The Back Alleys and Dark Corners of Abdomen and Pelvis Computed Tomography: The Most Frequent Sites of Missed Findings in the Multiplanar Era

OBJECTIVES: Radiologists reading multiplanar abdominal/pelvic computed tomography (CT) are vulnerable to oversight of specific anatomic areas, leading to perceptual errors (misses). The aims of this study are to identify common sites of major perceptual error at our institution and then to put these in context with earlier studies to produce a comprehensive overview. MATERIAL AND METHODS: We reviewed our quality assurance database over an 8-year period for cases of major perceptual error on CT examinations of the abdomen and pelvis. A major perceptual error was defined as a missed finding that had altered management in a way potentially detrimental to the patient. Record was made of patient age, gender, study indication, study priority (stat/routine), and use of IV and/or oral contrast. Anatomic locations were subdivided as lung bases, liver, pancreas, kidneys, spleen, mesentery, peritoneum, retroperitoneum, small bowel, colon, appendix, vasculature, body wall, and bones. RESULTS: A total of 216 missed findings were identified in 201 patients. The most common indication for the study was cancer follow-up (71%) followed by infection (11%) and abdominal pain (6%). The most common anatomic regions of error were the liver (15%), peritoneum (10%), body wall (9%), retroperitoneum (8%), and mesentery (6%). Data from other studies were reorganized into congruent categories for comparison. CONCLUSION: This study demonstrates that the most common sites of significant missed findings on multiplanar abdominal/pelvic CT included the mesentery, peritoneum, body wall, bowel, vasculature, and the liver in the arterial phase. Data from other similar studies were reorganized into congruent categories to provide a comprehensive overview.