The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 1: Pancreatic and Hepatobiliary Injuries

Abstract

Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority—namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. This first installment will focus on pancreatic and hepatobiliary injuries. Pancreatic trauma may be difficult to diagnose on CT, and MR may aid in demonstrating pancreatic duct disruption, allowing for accurate grading according to American Association for the Surgery of Trauma (AAST) criteria. It may also be a useful modality for monitoring evolution of pancreatic injuries and/or pseudocyst development, guiding potential stenting, and/or drainage. Biliary injuries are also optimally evaluated with MR, particularly when aided by the use of hepatobiliary contrast material. This can allow for accurate delineation of biliary ductal anatomy and aid in planning percutaneous or endoscopic treatment of bile leaks.

Magnetic resonance imaging in abdominal trauma—More relevant than ever

“…In their first part, the authors highlight important protocol strategies relevant to an acute trauma patient, such as minimizing the number of sequences, utilizing free-breathing or respiratory-triggered imaging over breath-hold sequences, and utilizing novel sequences for faster image acquisition and artifact correction. 2 Particular focus in this part is given to the role of MRI in hepatobiliary and pancreatic injuries. These injuries can have non-specific appearances at CT but dire consequences if gone undiagnosed.…”

“…Magnetic resonance imaging in abdominal trauma-More relevant than ever Devang Odedra, MD, MASc, FRCPC 1 , Mariano Scaglione, MD 2 , Raffaella Basilico, MD 3 , and Michael N. Patlas, MD, FRCPC 4 It is no surprise that computed tomography (CT) has become the workhorse of acute trauma imaging in most emergency departments around the world. While ultrasound and radiographs have utility in the initial screening for injuries, CT provides unparalleled spatial resolution and speed of image acquisition for an all-in-one solution for assessing the solid and hollow viscera of the abdomen.…”

“…1 Drs. Rajput and Mellnick 2 present a very timely review on this topic in current issue of CARJ. In their 2-part series, they have provided a comprehensive review of specific trauma scenarios when MRI plays a key role in diagnosing and guiding management, identified certain key points relevant to MRI protocols in trauma setting, and provided illustrative case examples of the relevant injuries on MRI.…”