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Gastroduodenal ulcers on CT: forgotten, but not gone.

Publication ,  Journal Article
Allen, BC; Tirman, P; Tobben, JP; Evans, JA; Leyendecker, JR
Published in: Abdom Imaging
January 2015

OBJECTIVE: To estimate the incidence of missed gastroduodenal ulcers on routine abdominal computed tomography (CT) and identify findings and methods to improve sensitivity of CT interpretation for peptic ulcers. MATERIALS AND METHODS: This is a retrospective chart and imaging review. Two blinded readers independently reviewed CTs performed within 7 days prior to endoscopy of 114 subjects; this included 57 consecutive subjects with proven gastroduodenal ulcers intermixed with 57 subjects with endoscopically normal examinations. Presence, location and size of ulcer crater, and ancillary findings (mural edema, asymmetric wall thickening, focal fat stranding, regional lymph nodes, and extraluminal gas) were recorded before and after review of multiplanar reformatted images. Radiology reports were then reviewed to determine if an ulcer was identified prospectively. RESULTS: Thirty-one ulcers (54%) were radiographically occult, missed by both readers. Thirteen ulcers were correctly and independently identified by both readers (sensitivity/specificity = 30%/100%). With review of multiplanar reformats, sensitivity and accuracy increased for both readers. When two or more ancillary findings were identified, the odds ratio of a true ulcer being present was greater than 5.6 (P = 0.0001). Both size and location of ulcer were important for detection; readers were more likely to identify gastric ulcers compared to duodenal or marginal ulcers (P = 0.02). Only 3/13 definitely visible ulcers were correctly identified during initial CT interpretation. CONCLUSIONS: Although CT has low sensitivity for peptic ulcer disease, the miss rate for visible peptic ulcers is high. Increased awareness, multiplanar imaging review, and identification of ancillary findings may improve sensitivity for gastroduodenal ulcers.

Duke Scholars

Published In

Abdom Imaging

DOI

EISSN

1432-0509

Publication Date

January 2015

Volume

40

Issue

1

Start / End Page

19 / 25

Location

United States

Related Subject Headings

  • Young Adult
  • Tomography, X-Ray Computed
  • Stomach
  • Sensitivity and Specificity
  • Retrospective Studies
  • Radiographic Image Enhancement
  • Peptic Ulcer
  • Observer Variation
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
 

Citation

APA
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ICMJE
MLA
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Allen, B. C., Tirman, P., Tobben, J. P., Evans, J. A., & Leyendecker, J. R. (2015). Gastroduodenal ulcers on CT: forgotten, but not gone. Abdom Imaging, 40(1), 19–25. https://doi.org/10.1007/s00261-014-0190-1
Allen, Brian C., Philippe Tirman, John P. Tobben, John A. Evans, and John R. Leyendecker. “Gastroduodenal ulcers on CT: forgotten, but not gone.Abdom Imaging 40, no. 1 (January 2015): 19–25. https://doi.org/10.1007/s00261-014-0190-1.
Allen BC, Tirman P, Tobben JP, Evans JA, Leyendecker JR. Gastroduodenal ulcers on CT: forgotten, but not gone. Abdom Imaging. 2015 Jan;40(1):19–25.
Allen, Brian C., et al. “Gastroduodenal ulcers on CT: forgotten, but not gone.Abdom Imaging, vol. 40, no. 1, Jan. 2015, pp. 19–25. Pubmed, doi:10.1007/s00261-014-0190-1.
Allen BC, Tirman P, Tobben JP, Evans JA, Leyendecker JR. Gastroduodenal ulcers on CT: forgotten, but not gone. Abdom Imaging. 2015 Jan;40(1):19–25.

Published In

Abdom Imaging

DOI

EISSN

1432-0509

Publication Date

January 2015

Volume

40

Issue

1

Start / End Page

19 / 25

Location

United States

Related Subject Headings

  • Young Adult
  • Tomography, X-Ray Computed
  • Stomach
  • Sensitivity and Specificity
  • Retrospective Studies
  • Radiographic Image Enhancement
  • Peptic Ulcer
  • Observer Variation
  • Nuclear Medicine & Medical Imaging
  • Middle Aged