Imaging Patients with Acute Abdominal Pain
Because acute abdominal pain may be caused by myriad diagnoses, the added value of imaging after clinical evaluation—particularly its effect on diagnostic accuracy and certainty and patient treatment—is important. Except in patients suspected of having cholecystitis, CT can be considered the primary imaging technique for the diagnosis of acute abdominal pain.
In a review article published in the October issue of Radiology (RSNA.org/Radiology), Jaap Stoker, M.D., of the Academic Medical Center at the University of Amsterdam in the Netherlands, and colleagues discuss the role of ultrasound, CT and MR imaging in adults presenting in the emergency department with acute abdominal pain. Authors also address other frequently encountered urgent diagnoses:
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Coronal contrast-enhanced reformatted CT image in 28-year-old man clinically suspected of having appendicitis shows inflamed appendix (straight arrow). Inflammation is more pronounced at the appendiceal tip, and discontinuity of the appendiceal wall is suggested. Small amounts of fluid (curved arrow) adjacent to the appendix are present. Adjacent fat inflammation (arrowheads) is more pronounced at the appendiceal tip. Surgery and histopathologic analysis results proved the presence of perforated retrocecal appendicitis. (Radiology 2009;253:31-46) © RSNA, 2009. All rights reserved. Printed with permission. |
• Acute appendicitis
• Acute diverticulitis
• Acute cholecystitis
• Bowel obstruction
• Perforated viscus
• Bowel ischemia
"Because ultrasound and CT are widely available, radiography is rarely indicated for the examination of patients with acute abdominal pain, with the exception of select patients groups—for example, patients with bowel obstruction," the authors conclude. "CT is an effective examination with results that have a positive effect on the treatment of many patients with acute abdominal pain."
Use of 3.0T MR Imaging for Evaluation of the Abdomen
Although it has some noteworthy technical limitations, 3.0T MR imaging is uniquely beneficial for evaluating the abdomen, especially for applications such as enhanced and nonenhanced hepatic imaging, diffusion-weighted imaging, angiography, MR pancreatography and colonography.
 High-resolution Maximum Intensity Projection image from 3.0T abdominal MR angiographic data obtained in a 53-year-old woman with a suspected renal mass in the right kidney provides excellent SNR and vascular detail. The image was acquired during a single 19-second breath hold using parallel imaging techniques (acceleration factor R = 3). Note the contrast material in the collecting system of the kidney, which is from a previous test bolus that was injected to determine the exact delay of the arterial phase for the subsequent MR angiogram of the abdominal vessels. (RadioGraphics 2009;29:1547-1563) © RSNA, 2009. All rights reserved. Printed with permission. |
In an article in the October special issue of RadioGraphics (RSNA.org/RadioGraphics), Sukru Mehmet Erturk, M.D., from the Sisli Etfal Training and Research Hospital in Istanbul, Turkey, and colleagues discuss and illustrate the technical basis, advantages and limitations and main clinical applications of 3.0T MR imaging, particularly in the abdomen. Authors specifically address:
• Tissue relaxation times and signal-to-noise ratio (SNR)
• Basic contrast and general guidelines
• Advanced pulse sequences and clinical applications
• Limitations and common artifacts
• Safety issues
"The higher SNR and spatial resolution of 3.0 T imagers may be used to improve the quality of abdominal MR imaging and clinical diagnosis. However, it should be noted that abdominal MR imaging at 3.0T is still in the early stages, and substantial modifications in the pulse sequences and hardware components are needed," authors concluded. "The ability to obtain physiologic and functional information within reasonable acquisition times makes the future bright for 3.0T abdominal MR imaging."
