Another study evaluating the incidence of acute mesenteric ischemia in patients >75 years of age demonstrated a high age-specific incidence in this population, with a greater incidence of acute mesenteric ischemia than acute appendicitis or ruptured abdominal aortic aneurysms. These patients often have a nonspecific presentation and authors suggest use of dual-phase (arterial and portal venous phase) CT with contrast to ensure adequate evaluation of mesenteric vasculature in all patients >75 years of age presenting with acute abdominal pain [75]. Acute Nonlocalized Abdominal Pain MRI Abdomen and Pelvis MRI has been shown to provide clinically useful information for rapid diagnosis of acute bowel pathology [35,58,84,85] and the following gynecological emergencies: ovarian hemorrhage, ectopic pregnancy, tumor rupture, torsion, hemorrhage, infarction, and pelvic inflammatory disease [36,86,87]. Although MRI has longer acquisition times relative to CT, improvements in technology combined with tailored abdominal protocols could be performed in 10 minutes or less [36,88]. One prospective study looking at the use of noncontrast MRI in 468 patients with acute abdominal pain (excluding renal colic), with an image acquisition time of under 2 minutes, showed an overall accuracy of 99% in diagnosing diseases ranging from acute bowel inflammation, obstruction, and pancreaticobiliary diseases, to renal inflammation and gynecological processes [36]. In the setting of acute pelvic pain, MRI with contrast can accurately diagnose acute appendicitis, ovarian torsion, and other adnexal diseases [37]. Because useful information can be obtained without contrast, MRI, when available, has been shown to be a reliable next step following US in the imaging of pregnant patients [89]. MRI is becoming a favored, invaluable problem-solving modality used in the imaging of pregnant patients because it avoids many of the drawbacks of US and CT.
Acute Nonlocalized Abdominal Pain. Another study evaluating the incidence of acute mesenteric ischemia in patients >75 years of age demonstrated a high age-specific incidence in this population, with a greater incidence of acute mesenteric ischemia than acute appendicitis or ruptured abdominal aortic aneurysms. These patients often have a nonspecific presentation and authors suggest use of dual-phase (arterial and portal venous phase) CT with contrast to ensure adequate evaluation of mesenteric vasculature in all patients >75 years of age presenting with acute abdominal pain [75]. Acute Nonlocalized Abdominal Pain MRI Abdomen and Pelvis MRI has been shown to provide clinically useful information for rapid diagnosis of acute bowel pathology [35,58,84,85] and the following gynecological emergencies: ovarian hemorrhage, ectopic pregnancy, tumor rupture, torsion, hemorrhage, infarction, and pelvic inflammatory disease [36,86,87]. Although MRI has longer acquisition times relative to CT, improvements in technology combined with tailored abdominal protocols could be performed in 10 minutes or less [36,88]. One prospective study looking at the use of noncontrast MRI in 468 patients with acute abdominal pain (excluding renal colic), with an image acquisition time of under 2 minutes, showed an overall accuracy of 99% in diagnosing diseases ranging from acute bowel inflammation, obstruction, and pancreaticobiliary diseases, to renal inflammation and gynecological processes [36]. In the setting of acute pelvic pain, MRI with contrast can accurately diagnose acute appendicitis, ovarian torsion, and other adnexal diseases [37]. Because useful information can be obtained without contrast, MRI, when available, has been shown to be a reliable next step following US in the imaging of pregnant patients [89]. MRI is becoming a favored, invaluable problem-solving modality used in the imaging of pregnant patients because it avoids many of the drawbacks of US and CT.