MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond

Acute abdominal and pelvic processes account for more than half of all surgical procedures performed in the emergency setting. Rapid and accurate diagnosis in the emergency department is essential for the appropriate management of these acute conditions. Magnetic resonance (MR) imaging is an attractive modality for diagnostic imaging in patients for whom the risks of radiation or the potential nephrotoxicity of iodinated contrast agents is a major concern, such as pregnant and pediatric patients. MR imaging is most useful for evaluating pregnant patients with acute lower abdominal pain believed to have an extra-uterine cause, such as appendicitis or ovarian torsion. Other patients with other conditions commonly seen in the emergency setting may be better evaluated with another cross-sectional imaging modality. Imaging protocols should be adapted to the constraints of acute illness, with emphasis placed on minimizing the duration of image acquisition, and should include strategies to decrease motion-related artifacts. A prudent approach is to select the imaging modalities that can best depict a particular subset of clinical conditions to help narrow the differential diagnosis. Disadvantages of MR imaging include its high cost, the limited availability of MR imaging systems and trained radiologists, and the incompatibility of MR imaging systems and the equipment used for intensive care and monitoring of patient status.