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E2133. How to Approach Complexity of Acute Abdomen on MRI: A Case-Based Review
Authors
  1. Jigarkumar Rangunwala; University of Mississippi Medical Center
  2. Juliana Sitta; University of Mississippi Medical Center
  3. Thomas Estes; Medical College of Georgia
  4. Pardeep Mittal; Medical College of Georgia
  5. Manohar Roda; University of Mississippi Medical Center
Background
Multiple studies have shown advantages of Magnetic Resonance Imaging (MRI) in the evaluation of acute abdomen-pelvis. MRI has gained popularity due to concerns about ionizing radiation exposure from overuse of computed tomography (CT), especially in children and pregnant patients. However, the diagnostic benefits of MRI go far beyond these subgroups of patients. Our presentation will highlight how MRI can be crucial in the diagnosis of acute abdomen. We will review abbreviated MRI protocol with discussion about strength and limitation of key sequences. Additionally, viewers will be guided through interesting case collection of challenging pathologies including gastrointestinal, genitourinary, obstetrics and gynecology.

Educational Goals / Teaching Points
Our exhibit will review indications of magnetic resonance imaging (MRI) in a variety of patient settings with acute pain in the abdomen-pelvis. Discuss MR imaging technique, abbreviated protocol, and its clinical case-based applications. Lastly, compare strengths and limitations of MRI in this clinical setting.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Acute abdomen abbreviated MRI protocol: Brief review of breath-hold fast sequences such as single-shot T2-weighted imaging, T2-weighted imaging with fat saturation, T1-weighted 4-point Dixon, True-fast imaging with steady state precession (Tru-FISP), Diffusion-Weighted Imaging (DWI), magnetic resonance cholangiopancreatography (MRCP) and optional post-contrast T1-weighted imaging with fat saturation. Case-based review by organ system: We will provide a collection of MRI case samples to cover common and uncommon pathologies encountered in the acute setting. The cases will be classified into various categories: Bowel-Mesenteric, Pancreatic-Splenic, Hepatobiliary, Genitourinary, Obstetrics and Gynecology.

Conclusion
MRI is accurate and definitive for wide spectrum of pathology that ranges from most common to most complex in variety of clinical settings. Furthermore, due to its excellent soft tissue contrast, multi-planar imaging, faster sequences, abbreviated protocols, and most of the pathologies encountered in this acute setting can be diagnosed without intravenous or oral contrast administration.