ISMRM 24th Annual Meeting & Exhibition 07-13 May 2016 Singapore

Educational Session: Body MRI Applications in the Emergency Department

Skill Level: Intermediate

Organizers: Ivan Pedrosa, M.D., Scott B. Reeder, M.D., Ph.D. & Edwin J.R. van Beek, M.D., Ph.D., M.Ed., FRCR

Monday 09 May 2016

This two-hour course focuses on body MRI applications in evaluating acutely ill patients in the Emergency Department. Emphasis will be made on presenting the technical challenges and opportunities for the implementation of fast, optimized body MRI protocols for evaluation of abdominal emergencies. MRI protocols for evaluation of patients with suspected pulmonary embolism will be presented. A comprehensive review of MR venography techniques will be discussed.

Target Audience
This course is aimed at radiologists, imaging scientists and MR technologists who wish to review the state-of-art MRI protocols for assessment of acutely ill patients in the Emegency Department and their implementation into routine clinical practice.

Educational Objectives
Upon completion of this course, participants should be able to:

  • Implement optimized, fast protocols for evaluation of emergency patients;
  • Demonstrate the utility of MRI in the diagnosis of Acute Appendicitis from the perspective of the Emergency Department Physician;
  • Convey the implementation of optimized MRA protocols for the expeditious assessment of acute pulmonary embolism; and
  • Illustrate the application of optimized MRV protocols for assessment of acute venous conditions in the body.

Moderators: Yu-Ting Kuo, Jing Yuan
Rapid MRI Protocols & Acquisitions for Emergency Patients
Jennifer Uyeda
MRI in Acute Appendicitis: The Emergency Physician Perspective
Michael D Repplinger1
1Emergency Medicine, University of Wisconsin - Madison, Madison, WI, United States
In this presentation, we will discuss the diagnostic accuracy of MR to diagnose appendicitis, both in the general population and in select cohorts. Additionally, we will discuss the evidence for various MR sequences (unenhanced, intravenous contrast-enhanced, and DWI) as well as the affect of radiologist expertise in abdominal MR on diagnostic accuracy. Finally, we will discuss how using MR in the emergency department setting impacts patient care, particularly their timely evaluation.

Pulmonary MRA
Jeffrey H. Maki1
1Radiology, University of Washington, Seattle, WA, United States
Accurately diagnosing pulmonary embolism is clinically vital, with CT Pulmonary Angiography (CTPA) the most often used diagnostic tool.  CTPA, however, is not without limitations.  The largest of these is ionizing radiation, which for younger patients can significantly increase lifetime attributable cancer mortality risk, especially considering a positive CTPA rate of <10%.   Additionally, many patients have iodine allergies or are pregnant.  Pulmonary MRA is an emerging technology that has benefited from new technical advances and recently proven to have a high negative predictive value similar to CTPA. Pulmonary MRA should be considered in the young and those where CTPA is contraindicated.

Charles Kim1
1Radiology, Duke University Medical Center, Durham, NC, United States
MR venography can play a vital role in the diagnosis and treatment planning for acute venous thrombosis if well-developed protocols and referral patterns are in place. The two primary emergency indications for MR venography will be discussed in detail: acute iliofemoral / lower extremity DVT  and acute SVC syndrome. The ideal MR venography contrast agents will be reviewed, as well as optimized MR venography protocols. This lecture will provide the audience with pertinent clinical information, pros and cons of various competing imaging modalities, and emphasize key reporting topics for these various pathologies.

Adjournment & Meet the Teachers

The International Society for Magnetic Resonance in Medicine is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing medical education for physicians.