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Updated: Feb 28, 2026
Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
Identifying intestinal malrotation on magnetic resonance examinations ordered for unrelated indications
Jill S Fay1, Victoria Chernyak2, Benjamin H Taragin2
1Department of Diagnostic Radiology, Montefiore Medical Center, 111 E. 210th St, Bronx, NY, 10467, USA. jsp1225@gmail.com.
Background:
Anatomical imaging findings indicating normal bowel rotation can be identified on cross-sectional imaging, including magnetic resonance imaging (MRI) performed for non-related indications.
Objective:
The goal of our study was to assess whether non-targeted MRI can accurately assess intestinal malrotation.
Materials And Methods:
Four anatomical landmarks were assessed on MRIs of the chest, spine or abdomen performed from January 2006 to June 2014, on patients who also had upper gastrointestinal series (UGI) performed within 10 years of the MRI date: 1) retroperitoneal duodenum, 2) left upper quadrant duodenojejunal junction, 3) superior mesenteric artery to the left of the superior mesenteric vein, and 4) right lower quadrant cecum. Two attending radiologists, one pediatric and one abdominal radiologist, independently reviewed the MR images. The pediatric radiologist reviewed images from UGI (considered the gold standard) to determine the intestinal rotation for each case. Validation of the criteria was performed on new patients imaged through January 2016.
Results:
The original cohort included 109 MRIs (15 chest, 41 spine and 53 abdomen) done on 109 patients (42% males, mean age: 10.2 years). If each of the 4 anatomical questions were answered "yes" (4-YES), specificity was 100% for each radiologist and malrotation was appropriately excluded. Using the 4-YES criteria, the pediatric radiologist excluded malrotation in 71 patients (65%) and the abdominal radiologist excluded it in 65 (60%), with concurrence for 57 patients. Validation of the 4-YES criteria in 23 new patients appropriately proved the 4-YES rule, with neither labeling the one new malrotation case 4-YES.
Conclusion:
If a radiologist can confidently answer "yes" to the four questions evaluated in this study, then intestinal rotation can be safely considered normal. Normal bowel rotation should be commented upon in MRI reports when these four anatomical locations are imaged, thus helping patients avoid unnecessary UGI and radiation exposure.
Insights
Non-targeted magnetic resonance imaging (MRI) can accurately assess normal intestinal rotation. Radiologists can confidently exclude malrotation if four key anatomical landmarks are identified on MRI, potentially avoiding unnecessary procedures.
Area of Science:
- Radiology
- Gastroenterology
- Pediatric Imaging
Background:
- Normal bowel rotation findings are identifiable on cross-sectional imaging like MRI.
- Incidental MRI findings can indicate normal intestinal rotation.
Purpose of the Study:
- To evaluate the accuracy of non-targeted MRI in assessing intestinal malrotation.
- To determine if specific anatomical landmarks on MRI can reliably exclude malrotation.
Main Methods:
- Retrospective review of 109 MRIs (chest, spine, abdomen) with comparison to upper gastrointestinal series (UGI).
- Assessment of four key anatomical landmarks: retroperitoneal duodenum, left upper quadrant duodenojejunal junction, SMA-SMV relationship, and right lower quadrant cecum.
- Independent review by pediatric and abdominal radiologists, with validation on 23 new cases.
Main Results:
- 100% specificity in excluding malrotation when all four anatomical landmarks were identified as normal (4-YES criteria).
- Pediatric radiologist excluded malrotation in 65% of cases; abdominal radiologist in 60%.
- Validation cohort confirmed the accuracy of the 4-YES criteria, correctly identifying a malrotation case.
Conclusions:
- Confident "yes" to the four assessed anatomical questions on MRI indicates normal intestinal rotation.
- Commentary on normal bowel rotation in MRI reports can prevent unnecessary UGI and radiation exposure.
- Utilizing MRI for assessing intestinal rotation enhances diagnostic efficiency and patient safety.
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