MR in the Emergency Room

The practice of Emergency Radiology continues to undergo rapid and substantial changes. The number and complexity of imaging tests performed on acutely ill patients have expanded rapidly. So has the need for near real-time interpretations of these examinations, which has resulted in an exponential growth in the number of emergency centers that provide around-the-clock coverage by onsite radiologists. Almost simultaneously, there has been a growing concern among health care providers and the public in general about the harmful consequences of the indiscriminate use of ionizing radiation (mostly delivered with computed tomography [CT]). Although the numerous benefits of the proper use of CT in the emergency setting are unquestionable, it is also true that alternative imaging tests are desirable in certain patient populations that are particularly prone to the potentially negative effects of the excessive use of this modality, such as children, young adults, and pregnant patients. Thus, it is not surprising that MR is being increasingly considered as the first-line test in a variety of clinical conditions that require immediate imaging evaluation in the emergency room. MR is also the “go to” modality when results of other examinations (CT, ultrasound) are inconclusive or nondiagnostic. The number of MR scanners installed in, or adjacent to, the emergency room of tertiary care centers has increased considerably, and this trend will only continue.

This issue of Magnetic Resonance Imaging Clinics of North America focuses on the proper use of MR in the emergency setting. Some articles address conditions that have been traditionally evaluated with MR, such as suspected stroke, spinal emergencies, and abdominal/pelvic pain in the pregnant patient. Other articles focus on the use of MR as a problem-solver or second-line modality, such as cranial trauma, head and neck infections, pancreaticobiliary emergencies, and musculoskeletal emergencies (traumatic and nontraumatic). Finally, the common theme in the remaining two articles is the use of MR in clinical situations, where this modality is a good alternative for diagnosis without the use of ionizing radiation: pediatric emergencies and a subgroup of acute pelvic and gastrointestinal emergencies. I am indebted to the contributing authors, who understood the importance of the topics and ensured that every article delivers a clear message about the appropriateness of the use of MR in specific circumstances. I also want to thank Suresh Mukherji, MD, for trusting me with the responsibility of editing this issue of Magnetic Resonance Imaging Clinics of North America , and Meredith Clinton and the Elsevier staff, for their continuous help.

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