Cine-MRI detection of intraabdominal adhesions: correlation with intraoperative findings in 89 consecutive cases

Authors: Lang, Reinhold¹; Buhmann, Sonja²; Hopman, Alexander³; Steitz, Heinrich-Otto³; Lienemann, Andreas²; Reiser, Maximilian²; Jauch, Karl-Walter³; Hüttl, Thomas³

Source: Surgical Endoscopy, Volume 22, Number 11, November 2008 , pp. 2455-2461(7)

Publisher: Springer

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Abstract:

This study aimed to evaluate the accuracy of functional cine-MRI in detecting abdominal adhesions.

For this study, 89 consecutive patients with adhesion-related complaints after previous abdominal surgery underwent preoperative workup including cine-MRI in transverse and sagittal orientations for a dynamic examination of an induced visceral slide. An abdominal map consisting of nine segments was created to document the location and extent of the adhesion. Cine-MRI and intraoperative findings were correlated.

A total of 59 laparotomies and 30 laparoscopies were performed. Four cases required open surgery due to severe adhesions. The use of cine-MRI scan for the detection of adhesions showed an overall accuracy of 90%, a sensitivity of 93%, and a positive predictive value of 96%. The stronger the adhesions, the more accurate the scan findings. Of 44 patients with second-degree MRI scan findings, 50% had second-degree intraoperative findings. Of 35 patients with third- and fourth-degree adhesions on MRI scans, 74% had exactly the same intraabdominal findings at surgery. The MRI scan showed adhesions located in the small intestines (75%), large intestines (35%), abdominal cavity (42%), and reproductive organs (32%). Intraoperatively, adhesions were found in the small intestines (70%), large intestines (40%), abdominal cavity (42%), and reproductive organs (28%).

Cine-MRI provides valid preoperative information with respect to extent, location, and strength of intraabdominal adhesions. Cine-MRI is a good alternative for diagnosing abdominal adhesions because objective findings of the scan and intraoperative findings correlate very well with each other.

Keywords: Abdomen; Adhesion; Adhesiolysis; Detection; MRI

Document Type: Research article

DOI: http://dx.doi.org/10.1007/s00464-008-9763-9

Affiliations: 1: Department of Surgery, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, D-81377, Munich, Germany, Email: Reinhold.Lang@med.uni-muenchen.de 2: Department of Clinical Radiology, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, D-81377, Munich, Germany 3: Department of Surgery, Klinikum Großhadern, University of Munich, Marchioninistrasse 15, D-81377, Munich, Germany

Publication date: 2008-11-01

Cine-MRI detection of intraabdominal adhesions: correlation with intraoperative findings in 89 consecutive cases

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