Whereas considered use of iodinated distinction media (ICM) could stay some extent of emphasis within the wake of final 12 months’s world ICM scarcity, the authors of a brand new examine warning in regards to the shortcomings of non-contrast computed tomography (CT) for diagnosing stomach ache in emergency departments (EDs).
For the multicenter examine, just lately revealed in JAMA Surgical procedure, researchers examined using non-contrast CT in 201 consecutive grownup sufferers (imply age of fifty.1) who offered to emergency departments with acute stomach ache. Out of the 211 sufferers, 98 sufferers had a complete of 104 main diagnoses 17 sufferers had secondary diagnoses and 92 sufferers had no main or secondary diagnoses, in line with the examine.
After the institution of a reference customary with dual-energy contrast-enhanced CT (CECT) in these sufferers, researchers digitally subtracted oral and IV distinction media. Then the examine authors assessed the efficiency of three specialist school radiologists and three radiology residents who interpreted the unenhanced CT scans.
Specialist radiologist school and radiology residents had a 70 % accuracy price general for deciphering unenhanced CT, in line with the examine authors.
“It is very important perceive the danger of withholding distinction medium so knowledgeable risk-benefit analyses might be made. On this consecutive cohort of ED sufferers presenting with stomach ache, unenhanced CT was persistently roughly 30 proportion factors much less correct than contrast-enhanced CT for main and secondary actionable findings,” wrote Matthew S. Davenport, M.D., who’s a William Martel Collegiate Professor of Radiology and co-director of the Ronald Weiser Heart for Prostate Most cancers throughout the Division of Stomach Radiology on the College of Michigan, and colleagues.
(Editor’s word: For associated content material, see “Examine Seems at Functionality of AI for Detecting Missed Liver Metastases on CECT,” “May Photon Counting CT Supplant MRI for Imaging Evaluation of Hepatic Steatosis?” and “Seven Takeaways from Greatest Apply Suggestions for Incidental Radiology Findings within the ER.”)
For main diagnoses, the examine authors mentioned the college radiologists had greater accuracy charges than the residents (82 % vs. 76 %). Whereas reviewing residents had higher accuracy charges for actionable secondary diagnoses (90 % vs. 87 % for school radiologists), Davenport and colleagues mentioned false-positive and false-negative diagnoses had an influence with these statistics. For school radiologists, there have been fewer false-negative outcomes for sufferers with main diagnoses (38 % vs. 62 % for residents) and a larger proportion of false-positive secondary diagnoses (63 % vs. 37 % for residents).
The examine authors identified that school radiologists had false-positive charges with unenhanced CT that ranged between 10 to 21 % and false-negative charges ranging between 13 to 19 %. Reviewing radiology residents had false-positive charges ranging between 8 to 19 % and false-negative charges between 15 to 27 %.
“False-negative outcomes at unenhanced CT could happen because of misdiagnosis or underdiagnosis and false-positive outcomes could happen from impaired radiologist confidence. These errors can hurt sufferers, delay care, and lead to further unneeded testing and intervention,” maintained Davenport and colleagues.
Past the inherent limitations of a retrospective examine, the authors acknowledged that the unenhanced CT knowledge was generated by subtracting oral and IV distinction medium from the examine’s reference customary. In addition they conceded that using single-energy, non-contrast CT could have resulted in several diagnostic accuracy charges.