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Abdomen CT
 
A computed tomography (CT) of the abdomen images the region from the thoracic diaphragm to the pelvic groin. The computed tomography technique uses x-rays to differentiate tissues by their different radiation absorption rates.
Oral contrast material can be given to opacify the bowel before scanning. An i.v. injection of a contrast agent (x-ray dye) improves the visualization of organs like liver, spleen, pancreas and kidneys and provides additional information about the blood supply.
Spiral- or helical CT, including improvements in detector technology support faster image acquisition with higher quality. Advanced CT systems can usually obtain a CT scan of the whole abdomen during a single breath hold. This speed increases the detection of small lesions (caused by differences in breathing on consecutive scans) and is beneficial especially in pediatric, elderly or critically-ill patients.
Changes in patient weight require variations in x-ray tube potential to maintain constant detector energy fluence. An increased x-ray tube potential improves the contrast to noise resolution (CNR).

An abdominal CT is typically used to help diagnose the cause of abdominal pain and diseases such as:
point appendicitis, diverticulitis;
point kidney and gallbladder calcifications;
point abscesses and inflammations;
point cancer, metastases and other tumors;
point pancreatitis;
point vascular disorders.

Other indications for CT scanning of the abdomen/pelvis include planning radiation treatments, guide biopsies and other minimally invasive procedures. Advanced techniques include for example 3D CT angiography, multiphasic contrast-enhanced imaging, virtual cystoscopy, virtual colonoscopy, CT urography and CT densitometry.
See also Contrast Enhanced Computed Tomography.
 
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  News & More:
Impact of Abdominal CT on the Management of Patients Presenting to the Emergency Department with Acute Abdominal PainOpen this link in a new window
'OBJECTIVE. The purpose of this study is to document the impact of CT performed in the emergency department of patients presenting ...'
Monday, 23 August 1999 by www.ajronline.org    
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Computed Tomography Enterography
 
(CTE) Computed tomography enterography is an imaging procedure to evaluate diseases affecting the mucosa and bowel wall of the small intestine. CTE uses oral contrast agents to improve bowel wall visualization. Several studies established that small bowel distention using negative oral contrast agent increases diagnostic performance of some abdomen CT studies.
The multi-detector row CT (MDCT) improves temporal and spatial resolution and 3D imaging processes offer a full examination of the small bowel with surrounding structures, depicting the small bowel inflammation associated with Crohn's disease by displaying mural hyperenhancement, stratification, and thickening.
CT enterography versus capsule endoscopy provides a non invasive study with comparable sensitivity, high specificity and overall accuracy.
See also Colonoscopy and Virtual Colonoscopy.


  Further Reading:
  News & More:
Computed tomographic enterography adds information to clinical management in small bowel Crohn's disease.Open this link in a new window
'BACKGROUND: CT enterography yields striking findings in the bowel wall in Crohn's disease. These images may help to evaluate ...'
Tuesday, 13 March 2007 by www.ncbi.nlm.nih.gov    
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Contrast Agents
 
(CA) Contrast agents are used to change the imaging characteristics, resulting in additional information about anatomy, morphology or physiology of the human body. Radiocontrast agents (also called photon-based imaging agents) are used to improve the visibility of internal body structures in x-ray and CT procedures. Contrast agents are also used to increase the contrast between different tissues in MRI (magnetic resonance imaging) and ultrasound imaging. The ideal imaging agent provides enhanced contrast with little biological interaction.
First investigations with radiopaque materials are done shortly after the discovery of x-rays. These positive contrast agents attenuate x-rays more than body soft tissues due to their high atomic weight. Iodine and barium have been identified as suitable materials with high radiodensity and are used until today in x-ray and CT contrast agents. Iodine-based contrast agents are water-soluble and the solutions are used nearly anywhere in the body. Iodinated contrast materials are most administered intravenous, but can also be introduced intraarterial, intrathecal, oral, rectal, intravesical, or installed in body cavities. Barium sulfate is only used for opacification of the gastrointestinal tract. Negative contrast agents attenuate x-rays less than body soft tissues, for example gas.

Iodinated contrast media are differentiated in:
point ionic contrast agents:
ionic dimer;
ionic monomer (high-osmolar contrast media).
point nonionic contrast agents:
nonionic dimer (low- or iso-osmolar contrast media);
nonionic monomer (low-osmolar contrast media).
Intravascular iodinated contrast agents are required for a large number of x-ray and CT studies to enhance vessels and organs dependent on the blood supply. Injectable contrast agents are diluted in the bloodstream and rapidly distributed throughout the extracellular fluid. The main route of excretion is through the kidneys, related to the poor binding of the agent to serum albumin. The liver (gall bladder) and small intestine provide alternate routes of elimination particularly in patients with severe renal impairment. The use of special biliary contrast agents is suitable for gallbladder CT and cholecystograms because they are concentrated by the liver to be detectable in the hepatic bile.
The introduction of fast multi-detector row CT technology, has led to the development of optimized contrast injection techniques. The amount of contrast enhancement depends on the contrast agent characteristics, such as iodine concentration, osmolality, viscosity, and the injection protocol, such as iodine flux and iodine dose. Adverse reactions are rare and have decreased with the introduction of nonionic contrast agents.
See also Contrast Enhanced Computed Tomography and Abdomen CT.

• View the NEWS results for 'Contrast Agents' (4).Open this link in a new window. 


  Further Reading:
  Basics:
POSITIVE CONTRAST MATERIAL: IODINATEDOpen this link in a new window
by www.e-radiography.net    
  News & More:
Contrast Medium Reactions, Recognition and TreatmentOpen this link in a new window
by www.emedicine.com    
Guidelines for Contrast Media from the European Society of Urogenital RadiologyOpen this link in a new window
'This perspective will present all guidelines produced to date by the Contrast Media Safety Committee of the European Society of ...'
Wednesday, 2 July 2003 by www.ajronline.org    
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Intravenous Pyelogram
 
(IVP) An intravenous pyelogram is a radiographic study of the kidney, ureters, and bladder. After the injection or infusion of iodinated contrast materials into the vein, the contrast medium is excreted by the kidneys. Due to the higher density of the dye, contrast filled areas appear white on x-ray images.
IVPs are used to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow. A pyelogram may also be performed with contrast media injection directly through a ureteral or nephrostomy catheter or percutaneously.
See also X-Ray Projection Imaging, Abdomen CT and Urologic Ultrasound.
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Omnipaque for Oral Use
 
Omnipaque (iohexol) is a nonionic, low-osmolar contrast agent and is also available for oral use, offering gastrointestinal (GI) visualization with minimal side effects. Omnipaque has a neutral taste that even kids will drink.
Orally administered iohexol is poorly absorbed from the normal gastrointestinal tract. Omnipaque is well tolerated and absorbed if leakage into the peritoneal cavity occurs.
The recommended dosage of undiluted Omnipaque (at a concentration of for example 350 mg/mL) for computed tomography of the abdomen in adults is 500 mL to 1000 mL, diluted to concentrations of 6 mg/mL to 9 mg/mL. The oral dose should be administered about 20 to 40 minutes prior to the CT scan.

Drug Information and Specification
NAME OF COMPOUND Iohexol
MANUFACTURER GE Healthcare
INDICATION Bowel opacification
APPLICATION Oral, rectal
CONCENTRATION 140, 240, 300 or 350 mg iodine
DOSAGE 500 - 1000 mL of diluted solution
PREPARATION Ready-to-use product, dilutable
STORAGE Protect vials and glass or polymer bottles from strong daylight and direct exposure to sunlight. Do not freeze. Storage at controlled room temperature, 20-25C (68- 77F);
PRESENTATION 50, 75, 100, 125, 150, 200 or 250mL bottle or +PLUSPAK (polymer bottle)
DO NOT RELY ON THE INFORMATION PROVIDED HERE, THEY ARE NOT A SUBSTITUTE FOR THE ACCOMPANYING PACKAGE INSERT!


  Further Reading:
  Basics:
Omnipaque? Package Insert(.pdf)Open this link in a new window
by www.amershamhealth-us.com    
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