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This article reviews the research to date, as well as our clinical experience from two institutions, on gadolinium-enhanced computed tomographic angiography (gCTA) for imaging the body. gCTA may be an appropriate examination for the small percentage of patients who would benefit from noninvasive vascular imaging, but who have contraindications to both iodinated contrast and magnetic resonance imaging. gCTA is more expensive than CTA with iodinated contrast, due to the dose of gadolinium administered, and gCTA has limitations compared with CTA with iodinated contrast, in that parenchymal organs are not optimally enhanced at doses of 0.5 mmol/kg or lower. However, in our experience, gCTA has been a very useful problem-solving examination in carefully selected patients. With the advent of 16-64 detector CT, in combination with bolus tracking, we believe that the overall dose of gadolinium needed for diagnostic CTA examinations, while relatively high, can be safely administered.

BACKGROUND AND PURPOSE/OBJECTIVE:Head CT is frequently ordered for trauma patients who are receiving anticoagulation. However, whether patients with a Glasgow Coma Scale (GCS) score of 15 and normal findings on neurologic examination require CT is still debated. The purpose of our study was to assess the use of cranial CT in patients receiving anticoagulants after head trauma and to establish clinical criteria to identify those in this group who do not need emergency CT. METHODS:We retrospectively reviewed patients receiving heparin or coumadin who had head trauma and who subsequently underwent cranial CT at a level I trauma center within a 4-year period. Patients were evaluated for mechanism of injury, clinical signs and symptoms of head injury, and type and reason for anticoagulation. Prothrombin time, international normalized ratio, partial thromboplastin time, GCS score, age, and head CT results were recorded for each patient. RESULTS:A total of 89 patients fulfilled the enrollment criteria. Among them, 82 had no evidence of intracranial injury on CT. Seven patients had evidence of intracranial hemorrhage. Patients without hemorrhage had no significant focal neurologic deficits and presented with an average GCS score of 14.8. Patients with intracranial hemorrhage tended to have focal neurologic deficits and presented with an average GCS score of 12.0. CONCLUSION/CONCLUSIONS:Patients with head injury, normal GCS scores, and no focal neurologic deficits and who are receiving the anticoagulants heparin or coumadin may not necessarily require emergency CT.

PURPOSE/OBJECTIVE:To prospectively evaluate and compare the diagnostic accuracy of unenhanced helical computed tomography (CT) for patients with nontraumatic acute abdominal pain with that of traditional abdominal radiography. MATERIALS AND METHODS/METHODS:Institutional review board approval and informed consent were obtained; this study was completed before implementation of the HIPAA. Ninety-one patients (44 men; 47 women; age range, 18-84 years; mean age, 48.5 years) with acute nontraumatic abdominal pain over a 7-month period were referred by the emergency department of one institution. These patients underwent a three-view acute abdominal series (AAS) and unenhanced helical CT. AAS included an upright chest radiograph and upright and supine abdominal radiographs. Unenhanced helical CT images with 5-mm collimation were obtained from the lung bases to the pubic symphysis, without intravenous, oral, or rectal contrast material. AAS and unenhanced helical CT images were each separately and prospectively interpreted by a different experienced radiologist who was blinded to patient history and the images and interpretation of the other examination for each patient. Final diagnosis was established with surgical, pathologic, and clinical follow-up. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and positive and negative likelihood ratios were calculated for AAS and unenhanced helical CT. Confidence intervals of 95% were calculated for each value with the standard equation for population proportions. Results of AAS and unenhanced helical CT examinations were compared with chi2 analysis. RESULTS:Among the 91 patients examined, unenhanced helical CT yielded an overall sensitivity, specificity, and accuracy of 96.0%, 95.1%, and 95.6%, respectively. The AAS interpretations yielded an overall sensitivity, specificity, and accuracy of 30.0%, 87.8%, and 56.0%, respectively. The accuracy of unenhanced helical CT was significantly greater than the accuracy of AAS (P < .05). CONCLUSION/CONCLUSIONS:AAS is an insensitive technique in the evaluation of nontraumatic acute abdominal pain in adults. Unenhanced helical CT is an accurate technique in the evaluation of adult patients with nontraumatic acute abdominal pain and should be considered as an alternative to radiography as the initial imaging modality.

Carcinosarcomas are very uncommon tumors, which are comprised of both malignant epithelial and mesenchymal elements. They occur most commonly in the head and neck, respiratory tract, and female reproductive organs. In the gastrointestinal tract, they are most often found in the oropharynx, esophagus, and, to a lesser extent, in the stomach. Carcinosarcomas rarely originate from the colon, but when they do, they are extremely aggressive malignancies. We report the radiologic and pathologic findings of a patient with a carcinosarcoma believed to have arisen from the colon and which involved the adjacent mesentery and omentum.

A rare source of potentially massive lower gastrointestinal hemorrhage in women is advanced gynecologic malignancy. Such patients can develop gastrointestinal hemorrhage with or without prior pelvic irradiation, due to arteriocolic fistulas. Angiography permits the correct diagnosis and subsequent embolotherapy.