Does high body mass index obviate the need for oral contrast in emergency department patients?

INTRODUCTION: High body mass index (BMI) values generally correlate with a large proportion of intra-peritoneal adipose tissue. Because intra-peritoneal infectious and inflammatory conditions manifest with abnormalities of the adipose tissue adjacent to the inflamed organ, it is presumed that with a larger percentage of adipose surrounding a given organ, visualization of the inflammatory changes would be more readily apparent. Do higher BMI values sufficiently enhance the ability of a radiologist to read a computed tomography (CT) of the abdomen and pelvis, so that the need for oral contrast to be given is precluded? METHODS: FORTY SIX PATIENTS WERE INCLUDED IN THE STUDY: 27 females, and 19 males. They underwent abdominal/pelvic CTs without oral or intravenous contrast in the emergency department. Two board certified radiologists reviewed their CTs, and assessed them for radiographic evidence of intra-abdominal pathology. The patients were then placed into one of four groups based on their body mass index. Kappa analysis was performed on the CT reads for each group to determine whether there was significant inter-rater agreement regarding contrast use for the patient in question. RESULTS: There was increasingly significant agreement between radiologists, regarding contrast use, as the study subject's BMI increased. In addition, there was an advancing tendency of the radiologists to state that there was no need for oral or intravenous contrast in patients with higher BMIs, as the larger quantity of intra-peritoneal adipose allowed greater visualization and inspection of intra-abdominal organs. CONCLUSION: Based on the results of this study, it appears that there is a decreasing need for oral contrast in emergency department patients undergoing abdominal/pelvic CT, as a patient's BMI increases. Specifically, there was statistically significant agreement, between radiologists, regarding contrast use in patients who had a BMI greater than 25.

Impaired myocardial SPECT imaging secondary to silicon- and saline-containing breast implants.

Early detection of coronary artery disease (CAD) in women has been challenging. Women are more likely to present with atypical symptoms, and non-invasive evaluation for CAD has been less accurate. Myocardial SPECT imaging is a well-established technique that provides important physiologic, anatomic, and prognostic information in women. Attenuation artifacts secondary to breast tissue are a common problem in women and can lead to decreased specificity of gated SPECT imaging. Cosmetic breast implants are increasing in popularity. The presence of a foreign object overlying the anterior wall of the heart in addition to native breast tissue can significantly increase attenuation artifacts. There is only one report to date describing attenuation artifact due to silicon breast implants in comparison to control, and there are no reports regarding saline breast implants. Here we report three cases of impaired myocardial SPECT imaging in women with breast implants: one patient with silicone implants, and two with saline-containing implants. Clinicians should be aware of this problem and women should be educated regarding the potential future diagnostic problems that may occur with breast implants before considering this cosmetic surgery.