Letter From the Guest Editor

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This issue of Seminars in Roentgenology is devoted to imaging of the abdomen.

Patients present for abdominal imaging for a range of problems, from acute to chronic, and unexpected findings frequently add challenge to the evaluation of the abdomen. In this issue, the articles concentrate largely, but not exclusively, on computed tomography (CT) and magnetic resonance (MR), because the abdomen is also evaluated by plain film, ultrasound, and nuclear medicine. This issue is also intended to familiarize readers with some of the new and exciting uses of CT and MR in the abdomen.

The issue begins with a discussion on common and uncommon causes of the acute abdomen. In these companion articles, Gopal Vijayaraghavan, MD, Rathachai Kaewlai, MD, and Ajay Singh, MD, discuss the most critical diagnostic features of causes of acute abdominal pain ranging from acute appendicitis to spontaneous splenic hemorrhage. They frame their discussion with the ACR Appropriateness Criteria®, which identifies CT with contrast as the most appropriate imaging study for most of these patients.¹ These authors present a concise but thorough discussion of most of the entities we encounter in practice.

Although many readers are familiar with CT enterography, which is presented in the ACR Appropriateness Criteria® as the most appropriate study for 5 of 6 scenarios of patients with Crohn disease,¹ Carmel G Cronin, MRCPI, FFR(RCSI), Derek G Lohan, FFR(RCSI), Ann Michelle Browne, MRCPI, et al discuss the next important modality for evaluation of the small bowel, MR enterography. With patient safety and radiation exposure increasing in the public consciousness, it behooves all of us to learn more about uses of magnetic resonance imaging, particularly in the setting of patients with chronic disease who require frequent imaging.

In her article, “Evaluating the Urothelium with CT Urography; Are we there yet?”, Anne Silas, MD, presents the current status of CT evaluation of the upper and lower urinary tract, which has largely replaced the intravenous urogram, addressing the radiation concerns and discussing technique and indications.

With the increasing use of cross-sectional imaging comes the increasingly common problem of unexpected findings, such as cystic lesions of the pancreas and liver lesions. Desiree Morgan, MD, recognizing the evolution of thought regarding pancreatic lesions, presents a systematic approach and helps define situations when they can be followed rather than resected. In “Imaging of Focal Liver Lesions,” Hyun-Jung Jang, MD, Hojun Yu, MD, and Tae Kyoung Kim, MD, present a comprehensive discussion of the work up and management of these lesions.

Obesity and overweight are problems that affect all types of imaging. Obesity and overweight were estimated to cost over $117 billion in the United States in 1995, updated to 2001 dollars.² With the increase in prevalence of the problem, these costs are even higher now. About two-thirds of Americans are overweight or obese.² The last 25 years have seen a rise in the use of gastric bypass, which has largely replaced earlier methods of bariatric surgery, and increased interest in adjustable gastric banding. The bariatric surgery patient with weight gain or abdominal pain is a scenario that we encounter with increasing frequency. In article titled “Imaging Following Bariatric Surgery for Morbid Obesity: Roux-en-Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding,” Laura R. Carucci, MD, and Mary Ann Turner, MD, discuss imaging in both the immediate and the delayed postoperative setting.

I hope our readers enjoy these articles as much as I have. I would like to thank all the authors for their hard work and dedication, and congratulate them on the result. I would also like to thank Dr. Jannette Collins for giving me the opportunity to serve as a guest editor. I would like to gratefully acknowledge the diligent production assistance of the publisher.

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References 

1. ACR Appropriateness Criteria® October 2008 Version. Accessed May 26, 2009
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2. Statistics Related to Overweight and Obesity (The Weight-control Information Network (WIN), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH)). http://win.niddk.nih.gov/statistics/#prevalAccessed May 26, 2009
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