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MRI of the Peritoneum: Spectrum of Abnormalities

Khaled M. Elsayes1,2, Paul T. Staveteig1, Vamsidhar R. Narra1, John R. Leyendecker3, James S. Lewis, Jr.4 and Jeffrey J. Brown1

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110.
2 Present address: Theodore Bilharz Institute, Giza, Egypt.
3 Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC.
4 Department of Surgical Pathology, Washington University School of Medicine, St. Louis, MO.


Figure 1
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  		Fig. 1A —Schematics of peritoneal anatomy. In these sagittal (A), axial (B), and coronal (C) views, pouch of Douglas and lateral paravesicular spaces are seen to communicate (green arrows) with peritoneal cavity. Peritoneum is shown in red. Ao = aorta, IVC = inferior vena cava, Spl = spleen.

 

Figure 2
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  		Fig. 1B —Schematics of peritoneal anatomy. In these sagittal (A), axial (B), and coronal (C) views, pouch of Douglas and lateral paravesicular spaces are seen to communicate (green arrows) with peritoneal cavity. Peritoneum is shown in red. Ao = aorta, IVC = inferior vena cava, Spl = spleen.

 

Figure 3
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  		Fig. 1C —Schematics of peritoneal anatomy. In these sagittal (A), axial (B), and coronal (C) views, pouch of Douglas and lateral paravesicular spaces are seen to communicate (green arrows) with peritoneal cavity. Peritoneum is shown in red. Ao = aorta, IVC = inferior vena cava, Spl = spleen.

 

Figure 4
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  		Fig. 2A —45-year-old man with right indirect inguinal hernia (arrows). Axial gradient-refocused-echo in-phase image (A) and axial fast spin-echo T2-weighted image (B) show bowel loops and fat herniating through right external inguinal ring.

 

Figure 5
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  		Fig. 2B —45-year-old man with right indirect inguinal hernia (arrows). Axial gradient-refocused-echo in-phase image (A) and axial fast spin-echo T2-weighted image (B) show bowel loops and fat herniating through right external inguinal ring.

 

Figure 6
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  		Fig. 3 —51-year-old woman with left ventral incisional hernia. Axial T1-weighted 3D volumetric interpolated breath-hold image shows left incisional hernia containing mesenteric fat and small-bowel loops (arrow).

 

Figure 7
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  		Fig. 4A —36-year-old man with acute peritonitis. Axial T1 gradient-refocused-echo volumetric interpolated breath-hold images before (A) and after (B) contrast administration show smooth linear enhancement of peritoneum (arrows, B) with unenhanced intraperitoneal fluid, representing acute peritonitis.

 

Figure 8
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  		Fig. 4B —36-year-old man with acute peritonitis. Axial T1 gradient-refocused-echo volumetric interpolated breath-hold images before (A) and after (B) contrast administration show smooth linear enhancement of peritoneum (arrows, B) with unenhanced intraperitoneal fluid, representing acute peritonitis.

 

Figure 9
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  		Fig. 5 —42-year-old man with sarcoidosis. Axial enhanced T1-weighted gradient-refocused-echo volumetric interpolated breath-hold image shows irregularly enhancing omental soft tissue (arrows) secondary to sarcoidosis.

 

Figure 10
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  		Fig. 6A —55-year-old woman with intraperitoneal subacute hematoma. Axial T2-weighted inversion-recovery image (A) and axial gradient-refocused-echo image (B) show subacute blood, best seen in perihepatic space (arrows). Use of inversion recovery eliminates near-field artifact.

 

Figure 11
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  		Fig. 6B —55-year-old woman with intraperitoneal subacute hematoma. Axial T2-weighted inversion-recovery image (A) and axial gradient-refocused-echo image (B) show subacute blood, best seen in perihepatic space (arrows). Use of inversion recovery eliminates near-field artifact.

 

Figure 12
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  		Fig. 7A —48-year-old man with infected intraperitoneal hematoma. Axial T2-weighted image (A) and axial T1-weighted gradient-refocused-echo volumetric interpolated breath-hold images before (B) and after (C) IV administration of contrast material show linear smooth peritoneal enhancement, with presence of intraperitoneal blood-intensity signal.

 

Figure 13
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  		Fig. 7B —48-year-old man with infected intraperitoneal hematoma. Axial T2-weighted image (A) and axial T1-weighted gradient-refocused-echo volumetric interpolated breath-hold images before (B) and after (C) IV administration of contrast material show linear smooth peritoneal enhancement, with presence of intraperitoneal blood-intensity signal.

 

Figure 14
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  		Fig. 7C —48-year-old man with infected intraperitoneal hematoma. Axial T2-weighted image (A) and axial T1-weighted gradient-refocused-echo volumetric interpolated breath-hold images before (B) and after (C) IV administration of contrast material show linear smooth peritoneal enhancement, with presence of intraperitoneal blood-intensity signal.

 

Figure 15
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  		Fig. 8A —54-year-old man with pneumoperitoneum. Axial in-phase (A) and out-of-phase (B) images show small amount of free air (arrows). Conspicuity is increased on in-phase images because of longer TE, resulting in greater susceptibility artifact.

 

Figure 16
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  		Fig. 8B —54-year-old man with pneumoperitoneum. Axial in-phase (A) and out-of-phase (B) images show small amount of free air (arrows). Conspicuity is increased on in-phase images because of longer TE, resulting in greater susceptibility artifact.

 

Figure 17
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  		Fig. 9A —48-year-old woman with bile leak. Axial fat-suppressed T1-weighted image (A) and axial (B) and coronal (C) fat-suppressed T1-weighted images 1 hr after IV administration of mangafodipir trisodium show hyperintense perihepatic fluid denoting bile leak (arrow, C).

 

Figure 18
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  		Fig. 9B —48-year-old woman with bile leak. Axial fat-suppressed T1-weighted image (A) and axial (B) and coronal (C) fat-suppressed T1-weighted images 1 hr after IV administration of mangafodipir trisodium show hyperintense perihepatic fluid denoting bile leak (arrow, C).

 

Figure 19
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  		Fig. 9C —48-year-old woman with bile leak. Axial fat-suppressed T1-weighted image (A) and axial (B) and coronal (C) fat-suppressed T1-weighted images 1 hr after IV administration of mangafodipir trisodium show hyperintense perihepatic fluid denoting bile leak (arrow, C).

 

Figure 20
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  		Fig. 10A —52-year-old man with biloma. Axial T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold image (A) and axial T2-weighted inversion recovery image (B) show lambda-shaped fluid collection (arrows) adjacent to caudate lobe, representing biloma.

 

Figure 21
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  		Fig. 10B —52-year-old man with biloma. Axial T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold image (A) and axial T2-weighted inversion recovery image (B) show lambda-shaped fluid collection (arrows) adjacent to caudate lobe, representing biloma.

 

Figure 22
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  		Fig. 11 —39-year-old woman with neurofibromatosis type 1. Axial T1-weighted volumetric interpolated breath-hold image obtained after IV administration of gadolinium chelate shows heterogeneously enhancing mass (arrow) involving small-bowel mesentery, representing neurofibromatosis.

 

Figure 23
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  		Fig. 12A —58-year-old man with mesothelioma. Gradient-refocused-echo out-of-phase image (A) and enhanced axial T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold images (B and C) show enhancing large mass (arrows, A and B), representing mesothelioma, which is entangling bowel loops.

 

Figure 24
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  		Fig. 12B —58-year-old man with mesothelioma. Gradient-refocused-echo out-of-phase image (A) and enhanced axial T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold images (B and C) show enhancing large mass (arrows, A and B), representing mesothelioma, which is entangling bowel loops.

 

Figure 25
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  		Fig. 12C —58-year-old man with mesothelioma. Gradient-refocused-echo out-of-phase image (A) and enhanced axial T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold images (B and C) show enhancing large mass (arrows, A and B), representing mesothelioma, which is entangling bowel loops.

 

Figure 26
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  		Fig. 13 —44-year-old woman with metastases from ovarian cancer. Axial enhanced T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold image shows nodular enhancement of peritoneum over liver surface (arrows), representing metastases in patient with history of ovarian cancer.

 

Figure 27
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  		Fig. 14 —41-year-old woman with ovarian cancer. Axial fat-suppressed gradient-refocused-echo T1-weighted enhanced image shows peritoneal tumor implants in perihepatic space (white arrow) and Morison's pouch (black arrow).

 

Figure 28
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  		Fig. 15A —48-year-old woman with mesenteric carcinoid tumor. Three-dimensional subvolume maximum-intensity projection shows narrowing of ileocolic artery (arrow).

 

Figure 29
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  		Fig. 15B —48-year-old woman with mesenteric carcinoid tumor. Enhancing mass (arrows) is seen on portal venous phase images, with involvement of draining veins.

 

Figure 30
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  		Fig. 15C —48-year-old woman with mesenteric carcinoid tumor. Enhancing mass (arrows) is seen on portal venous phase images, with involvement of draining veins.

 

Figure 31
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  		Fig. 16A —51-year-old man with mesenteric cyst. Axial enhanced T1-weighted 3D gradient-refocused-echo volumetric interpolated breath-hold image shows large, nonenhancing extrahepatic cystic structure (arrow) posterior to portal vein and anterior to hepatic artery, representing mesenteric cyst.

 

Figure 32
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  		Fig. 16B —51-year-old man with mesenteric cyst. T2-weighted image shows homogeneously bright signal (arrow).

 

Figure 33
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  		Fig. 17A —48-year-old woman with cystic liver lesion incidentally discovered on CT. Coronal T2-weighted HASTE image shows high-signal-intensity lesion (arrow) posterior to right hepatic lobe.

 

Figure 34
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  		Fig. 17B —48-year-old woman with cystic liver lesion incidentally discovered on CT. Unsubtracted (B) and subtracted (C) axial T1-weighted gadolinium-enhanced images show capsule-based lesion (arrows) secondary to endometriosis.

 

Figure 35
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  		Fig. 17C —48-year-old woman with cystic liver lesion incidentally discovered on CT. Unsubtracted (B) and subtracted (C) axial T1-weighted gadolinium-enhanced images show capsule-based lesion (arrows) secondary to endometriosis.

 

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