Purpose: To report the computed tomography (CT) findings of acute peptic ulcer disease (PUD) and to evaluate the usefulness of contrast media for diagnosis.
Methods: This retrospective study included 51 patients diagnosed with acute gastric peptic ulcer by endoscopy. Using a κ analysis, two radiologists independently reviewed contrast-enhanced emergency CTs performed within 24 h of endoscopy. Evaluation findings included low-attenuation wall thickening, focal wall thickening, focal luminal outpouching, perigastric fat stranding, ascites, adjacent lymphadenopathy, and high-density gastric contents. Of the 51 patients, 48 underwent both non-contrast-enhanced and contrast-enhanced CT, and two radiologists also evaluated the presence or absence of these findings on a non-contrast-enhanced CT. McNemar's test was used to evaluate the contrast media's usefulness.
Results: Interobserver variability of perigastric fat stranding revealed substantial agreement between evaluators, and other findings had almost perfect agreement. High-density gastric contents were the most recognized findings (60%). Low-attenuation focal wall thickening and focal luminal outpouching were observed in relatively large numbers (~50%) of the cases on contrast-enhanced CT. The CT examinations using contrast media provided significantly higher detectability of low-attenuation wall thickening and focal luminal outpouching than CT examinations without using contrast media.
Conclusion: Acute PUD can be suspected in patients with nonspecific abdominal symptoms in whom emergency CT shows high-density gastric contents, focal low-attenuation wall thickening, and/or focal luminal outpouching. Our study showed that contrast media are useful for diagnosis.
Keywords: Acute gastric peptic ulcer; Computed tomography; Endoscopy; Peptic ulcer disease.
Copyright © 2020. Published by Elsevier Inc.