Transvaginal US vs. CT in non-pregnant premenopausal women presenting to the ED: clinical impact of the second examination when both are performed.
Computed tomography
Non-traumatic abdominal pain
Nonpregnant
Premenopausal
Ultrasound
Journal
Abdominal radiology (New York)
ISSN: 2366-0058
Titre abrégé: Abdom Radiol (NY)
Pays: United States
ID NLM: 101674571
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
23
11
2021
accepted:
18
03
2022
revised:
17
03
2022
pubmed:
9
4
2022
medline:
18
5
2022
entrez:
8
4
2022
Statut:
ppublish
Résumé
To determine the clinical impact of the second examination when both CT and TVUS are obtained in the same ED visit for acute pelvic/lower abdominal symptoms in non-pregnant premenopausal women. 200 consecutive non-pregnant premenopausal women (mean age, 31.8 years; range, 18-49 years) who underwent both ED-based TVUS and abdominopelvic CT evaluation for acute symptoms over a 12 month period were included; 107 women had TVUS first, followed by CT; 93 women had CT first. All relevant clinical, radiologic, and pathologic findings were reviewed to establish a final diagnosis. Any additional clinical impact provided by the second imaging test was assessed by two experienced abdominal radiologists. Initial TVUS was interpreted as normal (n = 63) or mentioned incidental findings (n = 11) in 69% (74/107); subsequent CT established a non-gynecologic GI/GU etiology in 25 (34%). For 37% (34/93) of CT exams interpreted as normal, TVUS added no new information. In 32 cases (34%), TVUS further excluded ovarian torsion/adnexal pathology when initial CT was indeterminate/equivocal. Overall, CT following TVUS provided a key new or alternative diagnosis in 26% (28/107), whereas TVUS after CT provided a relevant new/alternative diagnosis in only 1/93 cases (p < 0.001). In nine cases (8%), CT confirmed a positive US diagnosis but detected relevant additional diagnostic information. CT following negative TVUS frequently identified a non-gynecologic cause of acute pelvic or lower abdominal symptoms in non-pregnant premenopausal women, whereas the main benefit of TVUS after CT was more confident exclusion of ovarian torsion.
Identifiants
pubmed: 35394154
doi: 10.1007/s00261-022-03504-6
pii: 10.1007/s00261-022-03504-6
pmc: PMC8990505
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2209-2219Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Stoker J, van Randen A, Lameris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology. 2009;253(1):31-46.
doi: 10.1148/radiol.2531090302
Potter AW, Chandrasekhar CA. US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 2008;28(6):1645-59.
doi: 10.1148/rg.286085504
Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol. 2009;52(1):2-20.
doi: 10.1097/GRF.0b013e3181958173
Andreotti RF, Lee SI, Choy G, DeJesus Allison SO, Bennett GL, Brown DL, et al. ACR Appropriateness Criteria on acute pelvic pain in the reproductive age group. J Am Coll Radiol. 2009;6(4):235-41.
doi: 10.1016/j.jacr.2008.12.004
Andreotti RF, Lee SI, Dejesus Allison SO, Bennett GL, Brown DL, Dubinsky T, et al. ACR Appropriateness Criteria(R) Acute Pelvic Pain in the Reproductive Age Group. Ultrasound Q. 2011;27(3):205-10.
doi: 10.1097/RUQ.0b013e318229ff88
Grunau GL, Harris A, Buckley J, Todd NJ. Diagnosis of Ovarian Torsion: Is It Time to Forget About Doppler? J Obstet Gynaecol Can. 2018;40(7):871-5.
doi: 10.1016/j.jogc.2017.09.013
Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med. 2011;30(9):1205-10.
doi: 10.7863/jum.2011.30.9.1205
Pickhardt PJ, Lawrence EM, Pooler BD, Bruce RJ. Diagnostic performance of multidetector computed tomography for suspected acute appendicitis. Ann Intern Med. 2011;154(12):789-96, W-291.
doi: 10.7326/0003-4819-154-12-201106210-00006
Duigenan S, Oliva E, Lee SI. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol. 2012;198(2):W122-31.
doi: 10.2214/AJR.10.7293
Hiatt KD, Ou JJ, Childs DD. Role of Ultrasound and CT in the Workup of Right Upper Quadrant Pain in Adults in the Emergency Department: A Retrospective Review of More Than 2800 Cases. AJR Am J Roentgenol. 2020;214(6):1305-10.
doi: 10.2214/AJR.19.22188
Pooler BD, Lawrence EM, Pickhardt PJ. Alternative diagnoses to suspected appendicitis at CT. Radiology. 2012;265(3):733-42.
doi: 10.1148/radiol.12120614
Henes FO, Pickhardt PJ, Herzyk A, Lee SJ, Motosugi U, Derlin T, et al. CT angiography in the setting of suspected acute mesenteric ischemia: prevalence of ischemic and alternative diagnoses. Abdom Radiol (NY). 2017;42(4):1152-61.
doi: 10.1007/s00261-016-0988-0
Mathur M, Scoutt LM. Nongynecologic Causes of Pelvic Pain: Ultrasound First. Obstet Gynecol Clin North Am. 2019;46(4):733-53.
doi: 10.1016/j.ogc.2019.07.007
Lameris W, van Randen A, van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ. 2009;338:b2431.
doi: 10.1136/bmj.b2431
Kanal KM, Butler PF, Sengupta D, Bhargavan-Chatfield M, Coombs LP, Morin RL. U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations. Radiology. 2017;284(1):120-33.
doi: 10.1148/radiol.2017161911
Gao Y, Lee K, Camacho M. Utility of pelvic ultrasound following negative abdominal and pelvic CT in the emergency room. Clin Radiol. 2013;68(11):e586-92.
doi: 10.1016/j.crad.2013.05.101
Yitta S, Mausner EV, Kim A, Kim D, Babb JS, Hecht EM, et al. Pelvic ultrasound immediately following MDCT in female patients with abdominal/pelvic pain: is it always necessary? Emerg Radiol. 2011;18(5):371-80.
doi: 10.1007/s10140-011-0962-7
Lehtimaki T, Juvonen P, Valtonen H, Miettinen P, Paajanen H, Vanninen R. Impact of routine contrast-enhanced CT on costs and use of hospital resources in patients with acute abdomen. Results of a randomised clinical trial. Eur Radiol. 2013;23(9):2538-45.
doi: 10.1007/s00330-013-2848-4
Rosen MP, Sands DZ, Longmaid HE, 3rd, Reynolds KF, Wagner M, Raptopoulos V. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR Am J Roentgenol. 2000;174(5):1391-6.
doi: 10.2214/ajr.174.5.1741391
Foinant M, Lipiecka E, Buc E, Boire JY, Schmidt J, Garcier JM, et al. [Impact of computed tomography on patient's care in nontraumatic acute abdomen: 90 patients]. J Radiol. 2007;88(4):559-66.
doi: 10.1016/S0221-0363(07)89855-6
Raman Patil A, Nandikoor S, Chaitanya Reddy S. CT in the diagnosis of adnexal torsion: a retrospective study. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2020;40(3):388-94.
doi: 10.1080/01443615.2019.1633514