CT's utility following inconclusive abdominal ultrasound varies

About one-third of computed tomography scans performed following an inconclusive abdominal ultrasound examination have positive findings, according to a recent study. Follow-up scans appear to be most useful in the diagnosis of renal lesions.

"Our study found that 32.9% of follow-up CT examinations had positive findings, while 42.7% had findings that were not significant and 11.7% were equivocal. The remaining 12% had incidental findings," said study co-author Supriya Gupta, MD, of Massachusetts General Hospital.

"While only about 33% of the CT examinations had positive findings, it doesn’t mean that the other CT exams were not valuable, as sometimes even negative exams add a lot to patient management," Dr. Gupta added.

The study, which was presented at the American Roentgen Ray Society annual meeting in Vancouver, BC, included 449 patients at Massachusetts General Hospital. The authors found that follow-up CT was most useful in diagnosing renal lesions. The positivity rate for CT was 87.5% for renal cysts and 81.8% for renal stones, Dr. Gupta said. Renal cysts and renal stones were two of the more common indications for recommending follow-up CT.

CT had the least value as a follow-up exam for indeterminate pancreatic and intestinal masses on ultrasound, with a less than 10% positivity rate, he noted.

The study results emphasize that the benefits of CT as a follow-up to inconclusive ultrasound examinations need to be more carefully reviewed; standardized guidelines for the use of follow-up CT need to be developed because the use of CT has cost and radiation implications, Dr. Gupta added.

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