Chronic Abdominal Discomfort: CT vs. MRI for Diagnosis

Chronic abdominal discomfort and abdominal CT diagnosis?

Dear Dr.
Chen,
Thank you for your response to this article (http://sp1.hso.mohw.gov.tw/doctor/All/ShowDetail.php?sat=1&q_no=113205).
I often experience abdominal sounds around my navel accompanied by a watery sound, which worsens when I lie flat at night.
Additionally, I feel a sense of pressure when lying down, and sometimes applying pressure with my hand can release gas and produce sounds of compression and fluid.
Lying on my side or stomach alleviates the discomfort somewhat.
However, the sensation of an internal foreign body pressing against my abdomen persists throughout the day, regardless of whether I have eaten, which causes me considerable concern.
Over the past eight months, I have lost 3 to 4 kilograms.
Initially, I thought it was just bloating, but the discomfort is localized to the area around the left and upper side of my navel.
Long-term use of anti-bloating medication has only provided slight relief.
Despite undergoing gastroscopy, colonoscopy, and abdominal CT scans, the underlying issue remains undiagnosed, leading me to suspect a problem with my small intestine.
In the past few months, I have undergone numerous X-ray examinations: two chest X-rays, one lateral chest X-ray, two abdominal KUB X-rays, a full mouth CT, and an abdominal CT (three times with contrast: once without contrast, once immediately after contrast injection, and once after the contrast had circulated).
The cumulative radiation dose may exceed 20 to 30 millisieverts, which raises my concern about undergoing further radiological examinations such as a PET scan.
A PET scan involves the administration of a tracer that targets different organs and tumor markers, resulting in varying levels of radiation exposure.
If there is a tumor in the small intestine, a PET scan could be beneficial.
Would switching to an MRI help identify lesions in the small intestine, or is there little difference in imaging between CT and MRI for the small intestine?
Thank you for your response, Dr.
Chen.
Wishing you peace and joy.

A-Lin, 20~29 year old female. Ask Date: 2016/10/14

Dr. Chen Jiaming reply Surgery

First of all, your symptoms (frequent abdominal rumbling around the navel accompanied by a watery sound) seem more like a minor functional gastrointestinal issue, and you may be overly anxious about it.
If you are trying to apply pressure to release gas and create the sound of water, the sensation of abdominal pressure may be due to chronic strain from repeated self-examinations of the abdominal muscles.
Since the CT scan did not reveal any structural lesions, it is unlikely that an MRI would find anything significant either.
The suggestion for a PET scan is primarily to alleviate concerns about tumors, but clinically, your symptoms do not appear to be caused by a gastrointestinal tumor.
Completing the examinations will not resolve your symptoms.
I recommend that you try to relax and avoid pressing on your abdominal wall for two weeks, and then see if the discomfort subsides.
Additionally, abdominal rumbling with a watery sound is quite normal; focusing on improving your sleep would be beneficial.

Reply Date: 2016/10/14

More Info

When it comes to diagnosing chronic abdominal discomfort, particularly in the context of suspected small intestine issues, the choice between CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) is significant. Both imaging modalities have their strengths and weaknesses, and understanding these can help guide the decision on which to use.

CT scans are widely used in abdominal imaging due to their speed and ability to provide detailed images of the abdominal organs. They are particularly effective in identifying structural abnormalities, such as tumors, cysts, and other lesions. In your case, since you have already undergone several imaging studies, including CT scans, and have not found any definitive abnormalities, it raises the question of whether further CT imaging would yield new information. Additionally, CT scans involve exposure to ionizing radiation, which is a valid concern given your history of multiple scans and the cumulative radiation dose you mentioned.

On the other hand, MRI is a non-invasive imaging technique that does not use ionizing radiation. It is particularly useful for soft tissue evaluation and can provide excellent contrast between different types of tissues. MRI is often preferred for assessing certain conditions in the abdomen, such as liver lesions, pancreatic disorders, and some gastrointestinal issues, including those related to the small intestine. However, MRI can be less effective than CT in visualizing calcifications and certain types of acute abdominal conditions.

In your specific situation, if there is a suspicion of a small bowel issue, MRI could be beneficial. It can help visualize soft tissue structures and may provide insights into conditions like inflammatory bowel disease, small bowel obstructions, or even tumors that might not be easily seen on a CT scan. However, it is important to note that while MRI can provide detailed images, it may not always be superior to CT for every condition, particularly in acute settings where rapid diagnosis is critical.

Regarding your concern about the cumulative radiation exposure from previous CT scans, opting for an MRI could be a prudent choice, especially if your symptoms persist and you are looking for a non-radiative imaging option. MRI can be particularly useful in cases where there is a need to differentiate between various types of soft tissue masses or to assess the extent of a disease process.

In conclusion, while both CT and MRI have their roles in abdominal imaging, the choice between them should be based on the specific clinical scenario, the type of information needed, and the patient's history. Given your ongoing symptoms and the limitations of previous imaging studies, discussing the potential benefits of an MRI with your healthcare provider would be a wise step. They can help determine if MRI is the appropriate next step in your diagnostic journey, considering your concerns about radiation exposure and the need for a thorough evaluation of your abdominal discomfort.

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