MR imaging in gastrointestinal emergencies

Abstract

Accurate and rapid diagnostic imaging is essential for the appropriate management of acute gastrointestinal conditions. Computed tomography (CT) is the modality most often used in this setting because of its widespread availability and the relative speed, ease, and uniformity with which evaluations can be performed. CT allows the diagnosis of a wide spectrum of acute gastrointestinal diseases with the adjustment of only a few variables in the acquisition protocol. For example, the contrast material volume, injection rate, and delay before image acquisition can be manipulated to enhance vascular or organ-specific contrast for myriad gastrointestinal diagnoses. Magnetic resonance (MR) imaging has similarly robust potential, although its integration into the acute care setting requires greater technical and logistical effort. Improved MR imaging sequences, advances in coil technology, streamlined imaging protocols, and increased technical and professional familiarity with the modality make it an increasingly attractive option when there is concern about patient radiation exposure or allergy to iodinated contrast material. A variety of acute abdominal conditions, including pancreatic and biliary tract trauma, choledocholithiasis, gallbladder disease, acute pancreatitis, and appendicitis can be rapidly and accurately demonstrated with MR imaging. MR imaging also can play a vital role in the follow-up assessment of treatment response and in the diagnosis of indeterminate findings at CT or ultrasonography. Nevertheless, incompatibility of patient monitoring devices with the MR magnet, lack of MR imaging system availability, and the acuity of illness may limit the use of the modality.