Key Points
Magnetic resonance imaging (MRI) has often been considered a second-line, alternative imaging modality for the evaluation of patients with suspected acute gastrointestinal tract pathology because of its limited availability, cost, and relatively long imaging times. The multiplanar capability and excellent soft-tissue contrast of MRI, combined with the advent of ultrafast MRI techniques, however, have increased the utilization of MRI in more recent years for the imaging assessment of acute conditions of the gastrointestinal tract. Furthermore, because of its lack of ionizing radiation, MRI not only plays an especially critical role in the imaging evaluation of pregnant patients presenting with acute abdominal symptoms, but also is evolving to become a principal imaging modality for the evaluation of young patients with inflammatory bowel disease. This chapter presents the general principles regarding the imaging protocols for the evaluation of appendicitis in pregnant and nonpregnant patients, and discusses the MRI appearances of a variety of common and uncommon acute conditions of the gastrointestinal tract.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Aho AJ, Heinonen R, Lauren P (1973) Benign and malignant mucocele of the appendix. Histological types and prognosis. Acta Chir Scand 139:392–400
Balthazar EJ, Megibow AJ, Gordon RB, et al (1987) Cecal diver-ticulitis: evaluation with CT. Radiology 162:79–81
Barbier C, Denny P, Pradoura JM, et al (1998) [Radiologic aspects of infarction of the appendix epiploica]. J Radiol 79:1479–1485
Barbosa JJ, Dockerty MB, Waugh JM (1946) Pancreatic heterotopia: a review of the literature and report of 41 authenticated surgical cases of which 25 were clinically significant. Surg Gynecol Obstet 82:527–542
Beall D P, Fortman BJ, Lawler BC, et al (2002) Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol 57:719–724
Bennett GL, Tanpitukpongse TP, Macari M, et al (2009) CT diagnosis of mucocele of the appendix in patients with acute appendicitis. AJR Am J Roentgenol 192:W103–W110
Bernstein CN, Greenberg H, Boult I, et al (2005) A prospective comparison study of MRI versus small bowel follow-through in recurrent Crohn's disease. Am J Gastroenterol 100:2493–2502
Birchard KR, Brown MA, Hyslop WB, et al (2005) MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol 184:452–458
Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215:337–348
Buckley O, Geoghegan T, McAuley G, et al (2007) Pictorial review: magnetic resonance imaging of colonic diverticulitis. Eur Radiol 17:221–227
Carr NJ, McCarthy WF, Sobin LH (1995) Epithelial noncarcinoid tumors and tumor-like lesions of the appendix. A clinicopathologic study of 184 patients with a multivariate analysis of prognostic factors. Cancer 75:757–768
Chan JH, Tsui EY, Luk SH, et al (2001) MR diffusion-weighted imaging of kidney: differentiation between hydronephrosis and pyonephrosis. Clin Imaging 25:110–113
Chintapalli KN, Chopra S, Ghiatas AA, et al (1999) Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 210:429–435
Cobben L, Groot I, Kingma L, et al (2009) A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. Eur Radiol 19:1175–1183
Cobben L P, Groot I, Haans L, et al (2004) MRI for clinically suspected appendicitis during pregnancy. AJR Am J Roentgenol 183:671–675
Cronin CG, Lohan DG, DeLappe E, et al (2008) Duodenal abnormalities at MR small-bowel follow-through. AJR Am J Roentgenol 191:1082–1092
Earls J P, Rofsky NM, DeCorato DR, et al (1997) Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: optimization with a test examination and a power injector. Radiology 202:268–273
Eyvazzadeh AD, Pedrosa I, Rofsky NM, et al (2004) MRI of right-sided abdominal pain in pregnancy. AJR Am J Roentgenol 183:907–914
Fattahi R, Balci NC, Perman WH, et al (2009) Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 29:350–356
Furukawa A, Saotome T, Yamasaki M, et al (2004) Cross-sectional imaging in Crohn disease. Radiographics 24:689–702
Ganguli S, Raptopoulos V, Komlos F, et al (2006) Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT. Radiology 241:175–180
Garcia K, Hernanz-Schulman M, Bennett DL, et al (2009) Suspected appendicitis in children: diagnostic importance of normal abdominopelvic CT findings with nonvisualized appendix. Radiology 250:531–537
Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, et al (2002) MR enteroclysis: technical considerations and clinical applications. Eur Radiol 12:2651–2658
Greenberg JJ, Esposito TJ (1996) Appendicitis after laparoscopic appendectomy: a warning. J Laparoendosc Surg 6:185–187
Hammond NA, Miller FH, Yaghmai V, et al (2008) MR imaging of acute bowel pathology: a pictorial review. Emerg Radiol 15:99–104
Hedrick E, Kozloff M, Hainsworth J (2006) Safety of bevacizumab plus chemotherapy as first-line treatment of patients with metastatic colorectal cancer: updated results from a large observational registry in the US (BRiTE) [meeting abstracts]. J Clin Oncol 24:3536
Herrmann KA, Michaely HJ, Zech CJ, et al (2006) Internal fis-tulas in Crohn disease: magnetic resonance enteroclysis. Abdom Imaging 31:675–687
Heverhagen JT, Ishaque N, Zielke A, et al (2001) Feasibility of MRI in the diagnosis of acute diverticulitis: initial results. Magma 12:4–9
Heverhagen JT, Sitter H, Zielke A, et al (2008) Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum 51:1810–1815
Higa E, Rosai J, Pizzimbono CA, et al (1973) Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendiceal “mucocele”. Cancer 32:1525–1541
Hoeffel C, Crema MD, Belkacem A, et al (2006) Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics 26:1373–1390
Hormann M, Puig S, Prokesch SR, et al (2002) MR imaging of the normal appendix in children. Eur Radiol 12:2313–2316
Incesu L, Coskun A, Selcuk MB, et al (1997) Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol 168:669–674
Israel GM, Malguria N, McCarthy S, et al (2008) MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging 28:428–433
Kanal E, Barkovich AJ, Bell C, et al (2007) ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 188:1447–1474
Kim S, Jain M, Harris AB, et al (2009) T1 hyperintense renal lesions: characterization with diffusion-weighted MR Imaging versus contrast-enhanced MR imaging. Radiology 251:796–807
Klein HM, Klosterhalfen B, Kinzel S, et al (1996) CT and MRI of experimentally induced mesenteric ischemia in a porcine model. J Comput Assist Tomogr 20:254–261
Koh DM, Miao Y, Chinn RJ, et al (2001) MR imaging evaluation of the activity of Crohn's disease. AJR Am J Roentgenol 177:1325–1332
Lai EC, Tompkins RK (1986) Heterotopic pancreas. Review of a 26 year experience. Am J Surg 151:697–700
Landen S, Bertrand C, Maddern GJ, et al (1992) Appendiceal mucoceles and pseudomyxoma peritonei. Surg Gynecol Obstet 175:401–404
Lee JC, Wong K P, Lo SS, et al (2008a) Acute ectopic pancreatitis. Hong Kong Med J 14:501–502
Lee KS, Rofsky NM, Pedrosa I (2008b) Localization of the appendix at MR imaging during pregnancy: utility of the cecal tilt angle. Radiology 249:134–141
Lee SS, Kim AY, Yang SK, et al (2009) Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 251:751
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 24:1301–1316
Liebig T, Stoupis C, Ros PR, et al (1993) A potentially artifact-free oral contrast agent for gastrointestinal MRI. Magn Reson Med 30:646–649
Lohan DG, Alhajeri AN, Cronin CG, et al (2008) MR enterography of small-bowel lymphoma: potential for suggestion of histologic subtype and the presence of underlying celiac disease. AJR Am J Roentgenol 190:287–293
Lohrmann C, Ghanem N, Pache G, et al (2005) CT in acute perforated sigmoid diverticulitis. Eur J Radiol 56:78–83
Low RN, Francis IR, Politoske D, et al (2000) Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J Magn Reson Imaging 11:127–135
Maccioni F, Bruni A, Viscido A, et al (2006) MR imaging in patients with Crohn disease: value of T2- versus T1-weighted gadolinium-enhanced MR sequences with use of an oral superparamagnetic contrast agent. Radiology 238:517–530
Maccioni F, Viscido A, Broglia L, et al (2000) Evaluation of Crohn disease activity with magnetic resonance imaging. Abdom Imaging 25:219–228
Madwed D, Mindelzun R, Jeffrey RB Jr (1992) Mucocele of the appendix: imaging findings. AJR Am J Roentgenol 159:69–72
Mangi AA, Berger DL (2000) Stump appendicitis. Am Surg 66:739–741
Marcos HB, Semelka RC (1999) Stomach diseases: MR evaluation using combined t2-weighted single-shot echo train spin-echo and gadolinium-enhanced spoiled gradientecho sequences. J Magn Reson Imaging 10:950–960
Martin DR, Danrad R, Herrmann K, et al (2005) Magnetic resonance imaging of the gastrointestinal tract. Top Magn Reson Imaging 16:77–98
McKenna DA, Meehan CP, Alhajeri AN, et al (2007) The use of MRI to demonstrate small bowel obstruction during pregnancy. Br J Radiol 80:e11–e4
Nitta N, Takahashi M, Furukawa A, et al (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21:156–165
Okuhata Y, Maebayashi T, Furuhashi S, et al (2008) Characteristics of ectopic pancreas in dynamic gadolinium-enhanced MRI. Abdom Imaging. http://www.springerlink.com/content/ kp444564843871v8/. Published December 2, 2008. Accessed May 1, 2009
Oto A, Ernst RD, Ghulmiyyah LM, et al (2009) MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdom Imaging 34:243–250
Oto A, Ernst RD, Shah R, et al (2005) Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging–initial experience. Radiology 234:445–451
Patel SJ, Reede DL, Katz DS, et al (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27:1705–1722
Pedrosa I, Lafornara M, Pandharipande P V, et al (2009) Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology 250:749–757
Pedrosa I, Levine D, Eyvazzadeh AD, et al (2006) MR imaging evaluation of acute appendicitis in pregnancy. Radiology 238:891–899
Pedrosa I, Rofsky NM (2003) MR imaging in abdominal emergencies. Radiol Clin North Am 41:1243–1273
Pedrosa I, Zeikus EA, Levine D, et al (2007) MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics 27:721–743; discussion 743–753
Pickhardt PJ, Levy AD, Rohrmann CA Jr, et al (2002) Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison. Radiology 224:775–781
Pickhardt PJ, Levy AD, Rohrmann CA Jr, et al (2003) Primary neoplasms of the appendix: radiologic spectrum of disease with pathologic correlation. Radiographics 23:645–662
Qizilbash AH (1975) Mucoceles of the appendix. Their relationship to hyperplastic polyps, mucinous cystadenomas, and cystadenocarcinomas. Arch Pathol 99:548–555
Rao PM, Sagarin MJ, McCabe CJ (1998) Stump appendicitis diagnosed preoperatively by computed tomography. Am J Emerg Med 16:309–311
Regan F, Beall DP, Bohlman ME, et al (1998) Fast MR imaging and the detection of small-bowel obstruction. AJR Am J Roentgenol 170:1465–1469
Rha SE, Ha HK, Lee SH, et al (2000) CT and MR imaging find-ings of bowel ischemia from various primary causes. Radiographics 20:29–42
Rioux M, Langis P (1994) Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology 191:523–526
Rofsky NM, Lee VS, Laub G, et al (1999) Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology 212:876–884
Rubesin SE, Furth EE, Birnbaum BA, et al (1997) Ectopic pancreas complicated by pancreatitis and pseudocyst formation mimicking jejunal diverticulitis. Br J Radiol 70:311–313
Sadowski EA, Bennett LK, Chan MR, et al (2007) Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 243:148–157
Sartoris DJ, Harell GS, Anderson MF, et al (1984) Small-bowel lymphoma and regional enteritis: radiographic similarities. Radiology 152:291–296
Shellock FG, Crues JV (2004) MR procedures: biologic effects, safety, and patient care. Radiology 232:635–652
Shin LK, Halpern D, Weston SR, et al (2005) Prospective CT diagnosis of stump appendicitis. AJR Am J Roentgenol 184:S62–S64
Siddiki H, Fidler J (2009) MR imaging of the small bowel in Crohn's disease. Eur J Radiol 69:409–417
Silva AC, Charles JC, Kimery BD, et al (2006) MR Cholangiopancreatography in the detection of symptomatic ectopic pancreatitis in the small-bowel mesentery. AJR Am J Roentgenol 187:W195–W197
Singh AK, Desai H, Novelline RA (2009) Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol 16:133–141
Singh AK, Gervais DA, Hahn PF, et al (2005) Acute epiploic appendagitis and its mimics. Radiographics 25:1521–1534
Sirvanci M, Balci NC, Karaman K, et al (2002) Primary epiploic appendagitis: MRI findings. Magn Reson Imaging 20:137–139
Sugrue M, Kozloff M, Hainsworth J (2006) Risk factors for gastrointestinal perforations in patients with metastatic colorectal cancer receiving bevacizumab plus chemotherapy [meeting abstracts]. J Clin Oncol 24:3535
Taouli B, Thakur RK, Mannelli L, et al (2009) Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 251:398–407
Truty MJ, Stulak JM, Utter PA, et al (2008) Appendicitis after appendectomy. Arch Surg 143:413–415
van Randen A, Bipat S, Zwinderman AH, et al (2008) Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 249:97–106
Verswijvel G, Vandecaveye V, Gelin G, et al (2002) Diffusion-weighted MR imaging in the evaluation of renal infection: preliminary results. Jbr-Btr 85:100–103
Walsh DC, Roediger WE (1997) Stump appendicitis–a potential problem after laparoscopic appendicectomy. Surg Laparosc Endosc 7:357–358
Woodfield C, Lazarus E (2008) MR imaging of appendicitis in pregnancy: comparison of appendix visualization without and with oral contrast material administration [abstract]. Radiological Society of North America Scientific Assembly and Annual Meeting Program 518
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Lee, K.S., Pedrosa, I. (2010). MRI of Acute Conditions of the Gastrointestinal Tract. In: Stoker, J. (eds) MRI of the Gastrointestinal Tract. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85532-3_17
Download citation
DOI: https://doi.org/10.1007/978-3-540-85532-3_17
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-85531-6
Online ISBN: 978-3-540-85532-3
eBook Packages: MedicineMedicine (R0)