This is an article from the radiology literature that essentially tries to say that CT is not the imaging modality of choice for upper abdominal pain.
It’s a retrospective review of 235 patients over a four-year period who had CTs of the abdomen reported as “normal” or “non-diagnostic” in the setting of upper abdominal pain. They determine false-negative studies if another diagnostic modality eventually provided a definitive diagnosis for the patient’s symptoms. Out of the 235, 81 were lost to follow-up and 27 were excluded for other reasons. Of the remaining 127, 46 were classified as false-negative and 81 were classified as true-negative.
The misses? 23 cases of pancreaticobiliary disease (biliary colic, cholecystitis, choledocholithiasis), 12 cases of gastritis/gastric ulcer disease, and 6 miscellaneous cases that included Mediterranean fever and prosthetic valve endocarditis.
So, yes, there is some inkling that CT of the upper abdomen is going to miss a segment of pathology. On the other hand, this paper presents incomplete data regarding the true positives and false positives – making evaluation of this specific imaging indication incomplete other than to remind clinicians that the evaluation may need to continue in the setting of a negative CT.
“Negative predictive value of intravenous contrast-enhanced CT of the abdomen for patients presenting to the emergency department with undifferentiated upper abdominal pain”
www.ncbi.nlm.nih.gov/pubmed/22072086