Limited abdominal MRI in the evaluation of acute right upper quadrant pain

K Y Oh, M Gilfeather, A Kennedy, C Glastonbury, D Green, W Brant, H C Yoon
Abdominal Imaging 2003, 28 (5): 643-51

BACKGROUND: We investigated whether limited abdominal magnetic resonance imaging (MRI) is as effective as transabdominal ultrasound (US) in evaluating patients presenting with acute right upper quadrant pain.

METHODS: Twenty-four patients underwent evaluation with a limited abdominal MRI using single-shot fast spin-echo sequences and a right upper quadrant US within 24 h. Two MRI and two US readers independently evaluated the images for gallstones, gallbladder wall thickness, pericholecystic fluid, acute cholecystitis, visualization of the common bile duct, and requests for further imaging. US and MRI findings were compared. Surgical pathology was the gold standard.

RESULTS: MRI and US demonstrated no statistically significant difference in the diagnosis of gallbladder wall thickening, the presence of gallstones or pericholecystic fluid, or the diagnosis of acute cholecystitis (p > 0.05). The sensitivity of both for acute cholecystitis was 50%, with specificities of 89% and 86% for US and MRI, respectively. US readers more frequently requested additional tests and displayed more variability in whether they could adequately see the common bile duct.

CONCLUSION: Limited MRI is equivalent to US in diagnosing gallstones, gallbladder wall thickening, pericholecystic fluid, and acute cholecystitis in patients presenting with symptoms of acute right upper quadrant pain. Especially in sonographically challenging patients, limited MRI may provide a faster, easier method of diagnosis.

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