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Published in: Emergency Radiology 6/2014

01-12-2014 | Review Article

The role of emergency MRI in the setting of acute abdominal pain

Authors: Noah G. Ditkofsky, Ajay Singh, Laura Avery, Robert A. Novelline

Published in: Emergency Radiology | Issue 6/2014

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Abstract

Abdominal pain is one of the most common reasons for patients to present to the emergency department (ED) in the USA, with an estimated seven million visits in 2007–2008, a figure which represents 8 % (±0.2 %) [2] of all ED visits and a 31.8 % increase from 1999–2000. Abdominal pain has a broad differential diagnosis that encompasses multiple organ systems and can provide a significant diagnostic challenge to the ED physician. Although magnetic resonance imaging (MRI) currently plays a limited role in the assessment of abdominal pain presenting to the ED in the nongravid population, its utility in the pregnant and pediatric population has already been proven. A proven diagnostic track record, lack of ionizing radiation and the ability to provide excellent tissue contrast without the use of nephrotoxic iodinated contrast, makes MRI an attractive imaging modality. As physicians and patients become more aware of the potential risks associated with exposure to ionizing radiation, ED MRI utilization is likely to increase. In this article, we discuss the MRI appearance of some of the most common diagnoses, which present as abdominal pain to the ED.
Literature
1.
go back to reference Bhuiya FA, Pitts SR, McCaig LF (2010) Emergency department visits for chest pain and abdominal pain: United States, 1999–2008. NCHS Data Brief 43:1–8PubMed Bhuiya FA, Pitts SR, McCaig LF (2010) Emergency department visits for chest pain and abdominal pain: United States, 1999–2008. NCHS Data Brief 43:1–8PubMed
3.
go back to reference Ginde AA, Foianini A, Renner DM, Valley M, Camargo CA Jr (2008) Availability and quality of computed tomography and magnetic resonance imaging equipment in U.S. emergency departments. Acad Emerg Med: Off J Soc Acad Emerg Med 15(8):780–783CrossRef Ginde AA, Foianini A, Renner DM, Valley M, Camargo CA Jr (2008) Availability and quality of computed tomography and magnetic resonance imaging equipment in U.S. emergency departments. Acad Emerg Med: Off J Soc Acad Emerg Med 15(8):780–783CrossRef
5.
go back to reference Griffey RT, Sodickson A (2009) Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol 192(4):887–892PubMedCrossRef Griffey RT, Sodickson A (2009) Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol 192(4):887–892PubMedCrossRef
6.
go back to reference Rosen MP, Ding A, Blake MA et al (2011) ACR appropriateness criteria(R) right lower quadrant pain–suspected appendicitis. J Am Coll Radiol: JACR 8(11):749–755PubMedCrossRef Rosen MP, Ding A, Blake MA et al (2011) ACR appropriateness criteria(R) right lower quadrant pain–suspected appendicitis. J Am Coll Radiol: JACR 8(11):749–755PubMedCrossRef
7.
go back to reference Singh S, Kalra MK, Hsieh J et al (2010) Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology 257(2):373–383PubMedCrossRef Singh S, Kalra MK, Hsieh J et al (2010) Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology 257(2):373–383PubMedCrossRef
8.
go back to reference Saini S, Seltzer SE, Bramson RT et al (2000) Technical cost of radiologic examinations: analysis across imaging modalities. Radiology 216(1):269–272PubMedCrossRef Saini S, Seltzer SE, Bramson RT et al (2000) Technical cost of radiologic examinations: analysis across imaging modalities. Radiology 216(1):269–272PubMedCrossRef
9.
go back to reference Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E (2012) MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics: Review Publication Radiological Society North America, Inc 32(2):317–334CrossRef Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E (2012) MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics: Review Publication Radiological Society North America, Inc 32(2):317–334CrossRef
10.
go back to reference Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J (2008) MRI vs. ultrasound for suspected appendicitis during pregnancy. Journal of magnetic resonance imaging: JMRI 28(2):428–433PubMedCrossRef Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J (2008) MRI vs. ultrasound for suspected appendicitis during pregnancy. Journal of magnetic resonance imaging: JMRI 28(2):428–433PubMedCrossRef
11.
go back to reference Leyendecker JR, Gorengaut V, Brown JJ (2004) MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. Radiographics: Review Publication Radiological Society North America, Inc 24(5):1301–1316CrossRef Leyendecker JR, Gorengaut V, Brown JJ (2004) MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. Radiographics: Review Publication Radiological Society North America, Inc 24(5):1301–1316CrossRef
12.
go back to reference Roy C, Saussine C, LeBras Y et al (1996) Assessment of painful ureterohydronephrosis during pregnancy by MR urography. Eur Radiol 6(3):334–338PubMedCrossRef Roy C, Saussine C, LeBras Y et al (1996) Assessment of painful ureterohydronephrosis during pregnancy by MR urography. Eur Radiol 6(3):334–338PubMedCrossRef
13.
go back to reference Singh A, Danrad R, Hahn PF, Blake MA, Mueller PR, Novelline RA (2007) MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics: Review Publication Radiological Society North America, Inc 27(5):1419–1431CrossRef Singh A, Danrad R, Hahn PF, Blake MA, Mueller PR, Novelline RA (2007) MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics: Review Publication Radiological Society North America, Inc 27(5):1419–1431CrossRef
15.
go back to reference Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V (2012) Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J Surg Res 175(2):185–190PubMedCrossRef Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V (2012) Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J Surg Res 175(2):185–190PubMedCrossRef
16.
go back to reference Heverhagen JT, Pfestroff K, Heverhagen AE, Klose KJ, Kessler K, Sitter H (2012) Diagnostic accuracy of magnetic resonance imaging: a prospective evaluation of patients with suspected appendicitis (diamond). J Magn Reson Imaging: JMRI 35(3):617–623PubMedCrossRef Heverhagen JT, Pfestroff K, Heverhagen AE, Klose KJ, Kessler K, Sitter H (2012) Diagnostic accuracy of magnetic resonance imaging: a prospective evaluation of patients with suspected appendicitis (diamond). J Magn Reson Imaging: JMRI 35(3):617–623PubMedCrossRef
17.
go back to reference Terasawa T, Blackmore CC, Bent S, Kohlwes RJ (2004) Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 141(7):537–546PubMedCrossRef Terasawa T, Blackmore CC, Bent S, Kohlwes RJ (2004) Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 141(7):537–546PubMedCrossRef
18.
go back to reference Johnson AK, Filippi CG, Andrews T et al (2012) Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. AJR Am J Roentgenol 198(6):1424–1430PubMedCrossRef Johnson AK, Filippi CG, Andrews T et al (2012) Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. AJR Am J Roentgenol 198(6):1424–1430PubMedCrossRef
19.
go back to reference Andersson RE, Lambe M (2001) Incidence of appendicitis during pregnancy. Int J Epidemiol 30(6):1281–1285PubMedCrossRef Andersson RE, Lambe M (2001) Incidence of appendicitis during pregnancy. Int J Epidemiol 30(6):1281–1285PubMedCrossRef
20.
go back to reference Dewhurst C, Beddy P, Pedrosa I (2013) MRI evaluation of acute appendicitis in pregnancy. J Magn Reson Imaging: JMRI 37(3):566–575PubMedCrossRef Dewhurst C, Beddy P, Pedrosa I (2013) MRI evaluation of acute appendicitis in pregnancy. J Magn Reson Imaging: JMRI 37(3):566–575PubMedCrossRef
21.
go back to reference Moore MM, Gustas CN, Choudhary AK et al (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42(9):1056–1063PubMedCrossRef Moore MM, Gustas CN, Choudhary AK et al (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42(9):1056–1063PubMedCrossRef
22.
go back to reference Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging: JMRI 21(2):156–165PubMedCrossRef Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging: JMRI 21(2):156–165PubMedCrossRef
23.
24.
go back to reference Nikolaidis P, Hammond N, Marko J, Miller FH, Papanicolaou N, Yaghmai V (2006) Incidence of visualization of the normal appendix on different MRI sequences. Emerg Radiol 12(5):223–226PubMedCrossRef Nikolaidis P, Hammond N, Marko J, Miller FH, Papanicolaou N, Yaghmai V (2006) Incidence of visualization of the normal appendix on different MRI sequences. Emerg Radiol 12(5):223–226PubMedCrossRef
25.
go back to reference Singh AK, Desai H, Novelline RA (2009) Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol 16(2):133–141PubMedCrossRef Singh AK, Desai H, Novelline RA (2009) Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol 16(2):133–141PubMedCrossRef
26.
go back to reference Hovde O, Moum BA (2012) Epidemiology and clinical course of Crohn’s disease: results from observational studies. World J Gastroenterol: WJG 18(15):1723–1731PubMedCentralPubMedCrossRef Hovde O, Moum BA (2012) Epidemiology and clinical course of Crohn’s disease: results from observational studies. World J Gastroenterol: WJG 18(15):1723–1731PubMedCentralPubMedCrossRef
28.
go back to reference Fidler JL, Guimaraes L, Einstein DM (2009) MR imaging of the small bowel. Radiographics: Review Publication Radiological Society North America, Inc 29(6):1811–1825CrossRef Fidler JL, Guimaraes L, Einstein DM (2009) MR imaging of the small bowel. Radiographics: Review Publication Radiological Society North America, Inc 29(6):1811–1825CrossRef
29.
go back to reference Andreotti RF, Lee SI, Dejesus Allison SO et al (2011) ACR appropriateness criteria(R) acute pelvic pain in the reproductive age group. Ultrasound Q 27(3):205–210PubMedCrossRef Andreotti RF, Lee SI, Dejesus Allison SO et al (2011) ACR appropriateness criteria(R) acute pelvic pain in the reproductive age group. Ultrasound Q 27(3):205–210PubMedCrossRef
30.
go back to reference Outwater EK, Mitchell DG (1996) Normal ovaries and functional cysts: MR appearance. Radiology 198(2):397–402PubMedCrossRef Outwater EK, Mitchell DG (1996) Normal ovaries and functional cysts: MR appearance. Radiology 198(2):397–402PubMedCrossRef
31.
go back to reference Togashi K (2003) MR imaging of the ovaries: normal appearance and benign disease. Radiol Clin North Am 41(4):799–811PubMedCrossRef Togashi K (2003) MR imaging of the ovaries: normal appearance and benign disease. Radiol Clin North Am 41(4):799–811PubMedCrossRef
32.
go back to reference Duigenan S, Oliva E, Lee SI (2012) Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol 198(2):W122–W131PubMedCrossRef Duigenan S, Oliva E, Lee SI (2012) Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol 198(2):W122–W131PubMedCrossRef
33.
go back to reference Kramer LA, Lalani T, Kawashima A (1997) Massive edema of the ovary: high resolution MR findings using a phased-array pelvic coil. J Magn Reson Imaging: JMRI 7(4):758–760PubMedCrossRef Kramer LA, Lalani T, Kawashima A (1997) Massive edema of the ovary: high resolution MR findings using a phased-array pelvic coil. J Magn Reson Imaging: JMRI 7(4):758–760PubMedCrossRef
34.
go back to reference Van Kerkhove F, Cannie M, Op de Beeck K et al (2007) Ovarian torsion in a premenarcheal girl: MRI findings. Abdom Imaging 32(3):424–427PubMedCrossRef Van Kerkhove F, Cannie M, Op de Beeck K et al (2007) Ovarian torsion in a premenarcheal girl: MRI findings. Abdom Imaging 32(3):424–427PubMedCrossRef
35.
go back to reference Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emergency radiology. 2013 Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emergency radiology. 2013
36.
go back to reference Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J (1994) Ovarian torsion: CT and MR imaging appearances. Radiology 190(2):337–341PubMedCrossRef Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J (1994) Ovarian torsion: CT and MR imaging appearances. Radiology 190(2):337–341PubMedCrossRef
37.
go back to reference Kawashima A, Glockner JF, King BF Jr (2003) CT urography and MR urography. Radiol Clin North Am 41(5):945–961PubMedCrossRef Kawashima A, Glockner JF, King BF Jr (2003) CT urography and MR urography. Radiol Clin North Am 41(5):945–961PubMedCrossRef
38.
39.
go back to reference Zaheer A, Singh VK, Qureshi RO, Fishman EK (2013) The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. Abdom Imaging 38(1):125–136PubMedCrossRef Zaheer A, Singh VK, Qureshi RO, Fishman EK (2013) The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. Abdom Imaging 38(1):125–136PubMedCrossRef
40.
43.
go back to reference Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA (2012) A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology 264(3):708–720PubMedCrossRef Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA (2012) A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology 264(3):708–720PubMedCrossRef
44.
go back to reference Hakansson K, Leander P, Ekberg O, Hakansson HO (2000) MR imaging in clinically suspected acute cholecystitis. A comparison with ultrasonography. Acta Radiol 41(4):322–328PubMedCrossRef Hakansson K, Leander P, Ekberg O, Hakansson HO (2000) MR imaging in clinically suspected acute cholecystitis. A comparison with ultrasonography. Acta Radiol 41(4):322–328PubMedCrossRef
45.
go back to reference Catalano OA, Sahani DV, Kalva SP et al (2008) MR imaging of the gallbladder: a pictorial essay. Radiographics: Review Publication Radiological Society of North America, Inc 28(1):135–155, quiz 324CrossRef Catalano OA, Sahani DV, Kalva SP et al (2008) MR imaging of the gallbladder: a pictorial essay. Radiographics: Review Publication Radiological Society of North America, Inc 28(1):135–155, quiz 324CrossRef
46.
go back to reference Tonolini M, Ravelli A, Villa C, Bianco R (2012) Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emerg Radiol 19(4):341–348PubMedCrossRef Tonolini M, Ravelli A, Villa C, Bianco R (2012) Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emerg Radiol 19(4):341–348PubMedCrossRef
47.
go back to reference Yeh BM, Liu PS, Soto JA, Corvera CA, Hussain HK (2009) MR imaging and CT of the biliary tract. Radiographics: Review Publication Radiological Society of North America, Inc 29(6):1669–1688CrossRef Yeh BM, Liu PS, Soto JA, Corvera CA, Hussain HK (2009) MR imaging and CT of the biliary tract. Radiographics: Review Publication Radiological Society of North America, Inc 29(6):1669–1688CrossRef
48.
go back to reference Loud PA, Semelka RC, Kettritz U, Brown JJ, Reinhold C (1996) MRI of acute cholecystitis: comparison with the normal gallbladder and other entities. Magn Reson Imaging 14(4):349–355PubMedCrossRef Loud PA, Semelka RC, Kettritz U, Brown JJ, Reinhold C (1996) MRI of acute cholecystitis: comparison with the normal gallbladder and other entities. Magn Reson Imaging 14(4):349–355PubMedCrossRef
49.
50.
go back to reference Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40(6):1307–1323PubMedCrossRef Gore RM, Yaghmai V, Newmark GM, Berlin JW, Miller FH (2002) Imaging benign and malignant disease of the gallbladder. Radiol Clin North Am 40(6):1307–1323PubMedCrossRef
52.
go back to reference Stimac D, Miletic D, Radic M et al (2007) The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis. Am J Gastroenterol 102(5):997–1004PubMedCrossRef Stimac D, Miletic D, Radic M et al (2007) The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis. Am J Gastroenterol 102(5):997–1004PubMedCrossRef
53.
go back to reference Viremouneix L, Monneuse O, Gautier G et al (2007) Prospective evaluation of nonenhanced MR imaging in acute pancreatitis. J Magn Reson Imaging: JMRI 26(2):331–338PubMedCrossRef Viremouneix L, Monneuse O, Gautier G et al (2007) Prospective evaluation of nonenhanced MR imaging in acute pancreatitis. J Magn Reson Imaging: JMRI 26(2):331–338PubMedCrossRef
54.
go back to reference Miller FH, Keppke AL, Dalal K, Ly JN, Kamler VA, Sica GT (2004) MRI of pancreatitis and its complications: part 1, acute pancreatitis. AJR Am J Roentgenol 183(6):1637–1644PubMedCrossRef Miller FH, Keppke AL, Dalal K, Ly JN, Kamler VA, Sica GT (2004) MRI of pancreatitis and its complications: part 1, acute pancreatitis. AJR Am J Roentgenol 183(6):1637–1644PubMedCrossRef
55.
go back to reference Taylor MR, Lalani N (2013) Adult small bowel obstruction. Acad Emerg Med: Off J Soc Acad Emerg Med 20(6):528–544CrossRef Taylor MR, Lalani N (2013) Adult small bowel obstruction. Acad Emerg Med: Off J Soc Acad Emerg Med 20(6):528–544CrossRef
56.
go back to reference Foster NM, McGory ML, Zingmond DS, Ko CY (2006) Small bowel obstruction: a population-based appraisal. J Am Coll Surg 203(2):170–176PubMedCrossRef Foster NM, McGory ML, Zingmond DS, Ko CY (2006) Small bowel obstruction: a population-based appraisal. J Am Coll Surg 203(2):170–176PubMedCrossRef
58.
go back to reference Hammond NA, Miller FH, Yaghmai V, Grundhoefer D, Nikolaidis P (2008) MR imaging of acute bowel pathology: a pictorial review. Emerg Radiol 15(2):99–104PubMedCrossRef Hammond NA, Miller FH, Yaghmai V, Grundhoefer D, Nikolaidis P (2008) MR imaging of acute bowel pathology: a pictorial review. Emerg Radiol 15(2):99–104PubMedCrossRef
60.
go back to reference Miller G, Boman J, Shrier I, Gordon PH (2000) Etiology of small bowel obstruction. Am J Surg 180(1):33–36PubMedCrossRef Miller G, Boman J, Shrier I, Gordon PH (2000) Etiology of small bowel obstruction. Am J Surg 180(1):33–36PubMedCrossRef
61.
go back to reference Menzies D, Ellis H (1990) Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl 72(1):60–63PubMedCentralPubMed Menzies D, Ellis H (1990) Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl 72(1):60–63PubMedCentralPubMed
62.
go back to reference Selvin E, Parrinello CM, Sacks DB, Coresh J (2014) Trends in prevalence and control of diabetes in the United States, 1988–1994 and 1999–2010. Ann Intern Med 160(8):517–525PubMedCrossRef Selvin E, Parrinello CM, Sacks DB, Coresh J (2014) Trends in prevalence and control of diabetes in the United States, 1988–1994 and 1999–2010. Ann Intern Med 160(8):517–525PubMedCrossRef
Metadata
Title
The role of emergency MRI in the setting of acute abdominal pain
Authors
Noah G. Ditkofsky
Ajay Singh
Laura Avery
Robert A. Novelline
Publication date
01-12-2014
Publisher
Springer Berlin Heidelberg
Published in
Emergency Radiology / Issue 6/2014
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI
https://doi.org/10.1007/s10140-014-1232-2

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