Evaluating the acute abdomen with MRI
Dr Andrew Plumb
Acute abdominal conditions are common and frequently have a poor outcome; emergency laparotomy carries a
mortality of over 10%. Radiologists are critical to ensure prompt, accurate diagnosis. In most cases, US and/or CT are
the workhorse; yet in some situations, US may be inadequate and CT may be undesirable (for example, pregnancy
or younger patients).
MRI is an accurate alternative that is increasingly available as scanning units become more numerous. It is safe in
pregnancy (with caution in the first trimester), and can often be successfully completed without gadolinium. T2-
weighted sequences, with and without fat suppression, are the cornerstone of imaging, supplemented by diffusionweighted
sequences and post-contrast scans where necessary. Existing small bowel scan protocols can be used
successfully in the acute setting.
Interpretation is challenging, and there is a long learning curve. Many conditions that are simple to identify on CT
are (initially) more challenging on MRI; examples of common conditions will be presented. Pitfalls in interpretation
will be highlighted. If there is diagnostic uncertainty after MRI, CT can always be performed as a “fail-safe” and
the patient is no worse off. Moreover, there are situations in which MRI is preferable due to its superior tissuecharacterisation
To learn about the:
• The potential advantages of using MRI for acute abdominal imaging
• Downsides of MRI for acute abdominal imaging
• Protocol design and optimisation
• Pitfalls in interpretation
• Ditkofsky NG et al (2014). The role of emergency MRI in the setting of acute abdominal pain. Emerg Radiol
• Leeuwenburgh M et al (2013). Comparison of imaging strategies with conditional contrast-enhanced CT and
unenhanced MR imaging in patients suspected of having appendicitis: a multicenter diagnostic performance
study. Radiology 268(1):135-143.
• Ray JG et al (2016) Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes.
1 CPD credit.
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Dr Andrew Plumb is an Academic Clinical Radiologist, with particular interest in abdominal imaging. He is currently
Senior Lecturer and Consultant Radiologist, University College London.
He trained in Oxford, Exeter and Manchester, being awarded the Frank Doyle Medal for the Final FRCR. He
undertook his PhD at UCL, part-funded by the RCR Kodak Fund Scholarship. He has since been awarded a £600k
personal fellowship by the National Institute for Health Research (NIHR), and holds >£5.5M in grant funding, £2.4M
as Chief Investigator.
Dr Plumb has published over 50 peer-reviewed papers, including in The Lancet Gastroenterology and Hepatology,
Gut and Radiology. He is the current British Society of Gastrointestinal and Abdominal Radiology Research Officer,
and a Research Committee Member for ESGAR. In 2019 he will become the RCR Roentgen Professor.
His main clinical interests are CT colonography, MR and US for bowel and pelvic floor imaging, and acute abdominal
imaging (including using MRI).