E4602. Points of Debate, Myths, and Misconceptions in Cross Sectional Abdominal Imaging: What is the Actual Evidence?
Authors
Nikitha Karkala;
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health
John Hines;
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health
Douglas Katz;
NYU Long Island School of Medicine
Background
There are many teachings in the radiology and general medicine literature which we as radiologists use to guide diagnostic interpretations and clinical decisions, however are these in fact accurate? Have they stood the test of time, or are they now outdated, and should be replaced by more current evidence-based knowledge? Was there sufficient evidence to implement these teachings in the first place? In this educational exhibit, we will review a sampling of such teachings in the subspecialty of gastrointestinal radiology.
Educational Goals / Teaching Points
In this educational exhibit, we will investigate the topics listed below. These will be examined in the light of the most recent available evidence, illustrated with examples from our academic radiology practices. Based on the available evidence, we will also discuss whether or not our treatments and recommendations should be updated. Are lung metastases from colon cancer rare in the absence of liver metastases? Lymphoma is a cause of the “misty mesentery”, and the “misty mesentery” on CT should be followed up as it may indicate early lymphoma. Does instillation of gel in the rectum for rectal cancer MRI staging artifactually decrease the circumferential resection margin in rectal cancer patients? Does a patient with acute diverticulitis as identified on CT need a follow-up optical colonoscopy because of an increased risk for colon cancer? Does localized extraluminal gas on CT (“microperforation”) in a patient with diverticulitis worsen the prognosis? Which modality (CT or fluoroscopy) is superior for detection of an upper GI tract (esophagus, stomach, duodenum) perforation? Should gallbladder polyps larger than 1 cm in size be resected due to risk of malignancy?
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this presentation, we will explore various modalities including CT, MRI, fluoroscopy, and PET as they relate to the topics of interest. We will illustrate relevant imaging findings and describe how they can help with diagnostic interpretation.
Conclusion
Cross-sectional abdominal imaging is a dynamic field with ongoing debates and evolving evidence. It is crucial for radiologists to stay informed about the latest research to make well-informed recommendations.
