From the Guidelines
Contrast-enhanced computed tomography (CE CT) of the upper abdomen is indicated for evaluating a wide range of conditions, particularly for assessing suspected pancreatic masses or inflammation, as it provides high-quality images for diagnosing pancreatic cancer and other abdominal pathologies, as recommended by the most recent guidelines 1.
Indications for CE CT Upper Abdomen
The following conditions are indications for CE CT of the upper abdomen:
- Suspected liver lesions (including metastases, hemangiomas, and primary tumors)
- Pancreatic masses or inflammation
- Adrenal abnormalities
- Splenic lesions
- Vascular conditions such as aneurysms or thrombosis
- Trauma assessment to identify active bleeding, organ lacerations, or hematomas
- Characterization of abdominal masses
- Evaluation for abscesses
- Assessment for complications of pancreatitis
Technical Considerations
Technical optimization is essential for high-quality CT images, including:
- Multiphase thin-section images including pancreatic, arterial, and portal venous phases
- Intravenous iodinated non-ionic contrast agent injection at 1.5 ml/kg and at a rate of 4-5 ml/s, as recommended by the ESMO clinical practice guideline for diagnosis, treatment, and follow-up of pancreatic cancer 1
Contraindications and Precautions
Before proceeding with CE CT, patients should be screened for contraindications, including:
- Severe renal impairment (eGFR <30 mL/min)
- Previous contrast reactions
- Metformin use (which may need temporary discontinuation) Adequate hydration before and after the procedure helps reduce the risk of contrast-induced nephropathy.
Diagnostic Criteria
Diagnostic criteria for pancreatic cancer include direct signs such as a hypovascular tumor and indirect signs such as main pancreatic and/or common bile duct dilation, segmental atrophy of the parenchyma, and abnormalities in pancreatic contour, as outlined in the ESMO guideline 1.
Comparison with Other Imaging Modalities
While other imaging modalities like MRI and PET-CT may be used in specific cases, CE CT remains the primary modality for diagnosing pancreatic cancer and other abdominal pathologies due to its high sensitivity and specificity, as supported by the most recent evidence 1.
From the FDA Drug Label
OMNIPAQUE diluted to concentrations from 6 mg Iodine/mL to 9 mg Iodine/mL administered orally in conjunction with OMNIPAQUE 300 at a concentration of 300 mg Iodine/mL administered intravenously is indicated in adults for contrast enhanced computed tomography of the abdomen. OMNIPAQUE diluted to concentrations from 9 mg Iodine/mL to 21 mg Iodine/mL administered orally in conjunction with OMNIPAQUE 300 at a concentration of 300 mg Iodine/mL administered intravenously are indicated in pediatric patients for use in contrast enhanced computed tomography of the abdomen.
Contrast-Enhanced (CE) CT Upper Abdomen Indications:
- Adults: CE CT upper abdomen is indicated when using OMNIPAQUE 300 at a concentration of 300 mg Iodine/mL administered intravenously in conjunction with oral administration of OMNIPAQUE at concentrations from 6 mg Iodine/mL to 9 mg Iodine/mL.
- Pediatric Patients: CE CT upper abdomen is indicated when using OMNIPAQUE 300 at a concentration of 300 mg Iodine/mL administered intravenously in conjunction with oral administration of OMNIPAQUE at concentrations from 9 mg Iodine/mL to 21 mg Iodine/mL 2.
From the Research
Indications for CE CT Upper Abdomen
The following are indications for CE CT upper abdomen:
- Colorectal cancer screening, as CE CT can identify signs of CRC, such as intraluminal mass, eccentric or circumferential wall thickening, focal wall enhancement, pericolic fat stranding, and enlarged lymph nodes 3
- Diagnosing acute appendicitis, as enhanced CT is superior to noncontrast CT in diagnosing appendicitis in all age and gender groups 4
- Evaluating new-onset painless jaundice, as CE CT can be used to detect biliary dilatation and diagnose the underlying cause of jaundice 5
- Investigating recurrent abdominal pain, although the evidence is limited and inconclusive 6
- Suspected appendicitis, as conditional CE CT (after negative or inconclusive ultrasound findings) can be used to diagnose appendicitis, although it may result in more false positives compared to immediate CE CT 7
Specific Conditions
Some specific conditions that may require CE CT upper abdomen include:
- Abdominal complaints, such as pain or jaundice, where the cause is unknown or suspected to be related to the colon, appendix, or biliary system 3, 4, 5
- Colonic polyps or suspected CRC, where CE CT can be used to identify signs of cancer and guide further investigation or treatment 3
- Acute appendicitis, where enhanced CT is recommended for diagnosis due to its high sensitivity and specificity 4