High density barium sulphate as an MRI oral contrast

High density barium sulphate suspension was investigated as an oral contrast on MRI. On 30 consecutive subjects, the stomach (in all cases) and the two first portions of the duodenum (in 21 cases) were filled with the suspension. This oral contrast behaved as a negative contrast, being hypointense on all pulse sequences (spin-echo T1-weighted, spin-echo T2-weighted and STIR). This characteristic is probably due to the low proton density of the suspension (260 +/- 40). Since barium sulphate is inexpensive, harmless and available on all radiologic departments, it is recommendable in MRI studies of the liver and head of the pancreas.     

Evaluation of STIR imaging as a complement to spin-echo MR and CT of the porta hepatis/hepatoduodenal ligament

Short TI inversion-recovery (STIR) imaging provides specific advantages over standard spin-echo (SE) MR sequences by producing additive effects of T1 and T2 brightening of pathology and suppression of the signal from surrounding fat. We retrospectively evaluated 12 patients with abnormalities, primarily neoplastic, of the porta hepatis/hepatoduodenal ligament (PH/HdL) with CT and MR imaging, including SE and STIR imaging. Masses on CT were of slightly decreased density compared to liver and seen in contrast to surrounding fat in the PH/HdL region. On MR, T1-weighted images provided comparable anatomic detail to CT, with masses clearly distinguished from surrounding fat due to the low signal intensity of masses as compared to fat. T2-weighted images clearly depicted intrahepatic lesions because of their high signal intensity relative to liver. Increased signal in extrahepatic lesions made them less distinctly seen from surrounding fat. STIR images best demonstrated tumor relative to fat. In six cases, CT was equivalent in demonstrating pathology to the best MR sequence. At least one MR sequence demonstrated pathology better than CT in 6 of 12 cases. In five of these six cases, the STIR sequence was better than CT. Thus, MR, particularly STIR imaging, provides a useful technique in imaging of PH/HdL pathology.     

Bone marrow imaging using STIR at 0.5 and 1.5 T.

We retrospectively examined MR images in 82 patients to evaluate the usefulness of short inversion time inversion recovery (STIR) in bone marrow imaging at 0.5 and 1.5 T. The study included 56 patients at 1.5 T and 26 patients at 0.5 T with a variety of pathologic bone marrow lesions (principally oncological), and compared the contrast and image quality of STIR imaging with spin-echo short repetition time/echo time (TR/TE), long TR/TE, and gradient-echo sequences. The pulse sequences were adjusted for optimal image quality, contrast, and fat nulling. STIR appears especially useful for the evaluation of red marrow (e.g., spine), where contrast between normal and infiltrated marrow is greater than with either gradient-echo or T1-weighted images. STIR is also extremely sensitive for evaluation of osteomyelitis, including soft tissue extent. In more peripheral (yellow) marrow, T1-weighted images are usually as sensitive as STIR. Limitations of STIR include artifacts, in particular motion artifact that at high field strength necessitates motion compensation. At 0.5 T, however, motion compensation is usually not necessary. Also, because of extreme sensitivity to water content, STIR may overstate the margins of a marrow lesion. With these limitations in mind, STIR is a very effective pulse sequence at both 0.5 and 1.5 T for evaluation of marrow abnormalities.     

Medial tibial pain: a dynamic contrast-enhanced MRI study.

The purpose of this study was to compare the sensitivity of different magnetic resonance imaging (MRI) sequences to depict periosteal edema in patients with medial tibial pain. Additionally, we evaluated the ability of dynamic contrast-enhanced imaging (DCES) to depict possible temporal alterations in muscular perfusion within compartments of the leg. Fifteen patients with medial tibial pain were examined with MRI. T1-, T2-weighted, proton density axial images and dynamic and static phase post-contrast images were compared in ability to depict periosteal edema. STIR was used in seven cases to depict bone marrow edema. Images were analyzed to detect signs of compartment edema. Region-of-interest measurements in compartments were performed during DCES and compared with controls. In detecting periosteal edema, post-contrast T1-weighted images were better than spin echo T2-weighted and proton density images or STIR images, but STIR depicted the bone marrow edema best. DCES best demonstrated the gradually enhancing periostitis. Four subjects with severe periosteal edema had visually detectable pathologic enhancement during DCES in the deep posterior compartment of the leg. Percentage enhancement in the deep posterior compartment of the leg was greater in patients than in controls. The fast enhancement phase in the deep posterior compartment began slightly slower in patients than in controls, but it continued longer. We believe that periosteal edema in bone stress reaction can cause impairment of venous flow in the deep posterior compartment. MRI can depict both these conditions. In patients with medial tibial pain, MR imaging protocol should include axial STIR images (to depict bone pathology) with T1-weighted axial pre and post-contrast images, and dynamic contrast enhanced imaging to show periosteal edema and abnormal contrast enhancement within a compartment.     

Magnetic resonance imaging of soft-tissue tumors: Comparison with computed tomography

Twenty-seven patients with soft-tissue tumors were examined with a Picker 0.15-tesla resistive magnet and by computed tomography (CT). In all but one patient, MRI was better than or equal to CT in defining the anatomic extent of the tumor. We could determine whether major vascular structures were engulfed by the tumor in 80% of the MRI examinations but only in 62% of the CT scans. MRI and CT were equally effective in determining the presence or absence of bony invasion. The MRI images of all the tumors showed increased signal intensity relative to normal muscle when spin-echo (SE) sulse sequences with long repeat times were used (SE: echo time [TE], 60 ms; repetition time [TR], 2,000 ms). When T1 weighted pulse sequences were used (SE: TE, 30 ms; TR, 500 ms or inversion recovery: inversion time, 500 ms; TE, 40 ms; TR, 2,000 ms) the malignant tumors showed decreased signal intensity compared to normal muscle. Only lipomas showed high signal intensity on both T1 and T2 weighted pulse sequences.     

Short TI short TR inversion recovery imaging using reduced flip angles

In this paper the effects of reducing the flip angle of the 90-degree observation pulse in inversion recovery imaging are described and analyzed. When incorporated in an IR sequence with a short inversion time (STIR), reduction to the 90-degree pulse allows a significant shortening of the repetition time without loss in contrast, although at the expense of some signal/noise. The generalized STIR sequence thus combines the previously reported advantages of a conventional STIR sequence--suppression of ghost artifacts from abdominal wall movement, suppression of chemical shift and boundary artifacts, additive effects of N(H), T1 and T2 on image contrast--with reduced power deposition and the advantages resulting from shorter repetition times, viz, single heart-beat triggering, increased number of signal averages for suppression of motion artifacts, acquisition of interleaved contiguous slices without cross-talk or considerable time savings when the number of required slices is limited. The proposed method is demonstrated and experimentally verified by imaging experiments on phantoms and human subjects. In principle the method is applicable to all cases where STIR imaging has been proven to be successful.     

Liver imaging at 1.5 tesla: pulse sequence optimization based on improved measurement of tissue relaxation times

In order to predict the most sensitive MR imaging sequence for detecting liver metastases at 1.5 T, in vivo measurements of T1 and T2 relaxation times and proton density were obtained using multipoint techniques. Based on these measurements, two-dimensional contrast contour plots were constructed demonstrating signal intensity contrast between hepatic lesions and surrounding liver parenchyma for different pulse sequences and pulse timing parameters. The data predict that inversion recovery spin echo (IRSE) imaging should yield the greatest contrast between liver metastases and liver parenchyma at 1.5 T, followed by short tau inversion recovery (STIR) and spin-echo (SE) pulse sequences. T2-weighted SE images provided greater liver/lesion contrast than T1-weighted SE pulse sequences. Calculated T1, T2, and proton density values of the spleen were similar to those of hepatic metastatic lesions, indicating that the signal intensity of the spleen may be used as an internal standard to predict the signal intensity of hepatic metastases on T1- and T2-weighted images at 1.5 T.     

MRI in the study of distal primary myopathopies and of muscular alterations due to peripheral neuropathies: possible diagnostic capacities of MR equipment with low intensity field (0.2 T) dedicated to peripheral limbs

The purpose of this work was to investigate whether or not an magnetic resonance imaging (MRI) equipment with a low field intensity (O.2 T) used in the study of muscular alterations can diagnose primary or secondary myopathies, due to peripheral neuropathies. In this study the peripheral areas of all patients were examined. A total of 40 patients (23 males and 17 females) were tested. Their age ranged from 10 to 78 years age (mean age 40.8, SD ± 19,45 years). The group includes 23 patients: 18 with Stainert Myotonic Distrophy, 5 were myositic, and the remaining 17 had peropheral neuropathies. Every patient received a clinic examination, followed by EMG and MRI. The MRI study was done with a system dedicated to the study of limbs (Artoscan, Esaote Biomedica) that used a 0.2 T permanent magnet. Spin-echo T₁, T₂-weighted, multiple-echo, and STIR sequences were used. A good correspondence was found between clinical and MRI data. Specifically, in the group of 23 myopathies, Sperman’s index was found to be 0.80 in its correlation between the clinical examination and MRI; in the group of 17 myopathies it was found to be 0.63. A discrepancy was found among clinical examination, EMG, and MRI in patients with neuropathies who were showing a lack of myelin and mixed ones. The T2-weighted and STIR sequences had great sensitivity in showing initial changes in the muscles. The SE T1-weighted sequence was especially useful in detecting degeneration in the fibrous adipose tissue. The STIR sequence because of its high sensitivity and greater speed of response could be used instead of the SE T2 weighted particularly in the study of patients, who were noted to tolerate a prolonge period of scanning. However, because these sequences have a low signal noise ratio, they must always be associated with a SE sequence, whenever there would be need of a precise determination of the structures under study. The MRI low field intensity was also found to be a useful technique in screening familial groups having a great number of myotonic distrophies. It can have a great clinical role in revealing muscular alterations, even in asymptomatic patients.     

Analyzing radiation absorption difference of dental substance by using Dual CT

The purpose of this study was to evaluate the changes of noise and computer tomography (CT) number in each dental substance, by using the metal artefact reduction algorithm; we used dual CT for this study. For the study, we produced resin, titanium, gypsum, and wax that are widely used by dentists. In addition, we made nickel to increase the artefact. While making the study materials, we made sure that there is no difficulty when inserting the substances inside phantom. In order to study, we scanned before and after using the metal artefact reduction algorithm. We conducted an average analysis of CT number and noise, before and after using the metal artefact reduction algorithm. As a result, there was no difference in CT number and noise before and after using the metal artefact reduction algorithm. However, when it comes to the noise value in each substance, wax's noise value was the lowest whereas titanium's noise value was the highest, after applying the metal artefact reduction algorithm. In nickel, CT number and noise value from artefact area showed a decreased noise value when applying the metal artefact reduction algorithm. In conclusion, we assumed that we could increase the effectiveness of CT examination by applying dual energy's metal artefact reduction algorithm.     

Correlation of the R1 and R2 values of gadolinium-based MRI contrast media with the ΔHounsfield unit of CT contrast media of identical concentration

The optimal volume of contrast medium must be injected into the patient who emits the maximum signal intensity in an ROI. This study was investigated four different type MRI and one CT contrast agent in vitro and sought to establish relations between concentration, MRI relaxivity, CT Hounsfield unites selected kVp and different MRI T1 sequences. Using a CT contrast medium and four different MRI T1 contrast media, we developed five different phantom series. The MRI contrast media phantom was imaged on 1.5T and 3T MRI systems and measured the R1 and R2 value. A CT scanner was used to obtain images of the Iopromide 370 phantom with the quality of radiation to obtain images. The Pearson's correlation coefficient analyses were conducted between MRI CM phantom series with Iopromide 370 phantom. The non-parametric statistical analyses were performed for the values of kVp. The ΔHU of the test solution of the CT contrast media was produced in the same amount as the exponentially increased concentration of the MRI contrast media according to the increase in the dilution concentration, and was influenced by the quality of the X-ray. Through the results of this experiment that considered the two aforementioned factors, an image with a high diagnosis value can be acquired from the information on the concentration of the MRI T1 contrast media.     

T1rho-weighted MRI using a surface coil to transmit spin-lock pulses

T1rho-weighted MRI is a novel basis for generating tissue contrast. However, it suffers from sensitivity to B1 inhomogeneity. First, excitation with a spatially varying B1 causes flip-angle artifacts and second, spin locking with an inhomogeneous B1 results in non-uniform T1rho contrast. In this study, we overcome the former complication with a specially designed spin-locking pulse sequence and we successfully obtain T1rho-weighted images with a surface coil. In this pulse sequence, the spin-lock pulse was divided into segments of equal duration and alternating phase. This "self-compensating" T1rho-preparatory pulse sequence was analyzed and the effect of an inhomogeneous B1 field was simulated using the Bloch equations. T1rho-weighted MR images of a phantom and a human knee joint in vivo were obtained on a clinical scanner with a surface coil to demonstrate the utility of the pulse sequence. The self-compensating T1rho-prepared pulses sequence resulted in substantially reduced image artifacts compared to the conventional, single-phase spin-lock pulse.     

T1ρ-weighted MRI using a surface coil to transmit spin-lock pulses

T1rho-weighted MRI is a novel basis for generating tissue contrast. However, it suffers from sensitivity to B1 inhomogeneity. First, excitation with a spatially varying B1 causes flip-angle artifacts and second, spin locking with an inhomogeneous B1 results in non-uniform T1rho contrast. In this study, we overcome the former complication with a specially designed spin-locking pulse sequence and we successfully obtain T1rho-weighted images with a surface coil. In this pulse sequence, the spin-lock pulse was divided into segments of equal duration and alternating phase. This "self-compensating" T1rho-preparatory pulse sequence was analyzed and the effect of an inhomogeneous B1 field was simulated using the Bloch equations. T1rho-weighted MR images of a phantom and a human knee joint in vivo were obtained on a clinical scanner with a surface coil to demonstrate the utility of the pulse sequence. The self-compensating T1rho-prepared pulses sequence resulted in substantially reduced image artifacts compared to the conventional, single-phase spin-lock pulse.     

MR imaging of fatigue stress injuries to bones: intra- and interobserver agreement

The aim of this study was to determine the validity of MR imaging (MRI) in the assessment of stress-related injuries to bone.MR images of 50 military recruits (8 females and 42 males; 18-27 (mean 20) years of age) were retrospectively evaluated twice for stress injuries to bone by 4 radiologists (2 musculoskeletal radiologists, 2 radiology residents). Coronal T1-weighed (T1W) and STIR images, as well as axial and coronal T2-weighted (T2W) fat-suppressed images were taken using a 1.0T scanner. Rates for sensitivity, specificity, and accuracy of MRI of the stress-related injuries were calculated. Intraobserver and interobserver agreement was determined with kappa statistics.Rates for MRI sensitivity were 27-96%, for specificity 65-100%, and for diagnostic accuracy 58-97%. Lowest rates were seen when reading T1W images and highest when reading STIR images. Readers showed moderate to excellent intraobserver agreement (kappa 0.75-0.95). Interobserver agreement was fair to excellent (kappa 0.41-0.91), and the lowest values were seen in the interpretation of T1W images. Normal findings could be differentiated from various grades of stress injury to bone.MRI is a valid means of revealing the presence of stress injuries to bone and their staging. Observer agreement is good to excellent when using T2W images and STIR images, while T1W images are of lesser value.     

Ferumoxide-enhanced MRI in patients with colorectal cancer and rising CEA: surgical correlation in early recurrence

The purpose of this study was to evaluate the value of Ferumoxide-enhanced magnetic resonance (MR) imaging in the detection of hepatic metastases in high-risk patients treated for colorectal cancer that have rising CEA. We used 19 patients treated previously for colorectal cancer with rising CEA levels underwent an unenhanced T(1)-weighted (T1W), T(2)-weighted (T2W), STIR, and Ferumoxide-enhanced hepatic MRI. Following these studies, a laparotomy was performed and the liver was evaluated by palpation and intraoperative ultrasound. Two observers who were blinded to surgical results evaluated each MR sequence separately. The number of lesions considered highly suspicious for metastatic lesions were determined for each sequence and were compared to the results of surgery. The McNemar test was used to compare the outcomes of the different sequences. MR Imaging was unable to detect small (<5 mm) metastases discovered at surgery. The best non-contrast sequences for detecting metastases were the STIR with 42% sensitivity, 83% specificity and an overall accuracy of 56% and the T1W sequence (sensitivity 38%, specificity 100%, accuracy 57%), which were not significantly different (p 0.4). The noncontrast T2W sequence had a sensitivity of 29% and a specificity of 77% with an overall accuracy of 46%. When all pre contrast scans were grouped together the common sensitivity was 42%, specificity was 77% and accuracy was 54%. The post-ferumoxide T(2)W scans had a sensitivity of 42%, specificity of 85%, and accuracy of 57%, but did not detect any additional lesions. There was no statistical difference between the pre- and post-contrast studies with regard to identifying patients with metastatic disease (p 0.1). In conclusion, we found small hepatic metastases in patients with early signs of recurrent colorectal cancer are difficult to detect on MRI. Ferumoxide-enhanced MRI was unable to detect additional hepatic metastases and performed no better than unenhanced MRI in detecting small hepatic metastasis.     

Abdominal aortic aneurysm evaluation: comparison of US, CT, MRI, and angiography

We studied 26 cases of abdominal aortic aneurysm with magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography (US), and angiography. Data acquired were compared to those obtained at surgery. Diameter of the aneurysm was correctly defined in all cases by CT and MRI, while angiography underestimated the diameter of lesions without peripheral calcifications. Involvement of renal arteries was present in four cases and correctly diagnosed with MRI and angiography in all of them. CT did provide this information in three cases and US were not useful. Also, iliac arteries involvement was depicted by CT, MRI, and angiography in 10 out of 10 patients. Coronal sections of MRI provided comparable images to those of angiography. By comparing these different techniques we verified the good reliability of MRI as investigation tool for an accurate evaluation of aneurysms; its only limit lying in the poor capability of detecting calcifications.     

Skeletal muscle lymphoma: MRI evaluation.

The magnetic resonance imaging (MRI) features of two cases of malignant lymphoproliferative disease involving skeletal muscle are presented. In both cases involved muscles were quantitatively and subjectively hypointense to fat on T1-weighted spin echo images, hypointense or isointense on T2-weighted spin echo images, and hyperintense on short tau inversion recovery (STIR) images. The findings suggest that lymphoproliferative disease should be considered as an etiology of a skeletal muscle lesion that is hypointense or isointense to fat on T2-weighted spin echo magnetic resonance images.     

Investigations and Modeling of the Effect of Magnetic Nanoparticles on MR Image Contrast

The investigations of nuclear magnetic resonance (NMR) relaxation of protons in aqueous solution and 2% agar–agar gel in the presence of magnetic nanoparticles were performed. To identify the effect of magnetic nanoparticles on the contrast of magnetic resonance images, the dependences of the MR signal intensity on the parameters of the two pulse radio-frequency (RF) sequences (spin-echo, gradient-echo) most commonly used in MRI for different values of the magnetic nanoparticle (MNP) concentration were simulated and analyzed. Recommendations for choosing the optimal values of pulse RF sequence parameters for MR imaging (MRI) in the presence of MNPs are formulated. MRI studies of phantom samples with 2% agar–agar gel containing MNPs have been performed for choosing the fast pulse RF sequence which shows the greatest contrast effect on MR images. A program for modeling magnetic resonance tomograms and determination of optimal values of pulse RF sequence parameters to achieve the best contrast of magnetic resonance images is developed. This program allows to reduce the time of MRI studies, to assess the possibility of using MNPs for contrast of MR images and to simulate the MR image in the presence of magnetic nanoparticles at the planning stage of procedures in MR-guided theranostics.     

Evaluation of Enhancement Effects as a Function of the Molarity of Gd-Based Contrast Media at 3.0 and 1.5 T: Based on the T1 Effective Pulse Sequence Parameter

The purpose of this study was to evaluate the alterations of diluted molarity of contrast media to emit the maximum signal intensity by changing the parameters of pulse sequences. The phantom was developed by diluting the magnetic resonance imaging (MRI) T1 contrast medium. The phantom images were obtained by 1.5 and 3.0 T MRI systems. We conducted Pearson’s analysis to reveal the correlation of the signal-to-noise ratio (SNR)_90%, the change of the concentration range of the contrast media which shows over 90% SNR, with changing the parameters of T1 effect pulse sequences in both 1.5 and 3.0 T imaging. As the flip angle increased, the SNR increased for all contrast media in magnetization-prepared rapid gradient echo and two-dimensional fast low angle shot pulse sequences at 1.5 and 3.0 T. Although the SNR increased until 30°, the SNR was almost the same over 30° in volumetric interpolated breath-hold examination at 1.5 and 3.0 T. The minimum contrast molarity of the representing SNR_90% was decreased according to the increasing time to repeat in spin echo. The present study revealed that the high concentration technique of contrast media on three pulse sequences (VIBE, MPRAGE, and 2D FLASH) could be useful to obtain images with better SNR.     

Study on the effects of gadolinium-based MRI contrast medium on X-ray scanning

Gadolinium has a higher atomic mass (64) than iodine (53). The K-edge absorption energy of gadolinium is 50.2 keV, which is in the absorbed wavelength range of the X-rays used by a CT scanner, suggesting that it has a high X-ray absorption ability. This study examined the effects of a gadolinium-based MRI contrast medium on the quality (mAs) and the quality (kVp) of radiation during a X-ray scan. A contrast medium phantom was manufactured after diluting the contrast medium to various concentrations. A CT scanner (Siemens, Somatom Senation 64, Germany) was used to obtain images by changing the quality of radiation from 80 kVp to 100, 120, and 140 kVp. At a constant quality of radiation of 120 kVp, the mAs was changed from 100 mAs to 200 and 300 mAs and images were obtained under each condition. The Hounsfield units (HUs) in a test tube were measured for analysis and comparison. The contrast enhancement by the contrast medium for CT scanning was 100% at a tube voltage of 80 kVp. The contrast enhancements at 100 kVp, 120 kVp, and 140 kVp were 93.8%, 87.7%, and 69.5%, respectively. In addition, although the quantity increased a fixed tube voltage, the HU of the test tube remained relatively constant, indicating that the absorption of the contrast medium had little association with the quantity of X-rays but had some correlation with the quality of radiation. A tube voltage of 80 kVp or lower is recommended when a MRI contrast medium is used CT scanning. When MRI scanning and X-ray scanning are conducted together, X-ray scanning should be performed first or after sufficient gadolinium contrast medium has been excreted.

     

Abdominal imaging studies: comparison of diagnostic accuracies resulting from ultrasound, computed tomography, and magnetic resonance imaging in the same individual

We retrospectively compared the diagnostic accuracy of abdominal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) studies performed on the same individual to determine the relative performance of these modalities in the evaluation of disease processes, arising from different intra-abdominal organ systems. We retrospectively reviewed all procedure codes accrued by our abdominal imaging section during a 1-year period to determine how many patients underwent all three imaging procedures in our institution within a 2-week interval. These cases were then further evaluated to determine: (1) the primary organ system of disease involvement, (2) the final diagnosis, and (3) the imaging modality that provided the most accurate information upon which appropriate medical management was based. Imaging findings were determined by review of diagnostic reports, and medical management was determined by chart review. Two thousand six hundred-ninety five patients underwent ultrasound, 4,394 patients underwent CT, and 872 patients underwent MRI for the investigation of abdominal disease. Among these 5,126 patients, 26 underwent sequential US, CT, and MRI evaluation within a two-week interval. Appropriate clinical management was based on the US findings in 12/26 cases (46%; 95% CI: 27-67%), CT findings in 16/26 cases (62%; 95% CI: 41-80%), and MRI findings in 24 cases (92%; 95% CI: 75-99%). Significant differences in directing appropriate clinical management were found when comparing the relative diagnostic accuracies of MRI to US (p = 0.0003) and MRI to CT (p = 0.009). However, differences were not significant when comparing CT to US (p = 0.27). All final diagnoses in a given patient were accurately determined by US in 7/26 cases (27%), by CT in 10/26 cases (38%), and by MRI in 23/26 cases (88%). When analyzed according to individual diagnoses (61 total), US detected 33 of 61 (54%) abnormalities, CT detected 41 (67%) abnormalities, and MRI detected 51 (84%) abnormalities. US correctly characterized 32 (52%) abnormalities, CT correctly characterized 36 (59%) abnormalities, and MRI correctly characterized 49 (80%) abnormalities. Ultrasound, CT, and MR imaging correctly diagnosed the disease process in 3 of 12 (25%), 3 of 12 (25%), and 10 of 12 (83%) patients, respectively, with liver disease; 2 of 9 (22%), 6 of 9 (66%), and 9 of 9 (100%) patients, respectively, with pancreatic disease; 17 of 17 (100%), 8 of 17 (47%), and 10 of 17 (58%) patients, respectively, with gallbladder and biliary disease; 2 of 8 (25%), 5 of 8 (63%), and 5 of 8 (63%) patients, respectively, with renal disease; 0 of 3 (0%), 2 of 3 (66%), and 3 of 3 (100%) patients, respectively, with adrenal disease; and 8 of 12 (75%), 12 of 12 (100%), and 12 of 12 (100%) patients with free intraperitoneal fluid. Our results provide new information, regarding the relative benefits of ultrasound, CT, and MRI for the investigation of abdominal diseases at our institution. This initial data suggests that ultrasound provides the most accurate diagnoses in the investigation of gallbladder disease; MRI provides the most accurate diagnoses in the investigation of hepatic, adrenal, and pancreatic disease; and either CT or MRI may be the most appropriate first imaging study for the detection of renal disease.