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Abdominal MRI

AAug 17 05

Alternative names
Nuclear magnetic resonance - abdomen; NMR - abdomen; Magnetic resonance imaging - abdomen; MRI of the abdomen; Abdominal MRI

Definition
A noninvasive procedure that uses powerful magnets and radio waves to construct pictures of the abdomen and its organs.

Magnetic resonance imaging (MRI) produces pictures of the inside of the abdomen without exposure to ionizing radiation (X-rays).

How the test is performed

Since MRI makes use of radio waves very close in frequency to those of ordinary FM radio stations, the scanner must be located within a specially shielded room to avoid outside interference. The patient will be asked to lie on a narrow table which slides into a large tunnel-like tube within the scanner. In addition, small devices may be placed around the head, arm, or leg, or adjacent to other areas to be studied. These are special body coils which send and receive the radio wave pulses, and are designed to improve the quality of the images. If contrast is to be administered, an IV will be placed, usually in a small vein of the hand or forearm. A technologist will operate the machine and observe you during the entire study from an adjacent room.

Several sets of images are usually required, each taking from 2 to 15 minutes. A complete scan, depending on the sequences performed, and need for contrast enhancement may take up to one hour or more. Newer scanners with more powerful magnets utilizing updated software and advanced sequences may complete the process in less time.

How to prepare for the test

No preparatory tests, diets, or medications are usually needed, unless the colon needs to be cleansed (with preparations such as a laxative or an enema). An MRI can be performed immediately after other imaging studies. Depending on the area of interest, the patient may be asked to fast for 4 to 6 hours prior to the scan.

Because of the strong magnets, certain metallic objects are not allowed into the room. Items such as jewelry, watches, credit cards, and hearing aids can be damaged. Pins, hairpins, metal zippers, and similar metallic items can distort the images. Removable dental work should be taken out just prior to the scan. Pens, pocketknives, and eyeglasses can become dangerous projectiles when the magnet is activated and should not accompany the patient into the scanner area.

Because the strong magnetic fields can displace or disrupt the action of implanted metallic objects, people with cardiac pacemakers cannot be scanned and should not enter the MRI area. MRI also should not be used for people with metallic objects in their bodies such as inner ear (cochlear) implants, brain aneurysm clips, some artificial heart valves, older vascular stents, and recently placed artificial joints. Sheet metal workers, or persons with similar potential exposure to small metal fragments, will first be screened for metal shards within the eyes with X-rays of the skull. The patient will be asked to sign a consent form confirming that none of the above issues apply before the study will be performed.

A hospital gown may be recommended, or the patient may be allowed to wear clothing without metal fasteners.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

How the test will feel

There is no pain. The magnetic field and radio waves are not felt. The primary possible discomfort is the claustrophobic feeling that some experience from being inside the scanner. The table may be hard or cold, but you can request a blanket or pillow. The machine produces loud thumping and humming noises during normal operation. Ear plugs are usually given to the patient to reduce the noise. A technologist observes the patient during the entire procedure and may be spoken to through an intercom in the scanner. Some MRI scanners are equipped with televisions and special headphones to help the examination time pass.

Excessive movement can blur MRI images and cause certain artifacts. If the patient has difficulty lying still or is very anxious, an oral or intravenous sedative may be given. There is no recovery time, unless sedation was necessary. After an MRI scan, you can resume normal diet, activity, and medications.

Why the test is performed
MRI provides detailed pictures of soft tissues without obstruction by overlying bone. It is often used to clarify findings from previous X-ray studies or CT scans. It can show or demonstrate wide areas of the abdomen from multiple planes. MRI can evaluate certain organ functions. It clearly shows Lymph nodes and blood vessels, and is a noninvasive imaging method for evaluation of blood flow.

MRI may be used in diagnosing abnormal growths. It can distinguish tumors or other lesions from normal tissues and can provide information for the staging (determination of the size, extent, and spread) of abdominal tumors. MRI is sometimes used to avoid the dangers of angiography, repeated exposure to radiation, or for patients that cannot receive iodinated contrast dye.

What abnormal results mean


The sensitivity of MRI depends, in part, on the experience of the radiologist.

Abdominal MRI may reveal many disorders, including:

     
  • obstructed vena cava  
  • Renal vein thrombosis  
  • renal arterial obstruction  
  • hydronephrosis (kidney enlargement from reflux of urine)  
  • glomerulonephritis (inflammation of the kidney glomeruli)  
  • acute tubular necrosis  
  • extent of tissue damage in organ (kidney) transplant rejection  
  • Pancreatic cancer  
  • adrenal masses  
  • mass (tumor) of the gallbladder  
  • other tumors or masses  
  • differentiates cancer from other types of lesions  
  • staging of prostate, uterine, or Bladder cancer  
  • lymphadenopathy (abnormalities of the Lymph nodes)  
  • portal vein obstruction (liver)  
  • Enlarged spleen or liver  
  • distended gallbladder or bile duct  
  • gallstones, bile duct stones  
  • focal diseases such as abscess, hemangiomas, or others

Additional conditions under which the test may be performed:

     
  • Abdominal aortic aneurysm  
  • acute renal failure  
  • adenomyosis  
  • atheroembolic renal disease  
  • carcinoma of the renal pelvis or ureter  
  • chronic renal failure  
  • cystinuria  
  • hydatidiform mole  
  • injury of the kidney and ureter  
  • insulinoma  
  • islet of Langerhans’ tumor  
  • medullary cystic disease  
  • multiple endocrine neoplasia (MEN) II  
  • multiple endocrine neoplasia (MEN) I  
  • nephrolithiasis  
  • Ovarian cancer  
  • pheochromocytoma  
  • skin lesion of histoplasmosis

What the risks are


There is no ionizing radiation involved in MRI, and there have been no documented significant side effects of the magnetic fields and radio waves used on the human body to date. The most common MR intravenous contrast agent, gadolinium, is very safe, and although there have been documented allergic reactions to it, this is extremely rare. If sedation is used, there are associated risks of over-sedation. The technologist monitors the patient’s vital signs, including heart rate and respiration as needed.

However, because the effects of strong magnetic fields on a fetus are not well documented at this time, pregnant women are usually advised to avoid MRI scans.

MRI is usually not recommended for acute trauma situations, because traction and
life-support equipment cannot safely enter the scanner area and scan times are relatively lengthy.

Special considerations

MRI is more accurate than a CT scan or other tests for certain conditions but less accurate for others. The function of the small and large bowel (intestines) is not readily visible. Disadvantages include the high cost, long duration of the scan, and sensitivity to movement. People with claustrophobia or who are confused or anxious may have difficulty lying still for the relatively long scan times. MRI is not portable (it cannot be taken to the patient, the patient must come to the scanner) and is incompatible with metallic implants, life-support devices, traction apparatus, and similar equipment.

MRI is superior in most cases in which differentiation of soft tissues is necessary. It can view organs that may be obscured by bone or foreign bodies on conventional X-rays or CT scans. It is capable of showing the tissues from multiple viewpoints and is a noninvasive way to evaluate blood flow.

See also:
Magnetic Resonance Imaging (MRI)
MRI of the head
Chest MRI
MRI of the thorax
Heart MRI
MRI of lumbosacral spine

Last Edited: Aug 17. 2005

Johns Hopkins patient information

Last revised: December 4, 2007
by Harutyun Medina, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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