List of Contents
MRI of the Upper Abdomen
In our Institute for Preventive Medicine in Witten the whole-body magnetic resonance tomography provides high resolution anatomical and functional imaging of the organs, tissues and structures of the upper abdomen.
In the following, we give you an exemplary overview of possible anatomical abnormalities or illnesses of this part of the body.
MRI diagnostics is able to differentiate between distinct stages of a liver steatosis. It is also called fatty liver, which is caused by the storage of lipids in the liver cells. The cells lose their efficiency and easily tend to inflammation. A highly developed fatty liver can lead to liver cirrhosis. The healthy liver tissue is replaced by connective tissue, which can no longer perform the normal functions of the liver. It leads to liver failure.
If this liver disease is detected early in the MRI, there are efficient strategies to counter it: for example by a diet change, weight reduction or giving up alcohol.
We can also spot early stages of benign or malignant liver tumors. Early-stage cancer can be treated very well, and in this phase it is possible to avoid the emergence of metastases within malignant tumors.
Furthermore, liver cysts can be distinguished from healthy tissue. They are liquid-filled, clearly delineated cavities that are benign and have a slow growth rate. Discomforts often occur only because of larger cysts. As these spatial demands displace healthy liver tissue, it is important to decide on a case-by-case basis if they should be removed.
Pathological liver tissue caused by liver cirrhosis is also visualised by the MRI. In the course of the disease, the structure of the liver is gradually destroyed. The healthy liver tissue is replaced by connective tissue, which cannot perform the natural functions in the body’s metabolism. It comes to liver hardening, nodules and scar tissue formation.
If cirrhosis progresses, the organ loses its important functions as a metabolism and detoxification centre. In severe cases, a liver donation is needed to replace the organ.
If, due to MRI imaging, the first abnormalities are detected, it is possible for the attending specialist to detect and specifically treat the causes of cirrhosis, thereby preventing further progression of this disease.
In the gall bladder, the bile juice produced in the liver is stored. This is targeted into the small intestine and serves digestion, especially with regard to fat metabolism.
Eye-catching changes in the gall bladder can be caused, for example, by enrichment of sludge. This bile sludge consists predominantly of viscous mucus, enriched by bile salts and cholesterol crystals. Moreover, sludge can be the cause of gallstone formation.
In addition, magnetic resonance imaging allows us to prove the first signs of a gallbladder tumor. Because these tumors only show symptoms in very late stages (e.g. due to the accumulation of the bile in the liver), it is even more important to start a suitable therapy after early detection in the MRI.
Another important issue with regard to the study of the gallbladder is the formation of gallstones. Most of them do not cause any discomfort and therefore do not have to be treated. But severe problems occur when gallstones enter the bile ducts and occlude them (see: bile ducts).
Furthermore, the MRI visualises changes in the gallbladder caused by a gall bladder hydrops. This is a morbidly enlarged bladder caused by a bile accumulation. After evaluating the findings we can support the attending physician in order to set up further appropriate diagnosis and therapy.
As a random finding in the MRI, gall bladder polyps can occur which usually do not lead to any symptoms. Larger polyps, however, should be removed along with the bladder, as in rare cases they might be precursors to gallbladder cancer.
The discharging bile ducts can be blocked by gallstones, which impair the discharge of the bile into the small intestine. The bile accumulates in the liver and the pancreas. The patient suffers from severe, colicky pain, complains of nausea and has to vomit. Also noticeable is the yellowish colouring of the skin and eyes by bilirubin, which is formed when the red blood cells degenerate.
The MRI provides us with information about the size, location and shape of the stones as well as the accumulation of the bile liquid. That’s how we can assess whether therapeutic measures concerning the discovered gallstones become necessary.
Tumors of the pancreas cause discomfort only in the late stage. This is the reason why it is even more important to make use of a diagnostic technique like the MRI, which detects the first tumorous abnormalities of the gland. Pleases note that early therapeutic intervention is particularly advantageous with regard to pancreatic cancer.
Anatomical abnormalities of the pancreas passage (passage expansion) can be precursors of a pancreatic tumor. Based on the data obtained, it is possible to clarify the underlying cause of the pancreas expansion.
As in the gallbladder, stones can develop in the pancreas that block it and impede the flow of digestive fluids. This may cause a pancreas inflammation. The MRI can visualise small stones that must be checked regularly.
Because of pancreatic inflammation, pseudo-cysts can develop. These are liquid-filled, clearly delineated cavities, which usually do not cause any symptoms. If the patient feels uncomfortable, a drainage can be performed or a removal of the cyst may be advisable.
Pancreatic inflammation (pancreatitis), which is caused, for example, by the outflow of bile into the gland, can occur in two forms: exsudativ and edematous. In the former, liquid is excreted from the pancreas due to the inflammatory processes, whereas the latter form shows a liquid storage in the pancreas. MRI imaging creates an optimal diagnostic basis for deciding which targeted measures should be taken against inflammation.
The spleen is part of the lymphatic system. It plays a role in the immune defense and is connected to the network of lymphatic vessels and lymph nodes, which is spread over our entire body.
In diagnostics, it is important to assess the size of this organ. Its proportion can, on the one hand, point to portal hypertension and on the other hand, to lymph gland cancer (lymphoma). In the latter case, it will be removed in the course of cancer therapy.
The adrenal glands occur in pairs, are well-vascularized, and are situated over the upper part of the kidneys. They consist of an outer part, the adrenal cortex, and an interior one, the adrenal medulla. They play an important role in hormone production (e.g. cortisol, adrenaline, norepinephrine).
Adenomas are benign tumors of the adrenal gland. They are often discovered by MRI as a random finding. If there is a clear fat proof of this area, this indicates the benignity of the tumor.
The phaeochromocytoma develops from medulla cells. This tumor is not easy to diagnose. It is usually benign, but in 10 percent of cases it is malignant. This tumor releases norepinephrine and adrenaline in an uncontrolled manner. As one of the main symptoms, patients often show attacks of high blood pressure while suffering from this tumor.
Adrenal carcinomas usually have irregular shapes and show a similarly inhomogeneous inner structure, revealed by the MRI images. Changes of tissue such as bleeding or calcification are also visible. Most malignant tumors do not show any fat content.
Metastases in the adrenal glands can often be detected in both organs. They are variable in size, usually have no fat content and show bleeding and calcification of the tissue.
High blood pressure occurs within many patients who show pathological changes in the adrenal glands. This may occur due to the increased cortisol release (Cushing’s disease, Cushing syndrome) or is caused by the morbid distribution of stress hormones (adrenaline, norepinephrine).
The kidneys play an important role in the body’s filter function. They flood toxins and degradation products with the urine, regulate the hormone, acid-base, electrolyte and water balance of the body. They also have an influence on blood pressure.
The MRI visualises the size of the two kidneys, and displays the vascularisation of the two organs. In addition, a possible urinary obstruction due to pathological changes in the bladder, can be depicted.
The kidney basin intercepts the formed urine and passes it to the ureter, which leads it into the urinary bladder. In the case of a urinary obstruction, the urine cannot be released and it accumulates in the kidney basin. This can cause inflammatory processes and lead to severe pain (pyelonephritis).
Kidney diseases often develop slowly and become noticeable when only about one third of the kidney function is left. The declared aim is therefore to detect pathological changes of the kidneys as early as possible (MRI precaution) so that we are able to prevent the risk of a chronic renal failure. Our advanced MR imaging techniques are also able to provide an accurate diagnosis of kidney tumors. We actually discover these tumors relatively often as a random finding. Small tumors of these slowly growing type can be removed while preserving the kidney. – An important detail of the MRI check-up!
Please learn more about the vascular status in “MRI of the vessels“ regarding arteriosclerosis, stenosis and aneurysms.
In addition, MRI detection of varices (varicose veins) is important in the upper abdomen. Here there is the risk of venous thrombosis, which can ultimately cause a pulmonary artery embolism (lower blood circulation of the lung tissue) after detachment of a blood clot.
Venous thrombosis is caused by a blood clot that occludes the vessel and inhibits the blood flow. A portal thrombosis (liver) can be caused, for example, by a bile carcinoma. Thrombosis can also occur in kidney veins. An MRI with a contrast agent visualises these morbid signs of thrombosis.
If the blood flow cannot take its normal path due to a restriction, the collateral circuits are formed by bypass circuits. For example, if a main artery fails for a variety of reasons, connected arteries take care of the organ, for example the liver. If a collateral circuit is detected, it is obvious that a main supplying artery is blocked.
Lymph Node Diseases
Malignant tumors of the lymph pathways (lymphoma) are described in more detail in the next chapter.
Moreover, the MRI can identify post-operative lymphoceles. This is an accumulation of lymphatic liquid, for example in the abdominal cavity, after the surgical removal of a lymph node. If free lymphatic fluid is detected in the MRI, this does not always require treatment. The lymph is usually absorbed. Only in rare cases a drainage of the area is necessary.
Kidney, liver or heart diseases often cause circulatory and metabolic disorders which can lead to lymphatic obstruction in the lymph pathways. Patients have swollen legs and feet in which the lymph accumulates (lymphedema).
Free Liquid / Ascites
Regarding the symptom of free liquid in the abdominal cavity caused by tumors or metastases, liver cirrhosis, peritoneal cancer or heart failure, we recommend the chapter “MRI of the pelvis“.
We will be happy to answer any questions you have about whole-body magnetic resonance imaging of the upper abdomen.