ABSTRACT
Background: Computed tomography has become an important tool in medical imaging to supplement conventional x-rays examination and ultrasonography.
Aim: To describe the pattern of abdomino-pelvic computed tomography findings in the adult Nigerian population. (A case study EKO Hospital, Ikeja).
Patients and Method: A retrospective study of 195 patients who underwent CT scan at EKO hospital, Ikeja between January, 2011 to March, 2012 was conducted. Statistical Package for Social Science (SPSS) Version 17.0 was used to analyze the data.
Results: The frequency of males referred for CT scan of abdomino-pelvis was significantly more than females (54.87%,n=107 Vs 45.13%, n=88;p<0.05). Age group between 30 to39 years had the highest frequency of referral (21.03%). Abdominal-pelvic pain and discomfort (21.03%) was the major reason for referral of patients for CT abdomino-pelvis. Benign prostate hypertrophy (BPH)(2.56%) and Ca prostate(2.05%) were least common reason for referral. Renal disorders incidence in men was 1.9 times more than in women. Enlarged liver with masses (55%) was a major finding in most patients within 50-59 years old. There is no significant association between CT abnormal findings and gender of the patient. (p>0.05)
CONCLUSION: The result of this study showed that males are referred abdomino-pelvic CT than females. It is also found that abdominal pain and discomfort was the major reason for referral of patients for CT abdomino-pelvis. Enlarged liver was a predominant finding in most of the patients. The result also showed that there is no significant association between CT abnormal findings and gender of the patient. Some incidental CT findings unrelated to the primary reasons for referral of patients were noted.
Keywords: Abdomino-pelvis, Computed tomography, referral, findings, pattern, Eko Hospital.
Table of contents
Title Page - - - - - - -i
Approval Page - - - - - -ii
Certification - - - - - -iii
Dedication - - - - - -iv
Acknowledgement - - - - - -v
Abstract - - - - - -vi
Table of contents - - - - - -vii
CHAPTER ONE
1.0 Introduction - - - - - -1
1.1 Statement of problem - - - - -3
1.2 Purpose of study - - - - - -4
1.3 Hypotheses - - - - - - -4
1.4 Significance of study - - - - - -5
1.5 Scope of study - - - - - -5
1.6 Literature review - - - - - -5
CHAPTER TWO
2.0 Theoretical background - - - - -23
2.1 Brief anatomy of the abdomen/pelvis - - -23
2.2 Quadrants and regions of the abdomino-pelvic cavity -24
2.3 CT and its equipment - - - - - -26
2.3.1 Scanner Generation - - - - - -27
2.4 Principle of CT scan - - - - - -28
2.5 Procedure for CT of the abdomen and pelvis - -29
2.6 Contrast media - - - - - - -33
2.7 Pathologic indications for CT abdomino/pelvis - -34
CHAPTER THREE
3.0 Research Methodology - - - - - -35
3.1 Research Design - - - - - -35
3.2 Sources of data - - - - - -35
3.3 Method of data collection - - - - -35
CHAPTER FOUR
4.0 Data analysis - - - - - -37
4.1 Presentation of data - - - - - -38
CHAPTER FIVE
5.0 Discussion - - - - - -47
5.1 Summary of findings - - - - - -51
5.2 Recommendation - - - - - -52
5.3 Limitations - - - - - -53
5.4 Area of further study - - - - - -53
5.5 Conclusion - - - - - -53
References
Appendix
INTRODUCTION
Computed tomography (CT) is an imaging modality that utilizes x-rays and an array of detectors to generate three-dimensional (3-D) images of the interior of the body through reconstruction and image processing. Since the introduction of computed tomography in the 1970’s, it has become an important tool in medical imaging to supplement x-rays and medical ultrasonography. It has more recently been used for preventive medicine or screening for disease. Usage of CT has increased dramatically over the past two decades in many countries. (1) An estimated 72 million scans were performed in United States in 2007. (2) The rapid increase in the utilization of cross-sectional imaging examinations over the past two decades, combined with the ongoing improvement in the spatial and contrast resolution of these studies, has led to a marked increased in the number of findings detected that are unrelated to the primary objectives of the examination.(3,4,5)
Moreover, the introduction of helical CT has created many important advances in detection and characterization off diseases throughout the body. Helical CT is widely accepted as the state of the art technology for evaluation of abdomen.(6)It has high speed of image acquisition of scans and thus allows more rapid scanning and acquisition of scan exclusively during peak level of contrast enhancement and re-construction of scan at overlapping interval.(7)
It is estimated that 0.4% of current cancer in the United States are due to CTs performed in the past and that this may increase to as high as 1.5 – 2% with 2007 rate of CT usage. (8) It is unclear whether the cost and risk of CT abdomino-pelvis are justified. Therefore, the clinical pattern of yield of this modality needs to be evaluated.
Although recent advancement in ultrasonography and its safety in terms of no use of ionizing radiation coupled with its non-invasiveness has reduced the use of CT scan as the first line of diagnoses of abdomino-pelvic abnormalities, ultrasound scans gives less resolution than CT and magnetic Resonance Imaging (MRI) and show less detail and fewer structure. Most often, CT is employed in staging of tumours and evaluation of incidental findings not demostratable by x-rays and ultrasound scan. It serves as confirmatory modality for abdomino-pelvic lesions. Though compared with CT, images of MRI have more detail which can be useful for analyzing soft tissues; CT is a modality of choice for patients with metallic device or implanted electric devices such as pacemaker which may be attracted to the powerful magnetic field of MRI.
Abdomino-pelvic CT is frequently performed for variety of complaints. Some of which are related to neoplasmic formation, suspected infections, inflammatory disease and some requests are related to the organs of abdomino-pelvic cavity which include the liver, kidneys, pancreas ,intestines ,spleen , and the pelvic organs such as uterus, bladder, prostate, and rectum. Although, some overlaps exist in the CT appearances of the different tissues and pathologic presentation, the findings are frequently unique enough to suggest a specific diagnosis. (9) In most cases, it is clinically difficult to ascertain the pattern of presentation of abdomino-pelvic abnormalities without pacifying the structures and the adjacent tissues.
This research work will give detail analyses of the pattern of findings of CT abdomino-pelvic and relate the findings with age and sex distribution. It will elucidate the major reasons for referral of patients for CT abdomino-pelvis.
