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<p>Acute abdominopelvic pain requires rapid imaging triage, traditionally dominated by computed tomography (CT) and ultrasound (US). However, advances in magnetic resonance imaging (MRI), including accelerated acquisition, motion-robust sequences, and non-contrast protocols, have expanded its role beyond a problem-solving tool toward selective first-line imaging in specific clinical scenarios. This review provides a decision-based framework for MRI utilization in nontraumatic abdominopelvic emergencies, integrating current evidence on diagnostic performance, workflow considerations, and clinical impact. MRI offers clear advantages in radiation-sensitive populations (pregnant and pediatric patients), in biliary obstruction, and for characterizing pancreatic complications, while remaining complementary in most other emergency settings. We highlight high-yield indications where MRI may replace or precede CT, supported by comparative data, and provide practical, rapid MRI protocols (&lt; 15&#xa0;min) adaptable to emergency workflows. Importantly, we present a balanced discussion of real-world constraints, including availability, cost, scan time, and patient tolerance, that currently limit universal adoption. MRI should therefore be viewed not as a universal replacement for CT, but as a targeted, high-value imaging strategy in selected emergency scenarios where it improves diagnostic confidence, avoids ionizing radiation, and influences management.</p>

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The evolving role of MRI in abdominopelvic emergencies: from problem-solving to first-line imaging

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月16日

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  • Usha Jayagurunathan,
  • Ankush Ankush,
  • Harish Gudi,
  • Sriram Jaganathan,
  • David Childs,
  • Janardhana Ponnatapura,
  • Eswara Moorthy Sellamuthu

摘要

Acute abdominopelvic pain requires rapid imaging triage, traditionally dominated by computed tomography (CT) and ultrasound (US). However, advances in magnetic resonance imaging (MRI), including accelerated acquisition, motion-robust sequences, and non-contrast protocols, have expanded its role beyond a problem-solving tool toward selective first-line imaging in specific clinical scenarios. This review provides a decision-based framework for MRI utilization in nontraumatic abdominopelvic emergencies, integrating current evidence on diagnostic performance, workflow considerations, and clinical impact. MRI offers clear advantages in radiation-sensitive populations (pregnant and pediatric patients), in biliary obstruction, and for characterizing pancreatic complications, while remaining complementary in most other emergency settings. We highlight high-yield indications where MRI may replace or precede CT, supported by comparative data, and provide practical, rapid MRI protocols (< 15 min) adaptable to emergency workflows. Importantly, we present a balanced discussion of real-world constraints, including availability, cost, scan time, and patient tolerance, that currently limit universal adoption. MRI should therefore be viewed not as a universal replacement for CT, but as a targeted, high-value imaging strategy in selected emergency scenarios where it improves diagnostic confidence, avoids ionizing radiation, and influences management.