Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretat
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INVITED REVIEW
Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation Akitoshi Inoue1,2 · Akira Furukawa3 · Kai Takaki2 · Yugo Imai2 · Shinichi Ota2 · Norihisa Nitta2 · Yoshiyuki Watanabe2 Received: 31 July 2020 / Accepted: 28 September 2020 © Japan Radiological Society 2020
Abstract Gastrointestinal tract lesions are major causes of acute abdominal pain. A rapid, accurate, and reliable diagnosis is required to manage patients. Magnetic resonance imaging (MRI) is a nonionizing modality that is beneficial for pregnant women, children, and young adults who are sensitive to ionizing radiation. For patients with renal impairment who are not accurately diagnosed with noncontrast computed tomography, noncontrast MRI can serve as an alternative diagnostic modality. MRI protocols used for acute abdominal pain are supposed to be optimized and prioritized to shorten scanning times. Singleshot T2-weighted and fat-suppressed T2-weighted imaging are important pulse sequences that are used to reveal pathology and inflammation in the gastrointestinal tract. Diffusion-weighted imaging clearly depicts inflammation and abscesses as hyperintense lesions. Most acute gastrointestinal tract lesions, including inflammation, ischemia, obstruction, and perforation, demonstrate bowel wall thickening. Bowel obstruction and adynamic ileus present bowel dilatation, and perforation and penetration show bowel wall defects. MRI can be used to reveal these pathological findings with some characteristics depending on their underlying pathophysiology. This review article discusses imaging modalities for acute abdominal pain, describes a noncontrast MRI protocol for acute abdominal pain caused by gastrointestinal tract lesions, and reviews MRI findings of acute gastrointestinal tract lesions. Keywords Emergency medicine · Magnetic resonance imaging · Gastrointestinal tract · Radiation exposure · Contrast media
Introduction Acute abdominal pain is a primary complaint that accounts for 5–10% of all visits to the emergency department [1]. Acute abdominal pain has various causes, including lifethreatening diseases that require urgent surgical intervention Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11604-020-01053-w) contains supplementary material, which is available to authorized users. * Akitoshi Inoue [email protected]‑med.ac.jp 1
Department of Radiology, National Hospital Organization, Higashi-ohmi General Medical Center, 255 Gochi‑cho, Higashiomi, Shiga 527‑8505, Japan
2
Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa‑cho, Otsu, Shiga 520‑2192, Japan
3
Department of Radiological Science, Tokyo Metropolitan University, 7‑2‑10, Higashioku, Arakawa‑ku, Tokyo 116‑8551, Japan
and benign self-limiting disorders [2]. Rapid, accurate, and reliable diagnosis of urgent cases is essential for the appropriate management of patients with acute abdominal pain. Conducting physical examinatio
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