences. In five of nine (56%) of those that had ultrasound, both studies were abnormal, with incomplete correlation of the abnormalities. Computed tomography and MRI were abnormal in two of two (100%) patients with good correlation of the abnormalities in one; in the other there was a minimal discrepancy in the estimation of the length of involved bowel. In 7 of 11 (64%) the barium study was abnormal. Good correlation to MRI findings was found in five of seven (71%) of patients. In two of seven (29%) both studies were abnormal, with incomplete correlation of the abnormalities. Barium underestimated the length of involved segment in these patients with inflammatory ileal thickening and ulceration. Notably, in both studies compression was limited because of patient discomfort and the involved segments obscured by overlap. Abdominal and pelvic MRI at 3 T is a useful imaging technique for evaluation of Crohn disease in the children. The extent of bowel wall involvement and extra-intestinal complications, such as abscesses and fistulas can be accurately assessed non-invasively, without the use of ionizing radiation or sedation. [ABSTRACT FROM AUTHOR]

Circumferential rectal cancers present at a more advanced stage than those located in a single quadrant. Although accurate staging is an important aspect of the preoperative management of the patient with a rectal cancer, the clinical and radiological staging of this subgroup of rectal cancer patients has been poorly studied. All patients with a rectal cancer were assessed clinically (by digital rectal examination and rigid sigmoidoscopy) before the radiological assessment by endorectal ultrasound (ERUS). Data collected included tumour height (distance from anal verge in centimetre) and tumour type (circumferential or non-circumferential). Radiological tumour staging was with the TNM system. Fifty-nine subjects (33 men, 26 women; median age 65 years (range 38–86 years)) were identified with a circumferential rectal cancer. Mean height of the cancer was 8 ± 0.4 cm (standard error of the mean; range 2–13 cm). Forty-two cancers were palpable, and 17 cancers were impalpable. All cancers assessed clinically as circumferential were confirmed as circumferential on ERUS scanning. Tumour stage as assessed by ERUS was either T3 ( n = 57) or T4 ( n = 2). Nodal status was N0 ( n = 29) and N1 ( n = 30). All rectal cancers assessed as circumferential on clinical examination have an ERUS stage of T3 or greater. [ABSTRACT FROM AUTHOR]