Sam Byott MBChB, Presenter: Nothing to Disclose

Ian Harris MBBCh, FRCR, Abstract Co-Author: Nothing to Disclose

To assess MR in acute abdominal imaging and ascertain if it is a reliable alternative to CT in patients under 60  

Four year prospective analysis from January 2009 – December 2013. In patients under 60 presenting with acute abdominal pain, MR was used either as a primary investigation, or following ultrasound when there was ongoing clinical concern. Rapid acquisition HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) coronal and axial sequences without intravenous contrast. Patients were followed up for minimum of 3 months.  

468 cases included in the study. 349 negative for acute abdominal pathology 116 positive for acute abdominal pathology  3 indeterminate MR Negative: 324 had uneventful follow up 22 had negative laparoscopies 3 had subsequent appendectomies, appendicitis on histology (3 days, 10 days and 2 months post scan) MR Positive: 64 had surgery confirming MR findings: 34 appendicitis, 14 SBO, 3 Ovarian torsion, 3 LBO, Intussusception, Ovarian carcinoma, Ovarian dermoid, 2 Pelvc inflammatory disease, Diverticular abscess, Crohns, 4 Endoscopy for acute bowel pathology 1 had surgery for MR diagnosis of appendicitis, sigmoid diverticular perforation identifed at surgery 51 were treated conservatively with concordant follow-up: 4 SBO, 11 diverticulitis, 6 Pelvc inflammatory disease, 7 Inflammatory bowel disease, 7 Colitis, 6 Pyelonephritis, 2 Cholecystitis, Renal abscess, Pseudomembranous colitis, Splenic heamatoma, Mesenteric adenitis, 2 Pancreatitis, Lymphoma, Epiploic appendagitis MR indeterminate: 1 treated conservatively, 1 had laparoscopic appendendectomy, normal appendix on histology, 1 had laparoscopic appendendectomy with acute appendicitis on histology Overall diagnostic accuracy of 99% (463/468), with respect to correlation between MR diagnosis and clinical/surgical follow up Negative laparoscopy rate: 4.9%                

This study demonstrates that rapid acquisition axial and coronal T2 HASTE MR is a practical, safe and effective method in the diagnosis of acute abdominal pain.  MR is the preferred option to CT in patients of an age prone to radiation with a potential surgical diagnosis.  

MRI in acute abdominal imaging is both effective and practical and is the preferred imaging option in patients of an age prone to radiation with a potential surgical diagnosis.

Byott, S, Harris, I, Rapid Acquisition Axial and Coronal T2 HASTE MR in the Evaluation of Acute Abdominal Pain.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012939.html