Ultrafast MRI in abdominal hernia diagnosis.

Poster No.: C-2307

Congress: ECR 2011
Type: Scientific Exhibit
Authors: 1 2
M. Repollés Cobaleda , A. ARJONILLA , M. Tomás Mallebrera ,
1

1 2 1
Á. Gómez Trujillo , M. A. FRANCO LOPEZ ; Madrid/ES,
2
MADRID/ES
Keywords: Hernia, Diagnostic procedure, MR, Abdominal wall
DOI: 10.1594/ecr2011/C-2307

Any information contained in this pdf file is automatically generated from digital material
submitted to EPOS by third parties in the form of scientific presentations. References
to any names, marks, products, or services of third parties or hypertext links to third-
party sites or information are provided solely as a convenience to you and do not in
any way constitute or imply ECR's endorsement, sponsorship or recommendation of the
third party, information, product or service. ECR is not responsible for the content of
these pages and does not make any representations regarding the content or accuracy
of material in this file.
As per copyright regulations, any unauthorised use of the material or parts thereof as
well as commercial reproduction or multiple distribution by any traditional or electronically
based reproduction/publication method ist strictly prohibited.
You agree to defend, indemnify, and hold ECR harmless from and against any and all
claims, damages, costs, and expenses, including attorneys' fees, arising from or related
to your use of these pages.
Please note: Links to movies, ppt slideshows and any other multimedia files are not
available in the pdf version of presentations.
www.myESR.org

Page 1 of 16
Purpose

Abdominal hernias are a frequent imaging finding in the abdomen.

Diagnosis is usually made at physical examination; however, clinical diagnosis can

be difficult, especially in patients with obesity, pain, atypical clinical history or unusual
location. [1] In these cases, abdominal imaging may be the first clue to the correct
diagnosis. In the past, conventional radiographs, barium studies or ultrasonography were
predominantly used in confirming or excluding abdominal wall hernias; currently, CT has
assumed a dominant role. [2].

Only a few studies suggest the use of MRI for the detection of abdominal wall hernias. [3]

The purpose of this study is to demonstrate the utility of ultrafast MRI for the diagnosis
of abdominal hernias.

Methods and Materials

Ultrafast MRI was performed in 10 patients referred for imaging studies to confirm a
suspected hernia due to physical examination limited by obesity, pain or bloating, atypical
clinical history or unusual location.

We assessed hernial sac location and its contents, abdominal wall thickness (thinning/
atrophy) and the presence and number of hernia rings.

SSHT2 sequences were obtained in axial, sagital and coronal planes using a body coil
to cover the whole abdominal cavity. Slice thickness was 7 mm. TE 80 ms, NEX=1.

Images were obtained in a single breath-hold during Valsalva´s maneuver. Valsalva's

maneuver is used to make the hernia more apparent because the increase in
intraabdominal pressure causes the hernial sac to enlarge and protrude through the
anatomic defect. [4] (Figure 1 and 2)

Neither oral nor intravenous contrast was administered.

Acquisition time was 9 seconds per sequence. The total time of study did not exceed 5
minutes in any case.

Images for this section:

Page 2 of 16
Fig. 1: Sagital SSHT2 image of the abdomen obtained with the patient at rest shows an
inguinal hernia containing fat.

Page 3 of 16
Fig. 2: Sagital SSHT2 image of the abdomen obtained during a Valsalva maneuver
shows how the inguinal hernia of the figure 1 becomes more evident.

Page 4 of 16
Results

In seven cases in our series a hernia was found (70%) . 20 % had imaging findings
different from hernia and in the other 10%, the study was normal.

Findings included:

• Three direct inguinal hernias. (Figure 2 and 3)

• One traumatic lumbar hernia. ( Figure 4 and 5)
• One incisional hernia.
• One Spigelian hernia. ( Figure 6 and 7)
• One paraumbilical hernia.
• Two patients with findings different from hernia: One inguinal
lymphadenopathy ( Figure 8) and one Nuck´s canal hydrocele ( Figure 9 and
10).
• One normal study.

The hernial sac was unique in all cases and accessories rings were not identified.

Images for this section:

Page 5 of 16
Fig. 1: Abdominal wall hernias clasification

Page 6 of 16
Fig. 2: Coronal SSHT2 image of the abdomen shows a direct inguinal hernia on the left
side of the groin.

Page 7 of 16
Fig. 3: Sagital SSHT2 image of the abdomen shows a direct inguinal hernia on the left
side of the groin.

Page 8 of 16
Fig. 4: Axial SSHT2 image of the abdomen shows the recurrence of a traumatic hernia
due to weakening along postoperative incision.

Page 9 of 16
Fig. 5: Coronal SSHT2 image of the abdomen shows the recurrence of a traumatic hernia
due to weakening along postoperative incision. Note the herniation of the descending
colon and bowel loops through the wall defect.

Page 10 of 16
Fig. 6: Ventral hernia in a woman who had undergone laparoscopy. Axial SSHT2 image of
the abdomen shows a ventral hernia through the spigelian fascia, which is the aponeurotic
layer between the rectus abdominis muscle medially, and the semilunar line laterally.

Page 11 of 16
Fig. 7: Coronal SSHT2 image of the abdomen shows an Spigelian hernia in a woman
who had undergone laparoscopy. Fat is seen in the hernia sac.

Page 12 of 16
Page 13 of 16
Fig. 8: Coronal SSHT2 image of the abdomen shows a right inguinal adenopathy. No
hernia was found.

Fig. 9: Coronal SSHT2 image of the abdomen shows a unicameral cystic mass with a
thin wall, located in the left inguinal region of a young woman.

Page 14 of 16
Fig. 10: Sagital SSHT2 image of the abdomen shows a unicameral cystic mass with a
thin wall located in the groin of a young woman.

Page 15 of 16
Conclusion

Abdominal wall hernias are a common finding at abdominal imaging.

Ultrafast MRI is an excellent technique for the assessment of abdominal wall hernias in
those cases with diagnostic suspicion and inconclusive findings on physical examination.

It provides information about the size and specific location of the anatomic defect, the
contents of the hernial sac and the state of the abdominal wall.

References

1. Ghahremani GG, Jimenez MA, Rosenfeld M, Rochester D. CT diagnosis of occult

incisional hernias. AJR Am J Roentgenol 1987; 148:139 -142.

2. Aguirre DA, Casola G, Sirlin C. Abdominal wall hernias: MDCT findings. AJR Am J
Roentgenol 2004;183:681-690.

3. Van den Berg JC, de Valois JC, Go PM, Rosenbusch G. Groin hernia: can dynamic
magnetic resonance imaging be of help? Eur Radiol 1998;8: 270-273.

4. Jaffe TA, O´Connell MJ; Harris JP, Paulson EK, Delong DM. MDCT of abdominal
wall hernias: is there a role for Valsalva´s maneuver? AJR Am J Roentgenol 2005; 184:
847-851.

Personal Information

Page 16 of 16