Eur Radiol (2003) 13:M25DOl 1O.1007/s00330-003-2128-9

© Springer-Verlag 2003

Bernd Hamm Multi-detector CT of the abdomen

B. Hamm(~)Department of Radiology,Charite University Hospital, Humboldt-Universitat zu Berlin,Schumannstrasse 20/21, 10117 Berlin, Germany

Great advances in CT have been made in the diagnosticassessment of the abdomen besides cardiac and vascularimaging. This progress results from the fast scanningtimes and the possibility of isotropic reconstruction inthe coronal plane and partly also in the sagittal plane.Image reconstruction is increasingly gaining in impor­tance in the clinical setting prior to important therapeuticdecisions such as major surgery in oncological patients.

Biphasic contrast-enhanced studies of liver tumorsknown from single-slice CT will also be performed withmulti-detector CT (MDCT). The axial images will con­tinue to be most crucial while coronal or sagittal recon­structions provide additional information prior to resect­ing interventions.

With its high spatial resolution and multiplanar recon­struction along the pancreatic duct, MDCT will becomea new tool for the detection of pancreatic tumors andimprove the detection of small tumors where imagingmodalities have thus far yielded disappointing results.

While CT has for many years been the method ofchoice in staging renal cell carcinoma, MDCT offers anas yet unfamiliar reliability in assessing tumor infiltra­tion of the vena cava and has already established itselfas an excellent modality for planning surgery in organ­sparing tumor resection.

Virtual colonoscopy as a young examination tech­nique represents a new challenge for radiologists: it isnot only possible to detect advanced tumor stages, butalso to diagnose both extra- and intraluminal morpholog­ical changes at a time when curative therapy, such aspolypectomy, is still possible; thus, a diagnostic tool,which may be justifiably used for screening, has becomeavailable. With regard to detection of colorectal polyps,CT colonography boasts a sensitivity comparable to thatof flexible colonoscopy. The reported data with CT co­lonography are based on more than 1200 patient examin­ations. It has become clear that patient preparation withmild bowel cleansing is absolutely necessary to avoidtoo many false-positive results. In the meantime, tech­niques to demarcate and subtract bowel contents fromthe image are being developed and the results of contrastagent studies are promising. Currently, virtual colonos­copy is indicated in the following cases: (a) following in­complete colonoscopy; (b) in patients who cannot under­go a colonoscopy for medical reasons; and (c) preopera­tively, to rule out secondary cancer and for staging. Dueto the currently limited amount of data verifying the ef­fectiveness of virtual colonoscopy in a large populationwith a low disease prevalence, its utilization as a screen­ing tool must still be viewed critically.