MSCT - multispiral computed tomography - one of the most informative methods in the diagnosis of diseases of the abdominal cavity, small pelvis, retroperitoneal space. Its use with contrasting significantly increases the resolution and reliability of the study.
Its essence lies in X-ray scanning of organs along a spiral trajectory with a very small step. The “slices” are very frequent, which makes it possible to visualize very small formations. MSCT is not a routine technique, therefore there are indications and contraindications for its use.
Record content:
- 1 Indications for research
- 2 How is it determined
- 3 Preparation and analysis
- 4 Decoding the results
- 5 When to see a doctor
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6 How to bounce back
- 6.1 Medications
- 6.2 Traditional methods
- 6.3 Other methods
- 7 Possible complications
- 8 Video about MSCT with contrast
Indications for research
MSCT of the abdominal cavity with contrast is used mainly as an expert research method, which is designed to dispel the doctor's doubts about the diagnosis. As a rule, MSCT is prescribed by therapists, oncologists or surgeons, as well as angiosurgeons.
To understand the indications for research, you need to understand the capabilities of the method. Multislice computed tomography using contrast compound allows you to visualize the following structures:
- stomach, intestines, since the hollow organs are best seen precisely after contrasting;
- stones and tumors of the hepatopancreatoduodenal zone (gallbladder, biliary tract);
- liver, its ducts, vascular structures of the organ (portal, caval systems);
- lymph nodes and other lymph collectors;
- vessels of the arterial and venous bed of different caliber;
- pancreas (inflammatory changes, neoplasms, cystic cavities);
- spleen;
- bone structure of the spine.
The study successfully detects tumors:
- stomach;
- intestines;
- pancreas;
- gallbladder;
- spleen.
In this case, both primary neoplasms and metastatic foci are visualized. The method makes possible the timely detection of tumors of such localizations that are difficult to reach for routine diagnostic methods, such as the pancreas and small intestine. In this situation, oncologists or gastroenterologists are referred to MSCT.
A picture of an “acute abdomen” always determines a condition that requires a quick response from the doctor and drawing up a plan for the further management of the patient as early as possible.
At the same time, severe abdominal pain, nausea, dyspeptic phenomena can fit into the clinical picture of diseases such as:
- appendicitis;
- cholecystitis;
- pancreatitis;
- adnexitis;
- colitis;
- pyelonephritis;
- renal and hepatic colic;
- ectopic pregnancy;
- apoplexy (rupture of the cyst) of the ovary.
Surgeons and gynecologists who doubt the diagnosis can prescribe the described method.
Diagnostic unclear situations are often encountered in the clinical practice of doctors of various specialties. To further search for the cause of the symptoms, MSCT is prescribed. This is true for jaundice, weight loss for no objective reason.
Vascular lesions of the kidneys, liver veins, abdominal aorta and its branches also require detailed visualization. For these reasons, a multispiral computed tomography of the abdominal cavity is prescribed.
Traumatic damage to the abdominal organs may not be visible with plain radiography or ultrasound. Therefore, MSCT with enhancement (using contrast agents) is used. In this case, the study is prescribed by a traumatologist.
How is it determined
The indications are determined as during a routine examination or taking an anamnesis. Usually, if a tumor was suspected earlier, with ultrasound or other examinations, this pathology was suspected.
Often, specialists look for the cause of complaints and symptoms in patients for a long time. The patient's condition worsens, and the true cause is not found. Then it is necessary to resort to conducting such studies as MSCT, it is better if with contrast.
When performing biochemical analyzes, an increased content of ASAT or ALAT, bilirubin or alkaline phosphatase is determined. Then it is necessary to exclude hepatitis, cirrhosis and tumors in the liver, pancreas, or in the gallbladder. When determining high numbers of creatinine, urea, renal pathology is excluded. MSCT copes with these tasks.
Preparation and analysis
Contrast-enhanced abdominal MSCT requires adherence to some recommendations. About two days before the study, patients should begin to prepare.
First of all, it is necessary to exclude bloating, flatulence. The accumulation of excess gases in the lumen of the stomach and intestines is the main factor that makes it difficult to visualize the contours and structure of internal organs.
Therefore, 2 days before the procedure, it is recommended to refrain from eating foods that cause fermentation, decay and accumulation of excess gas in the intestines:
- cabbage;
- beans, peas and other legumes;
- black breads;
- soda;
- kvass;
- flour products, muffins;
- alcohol;
- milk, fermented milk products;
- apples.
Experts strongly recommend that you wait an eight hour fasting interval before testing.
If the patient has diabetes, then the last meal may be 4 hours before the study.
MSCT of the abdominal organs involves a study using contrast. Therefore, it is important to assess renal function before performing it.
With a pronounced decrease in the glomerular filtration rate (GFR), they speak of renal failure. If there is a failure of renal function of 3b-4 stages, it is dangerous to inject the contrast. To determine GFR, a blood test for the concentration of creatinine and urea is taken.
Another problem that can be encountered when performing MSCT with contrast is allergic reactions to contrast compounds. To prevent them, it is important to collect the allergic history as carefully as possible, as well as to conduct a test. A small amount of iodine-containing contrast is injected into the vein of the elbow bend. Within 5-10 minutes. the patient's condition is assessed.
If necessary, assistance is provided, so there is always a kit in the office to help with anaphylactic shock and other allergic reactions. In the absence of undesirable reactions, the contrast is injected completely based on body weight.
It is best to come to the study in light clothing that does not hinder movement, which, if necessary, can be easily unbuttoned and removed. This is true for elderly patients, as well as for those who have serious joint problems, or have paresis or paralysis, which makes it difficult to move and self-care. It is better to take off jewelry, jewelry.
The doctor should be warned about the presence of prostheses, implants.
The doctor who will interpret the results of the study needs to have the results of previous studies in front of him for dynamics and comparison. They need to be demonstrated.
In the presence of a pronounced fear of enclosed spaces, premedication in the form of sedatives, sedatives is indicated. Sometimes ordinary atropine and relanium are enough.
This completes the preparation stage. The equipment table is located in the horizontal plane, and the patient is placed on it. After it is conveniently fixed, the stage enters the ring element, where X-ray sources, invisible to the patient, move in a spiral.
The study time with contrast can be up to half an hour. As soon as the patient begins to feel discomfort, he presses a special button to call the medical staff.
Decoding the results
Research results are provided in several formats. A description of the main organs, vascular elements and neoplasms, if any, is reflected on paper. If the description is qualitative, then the topography, or the relative position of organs relative to each other, will be reflected.
In addition, all footage is recorded on digital media in Dicom format. It is impossible for a person without medical education to independently understand these graphic images, sometimes animations or video files. Therefore, you need to focus on the conclusion given by the doctor who interpreted the results of MSCT.
First of all, you should pay attention to the size of the organ. The revealed sizes and indicators of the norm are described.
With an increase in the liver, one should think about steatohepatosis (fatty degeneration), and with a decrease in its size, on the contrary, about cirrhosis. With an increase in the spleen, blood diseases should be excluded first, and then infectious diseases. In the second case, the liver is enlarged in parallel.
Normal bile should be visualized in the gallbladder. Its walls are not thickened. Otherwise, we are talking about a diagnosis such as cholesterosis, or biliary dyskinesia. If a calculus is described in the lumen of the gallbladder, then this is a manifestation of gallstone disease.
Neoplasms in any of the organs can be of any shape and size. Only an oncologist can determine their nature. They are differentiated with cysts, malignant and benign tumors, metastatic, purulent (abscesses) foci. It is impossible to identify them on your own.
An ordinary cyst looks like a rounded formation with clear contours. Several daughter ones can be located inside one cystic cavity. The danger is represented by cysts of parasitic origin.
The blood flow in the cystic cavities is not expressed. Malignant tumors have a pronounced intensive blood supply. They are characterized by uneven contours and heterogeneous content. Purulent foci (abscesses) also look like rounded formations with a horizontal fluid level.
Adenomas are considered benign growths. They are also visible on MSCT. They often develop in the liver. When contrasting, the adenoma looks clearer, since its tissues capture the contrasting compound better and hold it longer. Around it, a fibrous field is visualized, the contours of which usually repeat the outlines of the tumor.
MSCT of the abdominal cavity with contrast allows to determine the presence of hepatocellular cancer. The sizes can be absolutely any. At the same time, the structure of the intrahepatic formation is extremely heterogeneous, multiple collaterals, vascular shunts are visible. On the other hand, in pancreatic cancer, the vessels feeding the tumor are very rarely seen.
When to see a doctor
After conducting MSCT with contrast, a comprehensive assessment of the results is required. Despite the fact that the description will be performed by a functional diagnostics doctor, it is necessary to combine him with clinical data, anamnesis and the results of other instrumental and laboratory surveys.
When the size of the liver changes, they first turn to a therapist, who, if necessary, prescribes a consultation with a gastroenterologist or hepatologist if there is a suspicion of cirrhosis. Identification of pathological changes in the spleen is an indication for consulting a hematologist.
When neoplasms are detected in the abdominal organs, they should be shown to the oncologist in order to determine the further scope of research and treatment, if necessary. If the tumor looks like a purulent one, a surgeon is required.
It will not be superfluous to consult a therapist after undergoing MSCT. A generalist will quickly determine which doctor you need to turn to next.
How to bounce back
Contrast-enhanced abdominal MSCT usually shows severe disease. Therefore, if a pathology is revealed in the conclusion, one should not look for information and methods of its treatment on the Internet or find out from friends who are far from medicine.
Specialists who make a conclusion on ultrasound, MRI, MSCT always indicate that the conclusion they have written is not a diagnosis, but requires the consultation of a narrow specialist. It is he who will appoint the ways to solve the problem.
Medications
With cholesterosis of the gallbladder, Ursodez is prescribed 200 mg 2-3 times a day under the cover of antispasmodics in the first three days. The same applies to biliary dyskinesia. This drug prevents the formation of stones, makes bile thinner. The severity of symptoms decreases.
With steatohepatosis, they resort to prescribing hepatoprotective agents. First of all, these are Essliver, Gepabene, Geptral. First, the funds are administered by the parenteral route. Then they smoothly switch to tablet forms. The treatment is carried out under the supervision of ASAT, ALAT.
With cysts, drug therapy is not indicated. A wait-and-see tactic is applicable in this situation. If the growth of cystic cavities is visible, then they think about the high risk of their malignancy. In this case, surgery is indicated.
For parasitic cysts, antiparasitic drugs are prescribed, for example, Praziquantel or Biltricid. In parallel, desensitizing therapy is shown.
Traditional methods
Alternative methods should be approached with caution, since very rarely their effectiveness and harmlessness has been proven by clinical studies. With dyskinesia of the biliary tract, steatohepatosis, cholesterosis of the gallbladder, the use of a decoction of oats is indicated. This is a good choleretic agent that also actively restores liver cells.
To prepare the broth, it is necessary to pour 5 tbsp into a thermos with a volume of 1-1.5 liters. l. oatmeal and pour boiling water over. Insist 5-6 hours. After that, filter and take a third of the glass three times a day, for 10-15 minutes. before meals. The course of treatment is 2 weeks.
Other methods
This can include surgical or radiation treatment used in the detection of cancer. The choice is made based on the stage, extent of the tumor, damage to other internal organs and lymph nodes.
Chemotherapy includes various anticancer drug regimens. Sometimes combined therapy is carried out using two or all three possible methods of treating malignant neoplasms that were detected by MSCT.
Possible complications
Late diagnosis and treatment of cancer increases the risk of a low five-year survival rate. This means that the likelihood of a favorable outcome of the disease is reduced. With cancer, the body is quickly depleted and faded away. Therefore, diagnostics using MSCT in oncology is very important.
With the timely detection of cirrhosis of the liver, it is possible to start treatment on time and preserve the function of the organ for a certain period. This helps to delay disability and the need for liver transplantation.
MSCT is a scarce and at the same time informative technique. The study of the abdominal cavity with its help, and even with contrast, is designed to place points at dubious clinical situations, when doctors cannot find the cause of complaints and symptoms using routine methods. The training requirements are not critical, but for maximum information content, they should not be neglected.
Article design: Vladimir the Great
Video about MSCT with contrast
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