A PROJECT PROPOSAL

ON

PATTERN OF ABDOMINO_PELVIC COMPUTED TOMOGRAPHY(CT) FINDINGS

IN ADULTS IN NIGERIA POPULATION (CASE STUDY OF ESUTH AND POSH).

BY

EMMANUEL UGOCHUKWU SAMUEL (2016/239558)

EZEAH CHINECHEREM MARYJANE (2016/238318)

EZE CHIBUZOR EMMANUEL (2016/239409)

ERUCHALU SOMTOCHUKWULYDIA (2016/239381)

A PROJECT SUBMITTED IN PARTIAL FULFILMENT FOR THE AWARD OF A

BARCHEOR OF SCIENCE IN MEDICAL RADIOGRAPHY

DEPARTMENT OF MEDICAL RADIOGRAPHY AND RADIOLOGICAL SCIENCES

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY

COLLEGE OF MEDICINE UNIVERSITY OF NIGERIA ENUGU CAMPUS

SUPERVISOR: DR. (MRS.) A.C. ANAKWUE

MAY, 2023
 OUTLINE

Chapter One

1.1 Background of study.

1.2 Statement of problem.

1.3 Objectives of study.

1.4 Significance of study.

1.5 Scope of study.

Chapter Two: Literature review

2.1 Conceptual Review.

2.2 Empirical Review.

Chapter Three: research methodology

3.1 Research design.

3.2 Location of study.

3.3 Study population.

3.4 Inclusion criteria.

3.5 Exclusion criteria.

3.6 Sample size.

3.7 Sampling technique.

3.8 Ethical approval.

3.9 source of data.

3.10 Instrument for data collection.

3.11 Procedure for data collection.

3.12 Data analysis.

 CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND STUDY

Through reconstruction and image processing, the imaging technique known as computed

tomography (CT) creates three-dimensional (3-D) images of the interior of the body from x-rays

and a variety of detectors. Computed tomography (CT) has grown in importance as a medical

imaging technology since its inception in the 1970s as a complement to x-rays and medical

ultrasonography. It is now more frequently utilized for illness screening or preventive medicine.

Over the past 20 years, CT usage has substantially expanded in several nations 1. In the United

States, there were reportedly 72 million scans conducted in 2007 2. Cross-sectional imaging

examinations have been used much more frequently over the past two decades, and this rapid

uptake, along with ongoing advancements in their spatial and contrast resolution, have resulted

in a noticeable rise in the number of findings discovered that are unrelated to the examination's

main goals3,4,5.

Furthermore, the development of helical CT has led to numerous significant improvements in the

identification and characterisation of illnesses across the body. The most cutting-edge technology

for evaluating the abdomen is typically regarded as being helical CT 6. It can scan quickly and

acquire scans only when contrast enhancement is at its highest level, allowing for faster scanning

and acquisition of scans at overlapping intervals7.

According to estimates, 0.4% of cancer cases in the US now can be attributed to CT scans from

the past, and with the rate of CT usage in 2007, this number could rise to 1.5–2% 8. It is
debatable if CT abdomino-pelvis is worth the expense and risk. Consequently, it is necessary to

assess this modality's clinical yield pattern.

Although the use of CT scans as the first line of diagnosis for abdomino-pelvic abnormalities has

decreased as a result of recent advancements in ultrasonography, the resolution of ultrasound

scans is lower than that of CT and magnetic resonance imaging (MRI), and they reveal less detail

and fewer structures. The most frequent uses of CT are for tumor staging and the examination of

unanticipated findings that cannot be seen using x-rays or ultrasonic scans. It acts as a

confirming modality for pelvic and abdominal lesions. Although MRI images are more detailed

than CT images, CT is still the modality of choice for patients with metallic devices or implanted

electric devices like pacemakers that may be attracted to the MRI's strong magnetic field.

CT of the abdomen and pelvis is commonly done for a number of symptoms. The liver, kidneys,

pancreas, intestines, spleen, and pelvic organs such as the uterus, bladder, prostate, and rectum

are among the requests that are related to neoplasmic formation, suspected infections,

inflammatory disease, and certain requests that are related to the organs of the abdomino-pelvic

cavity. Even though there are significant commonalities between the various tissues' CT

appearances and clinical presentations, the findings are typically distinctive enough to point to a

particular diagnosis9. Without calming the structures and the surrounding tissues, it can be

clinically challenging to determine the pattern of presentation of abdomino-pelvic disorders.

This study will provide in-depth analyses of the CT abdomino-pelvic pattern findings and

compare those findings to the distribution of ages and sexes. It will clarify the primary

justifications for referring patients for CT abdominal and pelvic imaging.

1.2 STATEMENT OF PROBLEM

• To the best of the researcher's knowledge, there is lack of documented research findings

of the topic under study.

• Following the above problem, documentation and analysis of the age and sex distributions of

patients referred for CT abdomino-pelvis in relation to the specific findings is vital.

1.6 OBJECTIVES OF STUDY

1.6.1 GENERAL OBJECTIVE

 To determine the pattern of abdomino-pelvic computed tomography findings in adult

nigerian population within Enugu metropolis

1.3.2 SPECIFIC OBJECTIVES

• To identify the major reasons for referral of patients for CT abdomino-pelvis.

• To determine the pattern of findings in abdomino-pelvic CT examination of adult patients in

Esuth Teaching Hospital(parklane) and POSH

• To find out the age and sex distributions of adults referred for CT abdomino-pelvic and

determine if there is significant association of abnormal CT findings with gender.

1.4 SIGNIFICANCE OF STUDY

•This work will help to determine the types of suspected leisions that are commonly referred for

CT abdomino-pelvis.

•This research will help to relate the occurrence of certain lesions to age and sex of the patients
•The research result will help in decision making and management of patients with certain

abdomino-pelvic lesions.

1.5 SCOPE OF STUDY

•This work would be retrospectively carried out on all the patients that had CT abdomino-pelvis

in Esuth Teaching Hospital and POSH.

 CHAPTER TWO

LITERATURE REVIEW

2.1 CONCEPTUAL REVIEW

2.1.1 BRIEF ANATOMY OF THE ABDOMEN/PELVIS

The bottom portion of the trunk, or abdomen, is located below the diaphragm. A bigger upper

portion, the abdomen proper, and a smaller lower portion, the true or lesser pelvis, are separated

by the plane of the pelvic inlet. The muscles that surround the abdomen in significant part are

easily adaptable to cyclical changes in the size of the abdominal cavity. They can become thinner

to accommodate abdominal distensions brought on by flatus, fat, a fetus, and fluid. The majority

of the gastrointestinal and urogenital systems are located in the belly. It also includes the

suprarenal glands, the spleen, and a large number of lymph nodes, blood arteries, and nerves.

Abdominal wall is made up of the following six layers: -

Skin, superficial fascia, muscles, layers of fascia like the diaphragmatic fascia, fascia

transversalis, fascia iliaca, pelvic fascia, extra-peritoneal connective tissue, and the peritoneum

all provide a slick surface for the movements of the abdominal viscera against one another 10. The

abdominal cavity is substantially larger than what the anterior abdominal wall inspection would

have you believe. Since the domes of the diaphragm arch far over the costal margin, a large

portion of it is hidden by the lower ribs. The upper poles of the kidneys, both suprarenals, much

of the stomach, the liver, and spleen are all concealed by the lower ribs. There is a sizable

amount of abdominal cavity that extends into the pelvis in the back. just behind the buttocks 11.
Along with housing the rectum, uterus, prostate, and bladder, the pelvic cavity also has a sizable

portion of the intestine. The Latin word for pelvis is "basin," and when tilted forward into the

anatomical position, the bony pelvis does resemble a pudding bowl, although one with a large

portion of the front wall missing. The lower portion of the front abdominal wall fills in this

deficit11. The 'real pelvis' and the 'false pelvis' are separated by the pelvic brim. The Obturator

Intermus, Piriformis, Levator Ani, and Cocygeus are the pelvic muscles. The hip bones, which

are covered in the Obturator Intermus and its fascia, create the lateral wall of the pelvis. The

sacrum forms the curving posterior wall, and Piriformis enters the larger sciatic foramen

laterally.

2.1.2 QUADRANTS AND REGIONS OF THE ABDOMINOPELIC CAVITY

The abdomen can be split into either four quadrants or nine regions to describe the placement of

numerous organs or other structures within the abdomino-pelvic cavity.

 FOUR ABDOMINAL QUADRANTS: Four quadrants would be created if two hypothetical

perpendicular planes were to be drawn through the umbilicus and through the abdomen. The

umbilicus, which on most people is located at the level of the intervertebral disc between L4

and L5, is where one plane would be transverse through the abdomen. The umbilicus and the

symphysis pubis would be located in the vertical plane, which would also be the mid-sagittal

plane. The abdomino-pelvic cavity would be divided into four quadrants by the two planes:

 Right upper quadrant (RUQ)

 Left upper quadrant (LUQ),

 Right lower quadrant (RLQ) and

 Left lower quadrant (LLQ)

 ANATOMY SUMMARY CHART – FOUR QUADRANTS ABDOMEN

RUQ LUQ RLQ LQ

Liver Spleen Ascending colon Descending colon

Gall-bladder Stomach Appendix Sigmoid colon

Right colic flexure Left colic flexure Caecum 2/3 of Jejunum

Duodenum Tail of pancreas 2/3 of ileum

Head of pancreas Left kidney ileocecal valve

Right suprarenal Left suprarenal

gland gland

NINE ABDOMINAL REGIONS can also be created by dividing the abdominal cavity into two

transverse and two vertical planes. The trans-tubercular plane and the trans-pyloric plane are the

two transverse planes. The lateral planes on the left and right are the two vertical planes. The

transtubercular plane is level with L5, while the transpyloric plane is level with the lower border

of L1. The mid-sagittal plane and each anterior superior iliac spine are where the right and left

lateral planes are situated; they are parallel to the mid-sagittal plane 12.

The nine areas that are thusly delineated are positioned in three zones: the median, the right, and

the left. The medium areas are the epigastric, umbilical, and hypogastric from above to below.
Hypochrondriac, lumbar, and iliac are the same regions on the right and left in the same

sequence.

2.1.3 COMPUTED TOMOGRAPHY (CT) AND ITS EQUIPMENT

Diagnostic x-rays are converted into a digital topographic image by computed tomography (CT).

In order to back-project an image using a mathematical technique, the basic idea of CT entails

digitizing an image obtained from a slit scan projection of the patient's body. Despite the fact that

CT scanning is often carried out transversely, sagittal and coronal sections can be created

digitally by processing the information. The image contains less scatter radiation because the CT

x-ray beam is constrained to a narrow slit13. An image of a much higher quality than what is

possible with conventional imaging techniques is produced by combining the transverse

scanning operation with slit scanning.

An image storage unit, computer, display console, couch, gantry, and x-ray tube are all

components of a contemporary CT equipment.

The mobile CT unit's frame is known as the gantry. The CT unit's most noticeable component, it

houses the x-ray tube and detectors. The gantry frame keeps the tube and detectors aligned and

houses the tools required to carry out the scanning motions. The gantry has a large aperture and

is used to position light sources like low-powered lasers and strong white halogen lights.

2.1.4 SCANNER GENERATIONS

The first CT scanner was the original Electro-Musical Instrument Ltd (EMI) head scanner, which

is sometimes used to categorize CT scanners by generation13.

FIRST GENERATION: The earliest generation of CT scanners were single ray devices

intended solely for head inspection. It has a straightforward stationary tube and two sodium

Iodide-scintillation crystal detectors. It produces pencil beams while moving linearly

transversely. After each transverse through 1800 with 10 rotations each scan, each linear

transverse provides 160 verticle values. The scan takes between 4.5 and 5 minutes.

SECOND GENERATION: This employs a linear array of up to 30 detectors with a single

projection fan-shaped beam rather than a pencil slit. It runs through 6 linear transverse scans,

each involving 300 revolutions. The scanning process takes 10 to 90 seconds.

THIRD GENERATION: To create a single projection, this uses a broader fan-shaped beam and

a curved array of 250–750 detectors. The linear scan and rotate system was eliminated because

the fan-shaped beam revolved 3600 times within the gantry and was wide enough to capture the

complete body in a single shot. The scan took between one and twelve seconds to complete13.

FOURTH GENERATION: With 600–2000 stationary detectors arranged in a 3600 ring, it

employs a single projection fan-shaped beam. The lack of movement caused by the detector ring

reduces the need for calibration. It is possible to scan for as little as 0.5 seconds or as long as 10

seconds. Helical/spinal CT units are one of the other contemporary CT unit designs.

2.1.5 PRINCIPLES OF CT SCANS

A cross-sectional radiograph of the head or body is produced via a CT scan, a radiographic

technique. An electronic detector measures the strength of the emerging beam after an x-ray

beam passes through the patient. The x-ray tube and detectors are installed at the frame's

opposite ends, and the entire assembly was spun around the patient to collect measurements from

various angles.
The computer is supplied the received radiation measurement. Each area of the body's

attenuation to x-rays is calculated by the computer. A grayscale image of these differential

attenuations is shown; bone often appears white and air as a black region. Due to the thinness of

the slices, it seems like a cross-section across the patient; there are no organs that would overlap

and obscure the image detail. As a result, some tiny structures that would not be visible with

conventional modalities can be resolved by the CT scan. For later usage, the image is saved on

optical storage media or in the computer's hardware.

2.1.6 PROCEDURE FOR CT OF THE ABDOMEN AND PELVIS

Before the patient is positioned supine on the table with the arms raised, all metallic objects

from the belly and pelvis area must be eliminated. To enable the radiographer to choose the

appropriate scan range for the procedure, a scanogram or scout is acquired. Routine pelvis CT

protocols frequently include scanning from the iliac crest to the symphysis pubis, also in 7 - to

10-mm slices, while an abdomen CT protocol typically includes scanning from the diaphragm to

the iliac crest in 7 to 10 mm slices. Thicker slices may then be used to scan any questionable

areas that were visible. Faster exposure times have enhanced CT picture quality by reducing

peristaltic motion artifacts. Volume scanning has also practically eliminated anatomic mis-

registration, which happened when the patient took a separate inspiration for each slice in

conventional CT, presuming the patient is able to hold their breath.

The radiographer instructs patients receiving abdomino-pelvic CT to hyperventilate before the

procedure. They inhale deeply for two or three breaths, and are then instructed to hold their

breath for the needed 20 to 30 seconds for the scan. A full abdominal and pelvis scan may need

two volume acquisitions—one for the abdomen and one for the pelvis—depending on the
scanner and the patient's health. Between the two exposures, the patient can be given a little rest

period to regain their breath. The protocol specifies the pitch needed for the scan; it is

determined by the exam sought and the clinical history. The table speed and slice thickness are

correlated with the pitch. To guarantee that the anatomy is best pictured, the choice of pitch is

crucial.

Fig ia:CT abdomen: axial image through upper liver and spleen14
Fig ib: Axial anatomy through upper liver and spleen (T10/T11 approx)14

Fig iia:CT section through pancreatic head and renal hila.14

Fig iib:Axial anatomy at level of pancreatic head (L1 approx)14

2.1.7 CONTRAST MEDIA

In abdominal and pelvic CT, oral/or rectal contrast media are necessary to separate the

gastrointestinal system from nearby structures. Large and tiny bowel segments that are not

opaque may be mistaken for lymph nodes, abscesses, or tumors.

Before the exam, oral contrast materials must be consumed in a way that will allow them to be

dispersed throughout the CT tract. The patient typically takes three doses of oral contrast. 1) The

evening before the test. (2) An hour prior to the test, and (3) Right before the test. This pattern

occurs because the contrast administered the previous evening will be in the large bowel, the

contrast administered an hour prior will be in the small bowel, and the contrast administered just

before the exam will be in the stomach.

If oral contrast has not reached the rectum, contrast media may be placed rectally. Barium sulfate

suspensions and non-ionic water soluble solutions are the two forms of positive contrast agents

used to calm the gastrointestinal tract. Each has been demonstrated efficient in particular

applications.

Barium Sulfate Suspension

Many delicious sulfate suspensions designed specifically for CT abdomen are available. Barium

sulfate suspension must have a low concentration (1% to 3%) in order to be beneficial in

abdominal CT and avoid streak artifacts on the image. If imaging is delayed after ingestion of the

contrast, beam hardening (streak) artifact may also develop because a large amount of the water

will be absorbed, leaving dense residual barium15.

Intravenous Contrast Media

Abdominal CT frequently needs non-ionic iodinated intravenous contrast media, like Pamiray,

especially for the examination of the liver and pancreas 16. In the abdomen, vessel opacification is

useful for separating vessels from masses, determining vessel pathology, and integrating.

2.1.7 PATHOLOGIC INDICATIONS FOR CT ABDOMEN/PELVIS

Abdomen

 Lymphoma,

 metastatic lesions of the liver, pancreas, kidney, adrenals, GIT, and spleen are among the

tumors in the abdomen.

 Inflammatory and infectious diseases.

 The renal stone

 Trauma

 Lymphadenopathy and circulatory disease16

Pelvis

 Ovarian, prostate, cervix, and urinary bladder tumors.

 Trauma;

 inflammatory or infectious condition.

2.2 EMPIRICAL REVIEW

Different people/groups of people have conducted research to examine the precise pattern of

findings from a CT abdomino-pelvic inquiry. In patients of abdominal TB, Shaukat et al.'s 17

study attempted to ascertain the results of a multi-detector CT scan. 47 abnormal scans were seen

in 58 patients with probable abdominal TB. They came to the conclusion that liver involvement

was least common and ascites was the most prevalent sign in patients with abdominal TB.

Hepatocellular carcinoma accounts for 80% to 90% of all liver malignancies and most frequently

affects adults in their 50s and 60s, according to Pan et al 18 in their investigation to identify the

prevalent CT abnormalities secondary to liver tumors. Hepatocellular carcinoma is the fifth most

frequent cancer worldwide, and colon cancer patients have a significant likelihood of liver

metastases. The most frequent primary liver tumor is a carvernous hemangioma, which can occur

anywhere between 0.4% and 20% of the time in the general population, according to research by

Karhunen et al19. on benign hepatic tumors and tumour-like disorders in men. Research on the

treatment of advanced hepatocellular carcinoma in the era of targeted therapy was done by Yan

et al20. According to their research, hepatocellular carcinoma is the most prevalent primary

hepatic tumor and one of the most prevalent cancers globally.

Pancreatic cancer is the fourth and fifth most frequent cancer in both men and women, according

to a study by Dimango et al21. on the epidemiology, CT diagnosis, and therapy of pancreatic

ductal adenocarcinoma. The ratio of men to women is 20:1. The majority of patients are above

60 years old. According to Bradley22 account of the international symposium on acute

pancreatitis, there are roughly 17 new instances of acute pancreatitis per 10,000 people in the

United States each year. 20% of acute pancreatitis cases were severe, whereas the other 80%
were mild. According to Remer et al23. examination of the imaging of chronic pancreatitis, there

are between 1.6% and 23% cases of the condition per 100,000 people worldwide each year. In

the United States, chronic pancreatitis prompts more than 122,000 outpatient visits. Prostate

cancer is the most prevalent non-cutanous cancer in men, according to research by Theodorescu 24

on prostate cancer diagnosis and staging, incidence, and death. In men under 40, it was hardly

ever diagnosed. 10% of male cancer-related deaths were attributable to it. Radiation dosages

were compared to patient age and disease severity by Morgan et al 25. They believed that patients

with severe acute pancreatitis got abdomino-pelvic CTs and were exposed to higher radiation

doses compared to individuals with less severe illness, independent of age.

Smith et al26. came to the conclusion that non-contrast CT had 97% sensitivity and 96%

specificity for detecting renal calculi in their investigation to evaluate the specificity and

sensitivity of CT in the diagnosis of renal calculi. In order to support the use of pelvic CT scan as

a standard staging image study, Alvarado et al 27 performed a retrospective analysis to assess the

prevalence of pelvic metastases as the initial site of metastases in patients with head and neck

original melanomas. 146 patients met the requirements for inclusion. The median age was 59.5

years, and 73% of people were men. Primary melanomas were found in 40% of cases of scalp,

32% of face, and 16% of sinus, mouth, and conjunctiva. Recurrence metastases developed after a

49-month interval, although none of the patients had pelvic metastases as the initial location of

recurrence. They expressed the opinion that individuals with head and neck primary melanoma

may not require a pelvic CT scan as part of a routine staging evaluation. Berg et al 28. used CT

scans of 59 individuals with pelvic injuries to test the sensitivity for identifying pelvic disease

and instability. 86% of all pelvic injuries were discovered during the abdominal and pelvic CT

scan. The sensitivity of the trauma CT scan for detecting pelvic instability was 93%. According
to the results, a high-quality CT scan should be able to sensitively detect both pelvic instability

and the damage mechanism.

According to Hassan's29 research, adenocarcinomas make up almost 95% of all malignant

stomach neoplasms. Lymphomas, leiomyosarcomas, carcinoid tumors, and sarcomas made up

the remaining 5% of tumors. The efficacy of abdominal ultrasound scans, CT scans, and MRIs

for the diagnosis of inferior vena cava (IVC) tumor thrombus in renal cell carcinoma was

investigated by Hong-feng et al30. 25 patients had IVC tumor thombus and renal cell carcinoma

diagnoses; of the 25 patients, ultrasound scan accurately identified 18 of 25; CT identified 23 of

25. They came to the conclusion that abdominal ultrasonography was less effective in diagnosing

IVC tumour thrombus in renal cell carcinoma than CT and MRI. The presence of regenerating

nodules in individuals with liver cirrhosis at CT during arterial portography was studied by Lim

et al31. Included were 28 patients with hepatocellular carcinoma. Cirrhosis was discovered in the

resected liver in 20 patients, chronic hepatitis in 4, and a normal liver in 4. They demonstrated

that at CT arterial portography, regeneration nodules in cirrhotic liver were seen as enhancing

nodules surrounded by narrow, lower attenuation septa. When a patient with an abdominal

gunshot wound was chosen for non-operative treatment (NOM), Velmahos et al 32 analyzed the

results of an abdominal CT scan. There were 100 individuals with abdominal gunshot wounds

(AGWs). Forty individuals had their management changed as a result of the CT findings. They

came to the conclusion that choosing AGWs patients for NOM using abdomen CT scanning was

a safe and effective procedure. The CT scan has a sensitivity and specificity of 90.5% and 96%,

respectively.

In their study to compare plain radiograph and CT scan, Gill et al 33. examined 25 patients who

had double vertical pelvic ring fractures and evaluated the pelvis using both plain radiograph and
CT scanning. They provided some CT scan suggestions and came to the conclusion that routine

CT screening was not necessary for all pelvic ring injuries due to the increased expense and

radiation exposure. In their study to assess the staging of renal cell carcinoma, Vikram et al 34.

estimated that 2%–3% of the visceral malignancies were renal cell carcinomas. Men had a 1.6

times higher incidence than women.

In a study on the effects of CT in patients with their first episode of suspected nephrolithiasis, Ha

et al35 found that men were more frequently affected than women and that the prevalence rose

with age until the age of 60. In order to determine if the pelvic component of a standard

abdominal CT scan contributes to the final diagnosis in organ-specific upper-abdomen

pathology, Ackermann et al36. looked into this. individuals with multiple organ involvement,

such as those with cancer and tuberculosis, were eliminated from the 133 individuals who

underwent CT scans. They came to the conclusion that, with staging renal mass and calculi

excluded, it was not required to include the pelvis in the radiation field when scanning a certain

upper-abdominal pathology.

According to Rana et al37., Renal cell carcinoma (RCC) accounts for 80–85% of all primary

renal cancers in adults and is the seventh most prevalent type of cancer. According to Rumpett et

al38., 0.4% to 2.6% of all renal carcinomas are collecting duct carcinomas (CDC), also known as

Bellini duct carcinomas, which develop from the conducting duct epithelium of the kidney. The

patient was typically 53 years old. When patients with non-traumatic stomach complaints visit

the emergency room, Abujudeh et al 39 aimed to ascertain how CT affects doctors' diagnostic

confidence and treatment choices. 584 patients who had non-traumatic stomach complaints were

included in them. Fisher's exact test and the log likelihood ratio were used to evaluate changes.

The two most frequent diagnoses were renal colic and intestinal obstruction (119 out of 584, or
20.4% and 13.7%, respectively). In 49% of patients, CT altered the primary diagnosis. The main

conclusions were that CT scanning enhanced diagnostic confidence from 70% to 90% and

caused 42% of patients to change their treatment choices.

Lee et al40. conducted research on hypervascular subepithelio Gastrointestinal masses; CT

correlation and their findings allowed for the full delineation of the tumor's area as well as the

identification of local invasion and distant metastases. Hakan et al 41. conducted a study to

examine the computed tomography (CT) and magnetic resonance imaging (MRI) results of

gastrointestinal system lipomas. They came to the conclusion that a lipoma can be accurately

diagnosed non-operatively using a CT or MRI examination, allowing for improved treatment

planning.

By retrospectively reviewing the abdominal CT scans of 28 patients who had undergone barium

examinations for this condition, Florian et al 42. characterized the CT findings of jejunal

diverticulosis and came to the conclusion that jejunal diverticula had characteristics findings on

CT, appearing as discrete round or avoid contrast collection or air-containing structure outside

with expected lumen of small bowel with smooth wall and no-recognizable small-bowel fold. In

this investigation, Kim et al43. used two pneumatosis cystoids coli patients to examine computed

tomography colonographic findings. Multiple gas-filled cysts were visible in the colon's wall on

a CT scan.

The accuracy of computed tomography (CT) in differentiating between the three patho-

physiological types of cecal volvulus was assessed by Eric et al 44. by analyzing the computed

tomography (CT) features of cecal volvulus. They included 10 patients who had cecal volvulus

that had been surgically verified. The findings demonstrated that CT was a good diagnostic tool
for identifying the three patho-physiological kinds of cecal volvulus in addition to diagnosing

cecal volvulus and its consequences.

In order to establish a standard for this CT research and to determine the efficacy of CT in the

diagnosis of abdominal wall hernias, Hoejer et al45. conducted a study. The examination of 24

patients with probable abdominal wall hernias. All underwent surgery. Two radiologists

evaluated the CT scans to determine the interobserver variation. The accuracy of the two

radiologists' CT diagnosis was 83% and 79%, respectively. Both CT examinations' sensitivity

and specificity were 0.83 and 0.67, respectively. Positive CT results had a 0.94 and 0.88

predictive value, while negative CT results had a 0.63 and 0.57 predictive value. The variation

between observers was 0.87. The study concludes that while a negative CT finding does not rule

out the diagnosis, a positive finding of an abdominal wall hernia is trustworthy. The CT

diagnostic' interobserver variability is acceptable.

CT conducted before the occurrence of bowel obstruction (pre-CT) is helpful in predicting the

presence of post-surgical intestinal obstruction, Obuchi et al 46. explored this. The pre-CT results

of 33 patients with post-surgical intestinal blockages were examined. The pre-CT findings were

compared to the post-CT findings in 16 patients who had intestinal obstruction and to the

intraoperative findings in 18 patients. Pre-CT revealed a variety of intriguing findings, including

a disparity in the bowel's caliber, the existence of two adjacent collapsed loops, the appearance

of the gut as if it were beaked, focal distention and/or wall thickness of the loops, and twisted

mesentery. Of 33 patients, 23 (or 70%) exhibited one or more of these pre-CT abnormalities. On

both the pre- and post-CT, all patients with a surgically shown closed loop obstruction had two

contiguous collapsed loops. Conservative therapy was shown to be ineffective in six (86%) of

seven patients who had focal dilated bowel loops and twelve (71%) of seventeen individuals who
had twisted mesentery on pre-CT. Pre-CT revealed a number of important discoveries. In light of

the fact that these findings can indicate the presence of post-surgical bowel obstruction and that

two adjacent collapsed loops on pre-CT are a marker of the presence of post-surgical closed loop

obstruction, they came to the conclusion that attention should be paid to these findings.

Localized intra-hepatic bile duct dilatation without a visible tumor or stone as shown on CT

scans was studied by Poortman et al 47. to determine the parameters that can indicate the existence

of a malignancy. The study comprised a total of 29 patients (male: 16, female: 13) with localized

intrahepatic bile duct dilatation without a visible mass, stone, or damage as shown on CT

imaging. Review of tumor marker levels, CT scan results of the intra-hepatic bile duct, and

related findings, as well as a history of extra-hepatic malignancy and biliary stone disease, were

conducted. The results were divided into two groups (patients with a malignancy and patients

with a benign condition) for analysis at a later time. 11 patients out of 29 had malignant lesions

(seven cholangiocarcinomas and four metastases).

Retrospective analysis of the abdomen CT results of 120 patients, whose CTs were performed

under the clinical impression of pancreatic disorders, was done by Han et al 48. Included in this

group are 20 people with acute pancreatitis, 12 people with chronic pancreatitis, and 41 people

with pancreatic tumors. 47 people were still found to have healthy pancreas. 108 out of 120

patients had the proper diagnosis made thanks to CT, which had 91% diagnostic accuracy, 95%

sensitivity, and 79% specificity. Positive CT diagnoses had a 93% predictive value, while

negative diagnoses had an 82% predictive value. Diffuse pancreatic enlargement (75%),

obliteration of peripancreatic fat planes (70%), peripancreatic "Dirty fat" (50%), and renal fascial

thickening (50%), were the most often seen CT findings of acute pancreatitis. The consequences
of acute pancreatitis included fluid accumulation, phlegmon, abscess formation, and pseudocyst

formation.

To the best of the researcher's knowledge, only a small number of studies have been conducted

to determine the patterns of CT abdomino-pelvic findings in the adult Nigerian population.

Additionally, the justifications for referring patients for CT abdomen/pelvis are not conclusively

demonstrated in the literature. In order to establish the pattern of findings in CT abdomino-pelvis

in eastern Nigeria (ESUTH and POSH), relate the findings to the age and sex distribution of the

patients, and define the primary indications for referral for CT abdomino-pelvis, this work has

several objectives.
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 RESEARCH DESIGN

This will be a retrospective non-experimental case study design.

3.2 LOCATION OF STUDY.

This study will be done in two radiography department in Enugu state i.e. Enugu State

University Teaching Hospital (ESUTH) and POSH.

3.3 STUDY POPULATION

The study will be carried out in different hospitals within Enugu metropolis

3.4 INCLUSION CRITERIA

 Request cards and radiologist reports of patients available and within the selected

hospitals.

 Request cards and radiologist reports of patients above the ages of 20 years.

3.5 EXCLUSION CRITERIA

 Request cards and radiologist reports of patients outside the selected hospitals.

 Request cards and radiologist reports of patients below the age of 20 years.

3.6 SAMPLE SIZE

The sample size that will be used in the study will be based on the available data during the

period of the study.

3.7 SAMPLING TECHNIQUE

A convenience sampling technique will be employed, using available and accessible patient data.

3.8 ETHICAL APPROVAL

Ethical approval will be gotten from the human research and ethics committee of the selected

hospitals. All data will be treated will discretion, and used only for the research purpose.

3.9 SOURCE OF DATA

The data collected will be secondary data. It will be collected by the researchers from involved

facilities.

3.10 INSTRUMENT FOR DATA COLLECTION

The instrument for data collection will be patient request cards and radiologist reports.

3.11 PROCEDURE FOR DATA COLLECTION

Information from the request cards and reports will be extracted and analyzed by the researchers.

3.12 DATA ANALYSIS

The data will be analyzed using the Statistical Package for Social Sciences (SPSS) version 23.

Descriptive statistics like percentages and frequencies will be used in the analysis. Spearman’s

correlation will be applied to ascertain if any correlation exists between gender, and age and the

findings from the request cards and report. The results will be presented using tables and figures.

A p-value less than or equal to 0.05 will be used as a criterion for statistical significance.
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