E2586. Diffusion Abnormalities in the Pediatric Patient with Acute Abdominal Pain
Authors
Audrey Nisbet;
University of Arizona Medical Imaging Department
Raza Mushtaq;
University of Arizona Medical Imaging Department
Dorothy Gilbertson-Dahdal;
University of Arizona Medical Imaging Department
Unni Udayasankar;
University of Arizona Medical Imaging Department
Background
Acute abdominal pain is a commonly encountered chief complaint in the pediatric emergency department, with infection frequently implicated in the final diagnosis. The clinical presentation of various gastrointestinal and genitourinary pathologies can overlap, resulting in a broad differential diagnosis that can be difficult to refine in the absence of reliable imaging. Prioritization of nonionizing medical imaging is paramount in the pediatric population, with magnetic resonance imaging (MRI) recognized as a valuable means of investigating equivocal precursor imaging and providing a more definitive evaluation of the etiology of abdominal pain. The knowledge of diffusion weighted imaging (DWI) abnormalities in various acute abdominal pathologies in the pediatric population is an invaluable tool in the radiologist’s repository to be able to provide the correct diagnosis and assist the clinician in the delivery of timely emergency care.
Educational Goals / Teaching Points
This educational exhibit will provide a brief introduction to the physics and acquisition technique of diffusion weighted magnetic resonance imaging, the history of diffusion in MRI, and the current role of diffusion in the evaluation of acute abdominal pain. This will be followed by a case-based presentation of common pediatric gastrointestinal and genitourinary pathologies encountered in the emergency department, most of which draw upon imaging patterns rooted in inflammation and infection, which can manifest as informative diffusion weighted findings.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pertinent gastrointestinal and genitourinary pathologies encountered in the pediatric emergency department include pyelonephritis, appendicitis, and pelvic inflammatory disease. Key MRI findings in these pathologies will be summarized, and a particular emphasis will be placed on the diffusion weighted findings that can be called upon to provide diagnostic clarity in the evaluation of acute abdominal pathologies.
Conclusion
With MRI more widely recognized as a reliable imaging modality for the evaluation of acute abdominal pain in the pediatric population, it is becoming more incumbent upon radiologists of all levels of training to maintain knowledge of the various MRI patterns seen in the most common etiologies of acute gastrointestinal and genitourinary pathologies. The employment of diffusion weighted sequences in standard protocols for the evaluation of acute abdominal pain in the pediatric population provides the radiologist with an additional problem-solving sequence, and with a confident understanding of the diffusion abnormalities in these pathologies, radiologists will be better equipped to deliver diagnostic accuracy to the greatest extent that current technology allows.
