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Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation

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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. Single-shot 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.

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Acknowledgements

The authors would like to thank Enago (https://www.enago.jp) for the English language review.

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Authors and Affiliations

  1. Department of Radiology, National Hospital Organization, Higashi-ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-8505, Japan

    Akitoshi Inoue

  2. Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan

    Akitoshi Inoue, Kai Takaki, Yugo Imai, Shinichi Ota, Norihisa Nitta & Yoshiyuki Watanabe

  3. Department of Radiological Science, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan

    Akira Furukawa

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Supplementary. 1 Cine MRI showing normal bowel motility. Small bowel containing a small amount of fluid shows moderate peristalsis. A total of 60 slices are acquired during the 30 s in a cine MRI scan. The frame rate of the movie is 6 frame/sec (actual 3 × speed) (MP4 1175 kb)

Supplementary. 2 Cine MRI of bowel obstruction. The dilated small bowel demonstrates accelerated bowel peristalsis. A total of 60 slices are acquired during the 30 s in a cine MRI scan. The frame rate of the movie is 6 frame/sec (actual 3 × speed) (MP4 1317 kb)

Supplementary. 3 Cine MRI of adynamic ileus. The dilated small bowel in the lower abdomen demonstrates a decreased bowel peristalsis rather than peristalsis that observed in the right upper abdomen. A total of 60 slices are acquired during the 30 s in a cine MRI scan. The frame rate of the movie is 6 frame/sec (actual 3 × speed) (MP4 2081 kb)

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Inoue, A., Furukawa, A., Takaki, K. et al. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Jpn J Radiol 39, 209–224 (2021). https://doi.org/10.1007/s11604-020-01053-w

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