Bowel-related abscesses: MR demonstration preliminary results

Abstract

The purpose of this study is to describe the appearance of bowel-related abscesses on magnetic resonance (MR) images. Sixteen consecutive patients who had bowel-related abscesses underwent MR examination at 1.5T. MR sequences included T 1-weighted fat-suppressed imaging pre- and post-intravenous gadolinium chelate administration (all patients) and breathing-independent single-shot T 2-weighted half Fourier turbo (fast) spin echo (6 patients). Patients with pelvic abscesses also underwent sagittal imaging with post-gadolinium T 1-weighted images (9 patients) and T 2-weighted turbo (fast) spin echo (8 patients). Abscesses were confirmed by open surgery or surgical drainage (6 patients), percutaneous drainage (8 patients), or combined physical examination, fluoroscopic fistulogram, and clinical follow-up (2 patients). Oval-shaped fluid collections were identified in all of the patients, which ranged in diameter from 2 cm to 18 cm, mean: 8 cm. Abscesses were low to intermediate in signal on T 1-weighted images, heterogenous and moderately high signal on T 2-weighted images, and low signal on post-gadolinium images. A layering effect of lower signal material in the dependent portion of the abscess was noted in abscesses in 6 of 14 patients on T 2-weighted images. Post-gadolinium images demonstrated a definable 3- to 7-mm thick abscess wall, which enhanced substantially with contrast. Definition of the wall was best shown on fat-suppressed images post-gadolinium. Substantial enhancement of surrounding periabscess tissues was demonstrated in all cases and was most clearly defined on fat-suppressed images. Image acquisition in two orthogonal planes was of value to demonstrate that fluid collections were oval, and separate from bowel. Image acquisition in the sagittal plane was useful in the evaluation of pelvic abscesses. The results from this preliminary study show that bowel-related abscesses are demonstrable on MR images using gadolinium-enhanced fat-suppressed T 1-weighted and turbo (fast) spin-echo T 2-weighted sequences. The presence of a thickened, enhancing lesion wall and enhancement of perilesional tissues on T 1-weighted fat-suppressed images were observed in all abscesses. A layering effect of low signal intensity material in the dependent portion of the abscess was an important ancillary feature.