Karın Ağrısında Manyetik Rezonans Görüntüleme
Özet
Karın ağrısı geniş bir ayırıcı tanıya sahip olup, öykü ve fizik muayenenin yetersiz kaldığı durumlarda görüntüleme yöntemleri tanıda kritik rol oynar. Ultrasonografi (USG) ve bilgisayarlı tomografi (BT)’ye ek olarak manyetik rezonans görüntüleme (MRG), iyonize radyasyon içermemesi ve yüksek yumuşak doku kontrastı sayesinde önemli bir alternatif sunar. MRG; intraabdominal ve pelvik abseler, apandisit, divertikülit, barsak obstrüksiyonu, pankreatikobiliyer patolojiler ve jinekolojik acillerin tanısında yüksek doğruluğa sahiptir. Difüzyon ağırlıklı görüntüleme, kontrast madde gerektirmeden iskemi ve inflamasyonu göstermede etkilidir. Manyetik rezonans kolanjiopankreatografi (MRKP) ise biliyer obstrüksiyonların değerlendirilmesinde noninvaziv ve güvenilir bir yöntemdir. Kontrastsız MRG, özellikle gebeler, çocuklar ve böbrek yetmezliği olan hastalarda USG’den sonra ikinci basamak görüntüleme olarak öne çıkar. Gebelikte MRG’nin tanısal etkinliği yüksek olup, gadolinyumlu kontrasttan kaçınılması önerilir. Bununla birlikte, inceleme süresinin uzunluğu, hemodinamik bozulma, hasta uyumu, implant varlığı ve gadolinyumla ilişkili riskler MRG’nin kullanımını sınırlayan faktörlerdir. Sonuç olarak MRG, uygun hasta seçimiyle akut karın ağrısının değerlendirilmesinde güvenli, etkili ve tamamlayıcı bir görüntüleme yöntemidir.
Abdominal pain has a broad differential diagnosis, and imaging plays a critical role when history and physical examination are insufficient. In addition to ultrasonography and computed tomography, magnetic resonance imaging (MRI) represents an important alternative because it does not involve ionizing radiation and provides excellent soft-tissue contrast. MRI demonstrates high diagnostic accuracy in the evaluation of intra-abdominal and pelvic abscesses, appendicitis, diverticulitis, bowel obstruction, pancreaticobiliary diseases, and gynecologic emergencies. Diffusion-weighted imaging is effective in detecting ischemia and inflammation without the need for contrast media, while MR cholangiopancreatography is a reliable and noninvasive technique for assessing biliary obstruction. Non-contrast MRI is particularly valuable as a second-line imaging modality in pregnant patients, children, and individuals with renal impairment. During pregnancy, MRI shows high diagnostic performance, and the use of gadolinium-based contrast agents is generally discouraged. However, long examination times, hemodynamic instability, limited patient compliance, the presence of implants, and potential risks related to gadolinium exposure restrict its use. Overall, with appropriate patient selection, MRI is a safe, effective, and complementary imaging modality in the evaluation of acute abdominal pain.
Referanslar
Kopitnik; NL, Kashyap; S, Dominique. E. Acute Abdomen. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459328/.
Herek D, Karabulut N. Manyetik Rezonans Görüntüleme. TTD Toraks Cerrahisi Bülteni. 2010;1(3).
Expert Panel on Gastrointestinal I, Scheirey CD, Fowler KJ, Therrien JA, Kim DH, Al-Refaie WB, et al. ACR Appropriateness Criteria(®) Acute Nonlocalized Abdominal Pain. J Am Coll Radiol. 2018;15(11S):S217-S31.
Lubarsky M, Kalb B, Sharma P, Keim SM, Martin DR. MR imaging for acute nontraumatic abdominopelvic pain: rationale and practical considerations. Radiographics. 2013;33(2):313-37.
Yew KS, George MK, Allred HB. Acute Abdominal Pain in Adults: Evaluation and Diagnosis. Am Fam Physician. 2023;107(6):585-96.
Inoue A, Furukawa A, Takaki K, Imai Y, Ota S, Nitta N, et al. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Jpn J Radiol. 2021;39(3):209-24.
Inci E, Kilickesmez O, Hocaoglu E, Aydin S, Bayramoglu S, Cimilli T. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol. 2011;21(4):768-75.
Miletić D, Stimac D, Uravić M, Petranović D, Mazur-Grbac M, Valković P, et al. [Magnetic resonance cholangiopancreatography]. Lijec Vjesn. 2007;129(10-11):336-43.
Khan H, Al Yafei AAF. Magnetic Resonance Cholangiopancreatography (MRCP): Innovations in Non-Invasive
Visualization of the Hepatobiliary and Pancreatic Systems. Japanese Journal of Gastroenterology and Hepatology. 2024;10(12):1-13.
Radiology ACo. ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia. Journal of the American College of Radiology. 2018;15(11):S332-S40.
Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;131(1):4-12.
Dempsey PJ, Delaney FT, Geoghegan T, Lawler L, Bolster F. MR imaging of acute abdominal pain in pregnancy. Br J Radiol. 2022;95(1136):20211114.
Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. Jama. 2016;316(9):952-61.
Masselli G, Derchi L, McHugo J, Rockall A, Vock P, Weston M, et al. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol. 2013;23(12):3485-500.
Alsadery HA, Bamalan OA, Aljubran HJ, Albaish LJ, Al Ghanim BZ. Non-obstetric Acute Abdomen in Pregnancy: a Review of Literature. Med Arch. 2023;77(4):293-8.
Kave M, Parooie F, Salarzaei M. Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women. World J Emerg Surg. 2019;14:37.
Brown KE, Hirshberg JS, Conner SN. Gallbladder and Biliary Disease in Pregnancy. Clin Obstet Gynecol. 2020;63(1):211-25.
Stanley AD, Tembelis M, Patlas MN, Moshiri M, Revzin MV, Katz DS. Magnetic Resonance Imaging of Acute Abdominal Pain in the Pregnant Patient. Magn Reson Imaging Clin N Am. 2022;30(3):515-32.
Tsai LL, Grant AK, Mortele KJ, Kung JW, Smith MP. A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Radiographics. 2015;35(6):1722-37.
ACR Manual on Contrast Media. Reston, VA: American College of Radiology; 2025.
Referanslar
Kopitnik; NL, Kashyap; S, Dominique. E. Acute Abdomen. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459328/.
Herek D, Karabulut N. Manyetik Rezonans Görüntüleme. TTD Toraks Cerrahisi Bülteni. 2010;1(3).
Expert Panel on Gastrointestinal I, Scheirey CD, Fowler KJ, Therrien JA, Kim DH, Al-Refaie WB, et al. ACR Appropriateness Criteria(®) Acute Nonlocalized Abdominal Pain. J Am Coll Radiol. 2018;15(11S):S217-S31.
Lubarsky M, Kalb B, Sharma P, Keim SM, Martin DR. MR imaging for acute nontraumatic abdominopelvic pain: rationale and practical considerations. Radiographics. 2013;33(2):313-37.
Yew KS, George MK, Allred HB. Acute Abdominal Pain in Adults: Evaluation and Diagnosis. Am Fam Physician. 2023;107(6):585-96.
Inoue A, Furukawa A, Takaki K, Imai Y, Ota S, Nitta N, et al. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Jpn J Radiol. 2021;39(3):209-24.
Inci E, Kilickesmez O, Hocaoglu E, Aydin S, Bayramoglu S, Cimilli T. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol. 2011;21(4):768-75.
Miletić D, Stimac D, Uravić M, Petranović D, Mazur-Grbac M, Valković P, et al. [Magnetic resonance cholangiopancreatography]. Lijec Vjesn. 2007;129(10-11):336-43.
Khan H, Al Yafei AAF. Magnetic Resonance Cholangiopancreatography (MRCP): Innovations in Non-Invasive
Visualization of the Hepatobiliary and Pancreatic Systems. Japanese Journal of Gastroenterology and Hepatology. 2024;10(12):1-13.
Radiology ACo. ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia. Journal of the American College of Radiology. 2018;15(11):S332-S40.
Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;131(1):4-12.
Dempsey PJ, Delaney FT, Geoghegan T, Lawler L, Bolster F. MR imaging of acute abdominal pain in pregnancy. Br J Radiol. 2022;95(1136):20211114.
Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. Jama. 2016;316(9):952-61.
Masselli G, Derchi L, McHugo J, Rockall A, Vock P, Weston M, et al. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol. 2013;23(12):3485-500.
Alsadery HA, Bamalan OA, Aljubran HJ, Albaish LJ, Al Ghanim BZ. Non-obstetric Acute Abdomen in Pregnancy: a Review of Literature. Med Arch. 2023;77(4):293-8.
Kave M, Parooie F, Salarzaei M. Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women. World J Emerg Surg. 2019;14:37.
Brown KE, Hirshberg JS, Conner SN. Gallbladder and Biliary Disease in Pregnancy. Clin Obstet Gynecol. 2020;63(1):211-25.
Stanley AD, Tembelis M, Patlas MN, Moshiri M, Revzin MV, Katz DS. Magnetic Resonance Imaging of Acute Abdominal Pain in the Pregnant Patient. Magn Reson Imaging Clin N Am. 2022;30(3):515-32.
Tsai LL, Grant AK, Mortele KJ, Kung JW, Smith MP. A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Radiographics. 2015;35(6):1722-37.
ACR Manual on Contrast Media. Reston, VA: American College of Radiology; 2025.
