Abstract
Objectives
Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels.
Methods
Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present.
Results
Overall sensitivity with 95 % CI for CT was 75 % (66–83 %) and 46 % (37–56 %) for radiography. Specificity was 87 % (77–94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %.
Conclusions
Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain.
Key Points
• Low-dose CT has a higher diagnostic accuracy than radiography.
• A systematic review shows that CT has better diagnostic accuracy than radiography.
• Radiography has no place in the workup of acute non-traumatic abdominal pain.
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Acknowledgements
Many thanks to Birger Persson and Per Ingverud for participating in the image evaluations. Thanks also to Margareta Landin at the Medical Library, Örebro University, for assistance with literature searches and to Ruzan Udumyan, Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, for statistical consultations. The scientific guarantor of this publication is Håkan Geijer. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study received funding from Region Örebro County. Ruzan Udumyan, Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, kindly provided statistical advice for the systemic review in this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.
Methodology: prospective diagnostic study and systematic review, performed at one institution.
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Alshamari, M., Norrman, E., Geijer, M. et al. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. Eur Radiol 26, 1766–1774 (2016). https://doi.org/10.1007/s00330-015-3984-9
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DOI: https://doi.org/10.1007/s00330-015-3984-9