Rapid acquisition axial and coronal T2 HASTE MR in the evaluation of acute abdominal pain

Abstract

PurposeTo assess T2 HASTE MR in acute abdominal imaging and ascertain if it is a reliable alternative to CT in patients under 60. Method and materialsIn a prospective diagnostic performance study from January 2009 to December 2013, patients under 60 presenting with acute abdominal pain, that required imaging following surgical review, were imaged with T2 HASTE MR. Rapid acquisition HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) coronal and axial sequences were obtained, without intravenous contrast. Patients were followed up clinically for a minimum of 3 months. Results468 cases included in the study. 349 were negative for acute abdominal pathology, 116 positive for acute abdominal pathology and 3 were indeterminate.In the MR positive group (n=116), 64 had surgery confirming findings (34 appendicitis, 14 SBO, 3 ovarian torsion, 3 LBO, intussusception, ovarian carcinoma, ovarian dermoid, 2 pelvic inflammatory disease, diverticular abscess, crohns, 4 endoscopy for acute bowel pathology) while 51 were managed conservatively with concordant follow up (4 SBO, 11 diverticulitis, 6 pelvic inflammatory disease, 7 inflammatory bowel disease, 7 colitis, 6 pyelonephritis, 2 cholecystitis, renal abscess, pseudomembranous colitis, splenic haematoma, mesenteric adenitis, 2 pancreatitis, lymphoma, epiploic appendagitis). 1 patient had an MR diagnosis of appendicitis but at laparoscopy a sigmoid diverticular perforation was diagnosed and the appendix was normal.In the MR negative group (n=349), 324 had uneventful follow-up, 22 had negative laparoscopies, while 3 had subsequent appendectomies, with appendicitis on histology (3 days, 10 days and 2 months post scan).In the MR indeterminate group (n=3), one was treated conservatively with uneventful follow up, one had laparoscopic appendectomy with normal appendix on histology, one had laparoscopic appendectomy with acute appendicitis on histology.When MR correlated with clinical follow up (n=468), overall diagnostic accuracy is 99% (463/468). When MR findings correlated with direct visualisation at surgery/endoscopy (n=90), sensitivity is 98% (95% CI) and specificity is 92% (95% CI). ConclusionThis study demonstrates that rapid acquisition axial and coronal T2 HASTE MR is a practical, safe and effective method in the diagnosis of acute abdominal pain.MR is the preferred option to CT in patients of an age prone to radiation with a potential surgical diagnosis. Clinical relevance/applicationMRI in acute abdominal imaging is both effective and practical and is the preferred imaging option in patients of an age prone to radiation with a potential surgical diagnosis.