Organs located retroperitoneally. MRI of the abdominal cavity and retroperitoneal space: indications and diagnostic features. Indications for MRI of the abdominal cavity and retroperitoneal space

The human abdominal cavity is lined from the inside thin shell called the peritoneum, which provides the secretion and absorption of small amounts of fluid for better work all organs. However, there are organs that this membrane does not affect: they are located behind the peritoneum. That is why the space limited in front by the peritoneum, and behind by the lumbar muscles and spine, is called retroperitoneal, or retroperitoneal. Examining it using ultrasound is often included in the standard protocol and is carried out together with ultrasound of the organs abdominal cavity.

A little anatomy

To understand where the retroperitoneum is located, you just need to know where the lumbar region of the back is located. Now we can accurately name the organs located in the retroperitoneal space:

• kidneys with ureters;
• adrenal glands;
• the aorta and inferior vena cava, which run along the spine.

There are organs that are partially covered by the peritoneum and are located in the abdominal cavity, and the other part is located retroperitoneally. Such bodies include:

• pancreas;
• duodenum;
• part of the large intestine: ascending and descending colon.

In addition to the organs, the retroperitoneal space is filled with fatty tissue that performs a supporting function.

Ultrasonography

Ultrasound of the retroperitoneal space is today one of the most accessible methods for diagnosing pathology of the kidneys and adrenal glands. Examination of the vessels, pancreas and intestines is included in the examination of the abdominal organs, however, for emergency indications, sonography can be done of any structure whose pathology the doctor suspects, up to the soft tissues of the lumbar region if a hematoma is suspected. Retroperitoneum is examined for the following indications:

Preparing for an ultrasound

Depending on which organ or system needs to be emphasized, preparation for the procedure is somewhat different.

The common thing is that you need to take a diaper with you, on which you can lie during the procedure and wipe off any remaining gel after it. In some medical organizations They provide disposable diapers, but you should take your own towel to dry yourself. It is necessary to take into account that wet wipes are not very good to use in this case, since they do not collect the gel that remains on the skin well.

Urinary system

Special preparatory activities not required. However, you should pay attention to the drinking regime: you should not drink a lot before the ultrasound, as this will provoke active kidney function and may lead to incorrect interpretation of some indicators during the examination. For example, the renal pelvis, which collects urine from the kidney to the ureter and then to the bladder, may expand slightly.

An enlarged renal pelvis may indicate the presence of pathology or a normal physiological process.

Adrenal glands

They are a paired endocrine organ located at the upper poles of the kidneys. The tissue of the adrenal glands is practically invisible during ultrasound, so the doctor visually assesses the area of ​​their location, in which any additional education, if they are.

The area of ​​the right adrenal gland is better visible, while the area of ​​the left is more difficult to visualize. This is due to the peculiarity of the anatomical location of the adrenal glands themselves and neighboring organs. The stomach is adjacent to the left adrenal gland, so the study is carried out on an empty stomach.

On an empty stomach - this means that you cannot eat or drink 8 hours before the examination, because both solid and liquid food will interfere with the examination.

Aorta and inferior vena cava

To examine the vessels, you need a diet that excludes foods that promote fermentation and gas formation in the intestines, as well as taking medications such as:

• activated carbon or other enterosorbents;
• enzyme preparations, for example, Mezim, Festal, Pancreatin and others;
• Carminatives: Simethicone and its analogues.

Ultrasound examination of the retroperitoneal space

Before starting the examination, it is necessary to remove clothing from the area under examination, lie down on a couch previously covered with a diaper, and follow the instructions of a specialist who will apply the gel to the area under examination or directly to the sensor and begin the examination.

You need to be prepared for the fact that during the examination you will have to change your body position several times. If the aorta can be examined in the supine position, then the kidneys and adrenal glands must be examined from all sides, that is, in the supine position, on the side, on the stomach, sitting and standing.

Normal indicators and the most common pathology

A qualitative study of the retroperitoneal space using ultrasound is impossible without determining the norm.

Kidneys

The shape of a normal kidney is oval or bean-shaped, the contour is clear and even, sometimes wavy. The longitudinal size should not exceed 12 cm and be less than 10 cm. However, the size of the kidneys depends on the constitutional characteristics of a person and the type of his activity, for example, professional athletes the buds may be larger.

The echostructure should be homogeneous, the echogenicity is average or normal, that is, the kidney parenchyma is slightly darker than the liver on ultrasound. The center of the bud, on the contrary, looks white.

Diffuse kidney changes

There is a change in the echostructure and echogenicity of the parenchyma of one or both kidneys.

Focal pathology

The most common formations detected by ultrasound of the kidneys are cysts. They can be single or multiple, small and giant, round and irregular in shape. Small cysts need to be monitored, that is, examined once a year. Very large sizes - removed.

Urolithiasis disease

Kidney pathology, characterized by the formation of stones of various compositions in the calyces or pelvis. When examined, the stones appear as a bright white structure that gives off a black shadow. They can be multiple or single, small or large, round, oval or irregular in shape.

Adrenal glands

Normally, this paired organ is not visualized.

Ultrasound of the retroperitoneal space most often reveals focal changes adrenal glands, the nature of which is quite difficult to judge, so the method of choice is computed tomography or magnetic resonance imaging.

Aorta

The normal diameter of the aorta is about 25 mm; if examination reveals an enlargement of a section of the vessel with a diameter of more than 30 mm, therefore, they speak of an aneurysm.

The doctor also pays attention to the walls of the aorta, since atherosclerotic plaques are often detected in older patients.

If there is a need to conduct an ultrasound of the organs of the retroperitoneal space, you should not delay, since it is in the retroperitoneum that vital important organs: kidneys, adrenal glands and the two largest vessels of the body.

Retroperitoneal space I Retroperitoneal space (spatium retroperitoneale; synonym)

cellular space located between the posterior part of the parietal peritoneum and the intra-abdominal fascia; extends from the diaphragm to the small pelvis.

In the retroperitoneal space there are the adrenal glands, ureters, descending and horizontal parts duodenum, ascending and descending colon, abdominal aorta and inferior cava, roots of the azygos and semi-gypsy veins, sympathetic trunks, a number of autonomic nerve plexuses, branches of the lumbar plexus, vessels and trunks, the beginning of the thoracic duct and the fatty tissue that fills the space between them ( rice. 1 ). A complex fascial plate divides the zebra line into a number of compartments. Near the lateral edge of the kidney, the retroperitoneum is divided into two layers - pre- and retrorenal. The first connects medially with the fascial sheaths of the aorta and inferior vena cava, passing to the opposite side, the second is woven into parts of the intra-abdominal fascia covering the crus of the diaphragm and the psoas major muscle. The retroperitoneal fiber layer is located between the intra-abdominal and retroperitoneal fascia. The fatty kidneys (perirenal tissue, paranephron) lie between the layers of the retroperitoneal fascia, it continues along the ureter. Peri-intestinal fiber (paracolon) is located between the posterior surfaces of the ascending and descending colon and retroperitoneal fascia. Laterally it is limited by the fusion of the latter with the parietal peritoneum, medially it reaches the root of the mesentery small intestine and contains fibrous plates (Toldt's fascia), vessels, and lymph nodes of the colon. An unpaired median space is also distinguished, containing the abdominal part of the aorta, the inferior vena cava, the nerves located next to them, lymph nodes and vessels, closed in their fascial sheaths.

Research methods. Use clinical methods- inspection, palpation, percussion. Pay attention to skin color, protrusions or swelling, infiltrates or abdominal wall. The most informative is the abdominal wall with the patient in the supine position with a cushion placed under the lumbar region. Clinical examination allows one to suspect a purulent-inflammatory cyst or a cyst, as well as some diseases of the organs located in it (see Aorta , Duodenum , Ureter , Pancreas , Kidneys) . The methods of X-ray examination used to diagnose diseases of the stomach are varied: examination of the chest and abdominal cavities, X-ray contrast examination of the stomach and intestines, Pneumoperitoneum , Pneumoretroperitoneum , Urography , pancreatography, (see Angiography) , selective branches of the abdominal aorta, Lymphography, etc. Among instrumental methods Ultrasound (see Ultrasound diagnostics) and computer X-ray studies play a leading role in diagnosing diseases of the genital area, which can be carried out on an outpatient basis in a diagnostic center. They make it possible to establish the localization of the pathological focus, its size, and relationships with surrounding organs and tissues. Diagnostic or therapeutic treatment is possible under X-ray television control.

Damage. Retroperitoneal, caused by mechanical trauma, is more common. large in size, especially in the first hours, clinical symptoms resemble a hollow or parenchymal organ of the abdominal cavity. Acute can cause the development of hemorrhagic shock (see Traumatic shock) . Symptoms of irritation of the peritoneum are revealed - sharp and tension in the muscles of the abdominal wall, positive Blumberg-Shchetkin, which allows one to suspect the development of Peritonitis. . However, unlike the hollow organs of the abdominal cavity, which are characterized by progression clinical manifestations peritonitis, with retroperitoneal hematoma they are less pronounced and gradually disappear. With a massive retroperitoneal hematoma, the gastrointestinal tract, the content of hemoglobin, hematocrit and the number of red blood cells in the blood decreases. Leading role in differential diagnosis belongs to laparoscopy (Laparoscopy) . With large retroperitoneal hematomas, they can leak into the abdominal cavity through an intact posterior layer of the peritoneum, which complicates diagnosis. Using X-ray examination methods, it is possible to detect damage to a hollow organ of the abdominal cavity, and with a retroperitoneal hematoma, blurred contours of the kidney, lumbar, Bladder, retroperitoneal sections of the intestine. More complete and accurate information is obtained from ultrasound and computed x-ray tomography.

Treatment of damage to the genital area is carried out in a hospital. In some cases, in the absence of signs of bleeding, damage to the abdominal organs and changes in the blood and urine, outpatient treatment is possible with mandatory daily monitoring of the victim’s condition for 2-3 days after. Treatment of isolated retroperitoneal hematomas without damage to the organs of the gastrointestinal tract is conservative and includes a set of measures aimed at combating shock, blood loss and paresis of the gastrointestinal tract. With ongoing internal bleeding or identifying signs of damage to the organs of the genital area (kidneys, pancreas, large vessels), emergency treatment is indicated.

The prognosis for isolated retroperitoneal hematomas is in most cases (favorable if infection does not occur.

Diseases. Purulent-inflammatory processes in the retroperitoneal tissue can be serous, purulent and putrefactive. Depending on the location of the lesion, paranephritis is distinguished , paracolitis (see Intestine) and retroperitoneal tissue itself. purulent inflammatory processes Z.p. consists of signs general intoxication(, high, anorexia, weakness, leukocytosis and shift leukocyte formula blood to the left, in severe cases, progressive dysfunction of cardio-vascular system and etc.). At the same time, changes in the contours or bulging of the abdominal wall in the lumbar or epigastric regions, the formation of infiltrate, muscle tension, etc. are detected. Retroperitoneal is often accompanied by flexion contracture in hip joint on the losing side. Severe complications of purulent-inflammatory processes of the pelvic floor are the breakthrough of a retroperitoneal abscess into the abdominal cavity with the subsequent development of peritonitis, the spread of retroperitoneal phlegmon in, the occurrence of secondary osteomyelitis of the pelvic bones or ribs, intestinal fistulas (Intestinal fistulas) , Paraproctitis , purulent leaks in the gluteal region, on. The diagnosis of a purulent-inflammatory process is made on the basis clinical picture, as well as data from ultrasound and x-ray examinations. Treatment of inflammatory processes of Z. p. in the absence of signs of suppuration is conservative (antibacterial, detoxification and immunostimulating). When phlegmon or abscess forms, opening them is indicated. As a result of a purulent-inflammatory process in the retroperitoneal space, retroperitoneal disease can develop (see Ormond's disease) .

Tumors Z. p. arise from the tissues of the organs located in it (duodenum, ureter, kidney, etc.) and non-organ tissues (adipose tissue, muscles, fascia, vessels, nerves, sympathetic nerve nodes, lymph nodes and vessels). According to histogenesis, tumors of mesenchymal origin (mesenchymomas, lipomas, liposarcomas, fibromas, fibrosarcomas, etc.), neurogenic (neurilemmomas, neurofibromas, paragangliomas, neuroblastomas, etc.), teratomas, etc. are distinguished. rice. 2-8 ). There are benign and malignant, single and multiple retroperitoneal tumors.

Early symptoms for retroperitoneal tumors are usually absent. Gradually, the tumor reaches large sizes, displacing neighboring organs. Patients feel discomfort in the abdominal cavity, aching pain in the stomach and lower back. Sometimes a tumor is discovered by chance during palpation of the abdomen, a feeling of heaviness in the abdomen caused by the tumor, or in case of dysfunction of the intestines or kidneys (intestinal obstruction (Intestinal obstruction) , renal failure(Kidney failure)), etc.

With extensive retroperitoneal tumors, venous and lymphatic drainage, which is accompanied by edema and venous stagnation in lower limbs, as well as ascites, dilation of the saphenous veins of the abdomen. Unlike malignant benign tumors Salaries, even large ones, have little effect on general state patient, however, with continued growth, they can disrupt the function of neighboring organs.

To clarify the diagnosis, an x-ray is performed, ultrasound examination and needle biopsy. Differential is carried out with retroperitoneal organ tumors (kidneys, adrenal glands), some intra-abdominal tumors (intestinal mesentery, ovary), with retroperitoneal abscess or hematoma, leak, aneurysm of the abdominal aorta.

Treatment in most cases is surgical. Some types of sarcomas are amenable to chemotherapy, radiation, or combination treatment. The prognosis is unsatisfactory. Retroperitoneal tumors, especially sarcomas, are characterized by frequent recurrence.

Operations. The main operational access to the Z. p. is extraperitoneal penetration into the Z. p. through the lumbar region ( rice. 9 ). In some cases, for example during operations on abdominal aorta, a transperitoneal method is used, in which the sternum is opened after laparotomy by dissecting the posterior layer of the parietal peritoneum. Operations performed on the organs of the pancreas are described in dedicated articles, for example, Pancreas , Kidneys .

Bibliography: Durnov L.A., Bukhny A.F. and Lebedev V.I. retroperitoneal space and abdominal cavity in children, M., 1972; Clinical, ed. N.N. Blokhin and B.E. Peterson, vol. 2, p. 340, M., 1979; Clinical, ed. Yu.M. Pantsyreva, p. 414, M., 1988; Operational, ed. ON THE. Lopatkina and I.P. Shevtsova, s. 116, L., 1986; Hegglin Y. Surgical examination, . with German, p. 189, M., 1980; Surgical abdomen, ed. A.N. Maksimenkova, s. 632, L., 1972; Cherkes V.L., Kovalevsky E.O. and Soloviev Yu.N. Extraorgan retroperitoneal tumors, M., 1976.

Rice. 4. Microscopic specimens of some tumors of the retroperitoneal space: leiomyosarcoma; hematoxylin and eosin staining; ×250.

peritoneum; 2 - descending colon; 3 - prerenal fascia; 4 - Toldt's fascia; 6 - abdominal; 7 - medial crus of the diaphragm; 8 - small intestine; 9 - inferior vena cava; 10 - greater lumbar; 11 - ascending colon; 12 - right paracolic; 13 - muscles of the anterolateral abdominal wall; 14 - peri-intestinal fiber; 15 - retroperitoneal fascia; 16 - intra-abdominal fascia; 17 - retrorenal fascia; 18 - quadratus lumborum muscle; 19 - deep back muscles; 20 - perinephric fiber; 21 - retroperitoneal fiber layer">

Rice. 1. Retroperitoneal space on a transverse section of the abdomen: 1.5 - parietal peritoneum; 2 - descending colon; 3 - prerenal fascia; 4 - Toldt's fascia; 6 - abdominal aorta; 7 - medial crus of the diaphragm; 8 - mesentery of the small intestine; 9 - inferior vena cava; 10 - psoas major muscle; 11 - ascending colon; 12 - right paracolic sulcus; 13 - muscles of the anterolateral abdominal wall; 14 - peri-intestinal fiber; 15 - retroperitoneal fascia; 16 - intra-abdominal fascia; 17 - retrorenal fascia; 18 - quadratus lumborum muscle; 19 - deep back muscles; 20 - perinephric fiber; 21 - retroperitoneal fiber layer.

Rice. 3. Microscopic specimens of some tumors of the retroperitoneal space: polymorphic liposarcoma; hematoxylin and eosin staining; ×50.

teratocarcinoma; triple Masson staining; ×100">

Rice. 8. Microscopic specimens of some tumors of the retroperitoneal space: teratocarcinoma; triple Masson staining; ×100.

ganglioneuroblastoma; hematoxylin and eosin staining; ×250">

Rice. 6. Microscopic specimens of some tumors of the retroperitoneal space: ganglioneuroblastoma; hematoxylin and eosin staining; ×250.

lipoma; hematoxylin and eosin staining; ×50">

Rice. 2. Microscopic specimens of some retroperitoneal tumors: fetal lipoma; hematoxylin and eosin staining; ×50.

pheochromocytoma; triple Masson staining; ×100">

Rice. 7. Microscopic specimens of some retroperitoneal tumors: pheochromocytoma; triple Masson staining; ×100.

rhabdomyosarcoma; triple Masson staining; ×600">

Rice. 5. Microscopic specimens of some retroperitoneal tumors: embryonal rhabdomyosarcoma; triple Masson staining; ×600.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet encyclopedia. - 1982-1984.

Borders: The retroperitoneal space (spatium retroperitoneale) is located between the parietal peritoneum back wall abdomen and intraperitoneal fascia (fascia endoabdominalis), which, lining the muscles of the posterior wall of the abdomen, acquires their names: in the transverse abdominal muscle - transverse fascia (fascia transversalis), in the quadratus lumborum muscle - quadratic fascia (fascia quadrata), in the psoas major muscle - lumbar fascia (fascia psoatis).

Layers of the retroperitoneum

Intra-abdominal fascia (fascia endoabdominalis).

The retroperitoneal tissue space itself (textus cellulosus retroperitonealis) in the form of a thick layer of fatty tissue stretches from the diaphragm to the iliac fascia (fascia iliaca). Dividing to the sides, the fiber passes into the subserosal base (tela subserosa) of the anterolateral wall of the abdomen. Medially behind the aorta and inferior vena cava it communicates with the same space on the opposite side. From below it communicates with the retrorectal cellular space of the pelvis. At the top it passes into the tissue of the subdiaphragmatic space and through the sternocostal triangle communicates with the subserous base of the parietal pleura in the thoracic cavity. The retroperitoneal tissue space contains the aorta, inferior vena cava, lumbar lymph nodes, and thoracic duct.

The renal fascia (fascia retrorenalis) is the posterior layer of the retroperitoneal fascia, starts from the peritoneum at the place of its transition from the lateral to the posterior wall of the abdomen, at the outer edge of the kidney it is divided into posterior and anterior leaves. The renal fascia separates the retroperitoneal cellular space from the perinephric tissue, descends downwards behind the ureter and turns into the ureteral fascia (fascia retroureterica), which thins downwards and is lost in the lateral cellular space of the pelvis.

Fatty capsule of the kidney (perinephric fiber), ( capsula adiposa renis) – loose fatty tissue that covers the kidney from all sides.

The kidney (gen) is covered with a dense fibrous capsule (capsula fibrosa renis).

Fatty capsule of the kidney.

Prerenal fascia (fascia prerenalis) – the anterior layer of the renal fascia (fascia renalis), above and laterally merges with the renal fascia, below passes into the preureteric fascia (fascia praeureterica). The prerenal and retrorenal fascia form the fascial bursa for the kidney and its fat capsule.

Pericolic tissue (paracolon) is located behind the ascending and descending colon. At the top it reaches the root of the mesentery of the transverse colon, at the bottom - the level of the cecum on the right and the root of the mesentery sigmoid colon on the left, externally limited by the attachment of the renal fascia to the peritoneum, medially reaching the root of the mesentery of the small intestine, posteriorly limited by the prerenal and preureteral fascia, in front by the peritoneum of the lateral canals and retrocolic fascia.

The retrocolic fascia (Told's fascia (fascia retrocolica)) is formed during intrauterine development as a result of fusion of the layer of the primary mesentery of the colon with the parietal layer of the primary, in the form of a thin plate lies between the paracolic tissue (paracolon) and the ascending or descending colon.

Colon: in the right lumbar region - the ascending colon (colon ascendens), in the left - the descending colon (colon descendens).

Visceral peritoneum (peritoneum viscerale).

Organs of the retroperitoneal space.

Bud- a paired organ with a size of about 10x5x4 cm and a weight of approximately 150 g, located in the upper part of the retroperitoneum. In each kidney, it is customary to distinguish between the anterior and posterior surfaces, the outer and inner edges, the upper and lower poles. In relation to the spine, the left kidney is located at the level: Th11 - L2, and the hilum is below the XII rib, the right kidney is located at the level: Th12–L2, the hilum is at the level of the XII rib. On the concave medial edge of this organ there is a depression - the so-called renal gate, from which the renal pedicle emerges. The elements of the renal pedicle are located from front to back in the following sequence: renal vein, renal artery, pelvis. The division of kidney segments is based on the branching of the renal artery. The kidney consists of 5 segments: 2 pole, 2 anterior and posterior. The kidneys are covered with peritoneum extraperitoneally.

Syntopy of the kidneys. Posteriorly, the kidney is adjacent to: the lumbar part of the diaphragm; to the quadratus lumborum muscle; to the transverse abdominal muscle; to the psoas major muscle. The adrenal glands are adjacent to the upper pole of the kidneys. Adjacent to the right kidney in front: the right lobe of the liver; descending part of the duodenum; ascending colon and right flexure of the colon. Adjacent to the left kidney in front: the posterior wall of the stomach; tail of the pancreas; spleen; left flexure of the colon; parietal peritoneum of the left mesenteric sinus.

Fixation of the kidneys in the retroperitoneal space occurs due to: the fatty capsule of the kidney, the prerenal and renal fascia, which give jumpers to the fibrous capsule of the kidney; vascular pedicle; intra-abdominal pressure, which presses the kidney with its membranes to the muscular renal bed formed posteriorly by the quadratus lumborum muscle, medially by the psoas major muscle, posteriorly and laterally by the aponeurosis of the transverse muscle, above the 12th rib by the diaphragm.

It is supplied with blood by the renal artery (a. renalis), which arises from the abdominal part of the aorta (pars abdominalis aortae), with the right one being longer than the left one and passing behind the inferior vena cava. Blood outflow occurs through the renal vein (v. renalis). The renal veins flow into the inferior vena cava (v. cava inferior), with the left one being longer than the right one and passing in front of the aorta. Innervation : Plexus renalis is formed by branches of nn. splanchnici, truncus sympathicus, plexus coeliacus. Lymph from the kidneys flows to the lumbar and aortic lymph nodes.

Adrenal(glandula suprarenalis) is a paired organ in the shape of a flattened cone measuring 50x25x10 mm, lying above the upper end of the kidney in a sheath formed by the prerenal fascia.

Syntopy. Right adrenal gland: anterior surface in contact with the visceral surface of the liver; renal - to the upper end right kidney; medial edge - with the inferior vena cava. Left adrenal gland: the anterior surface is adjacent to the tail of the pancreas, the splenic vessels and the peritoneum of the posterior wall of the omental bursa; the posterior - to the lumbar part of the diaphragm; renal - to the upper end and medial edge of the left kidney; the medial edge is in contact with the abdominal aorta and the celiac ganglion (ganglion coeliacus) lying on it.

Blood supply is carried out by the adrenal arteries (aa. suprarenales superior, media et inferior). Blood flow through the veins of the same name, flowing into the renal veins. Lymph flows into the lymphatic para-aortic nodes. Innervation: Plexus coeliacus et renalis, n. phrenicus.

Ureter(ureter) - a paired organ that removes secondary urine from the kidneys and connects the renal pelvis with the bladder, has the shape of a tube 30-35 cm long and 5-10 mm in diameter. The ureter is divided into the abdominal part (pars abdominalis) - from the renal pelvis to the border line (linea terminalis) and the pelvic part (pars pelvina), located in the pelvis. There are 3 narrowings along the ureter: at the transition of the pelvis to the ureter, at the border line and before entering the bladder. Surrounded by fiber and pre- and posterior-ureteric fasciae (fasciae praeureterica et retroureterici), the ureters descend along the psoas major muscle (m. psoas major) together with the femoral-genital nerve (n. genitofemoralis) and at the border line bend through the external iliac artery on the right and the common iliac artery on the left, going into the lateral cellular space of the pelvis.

Syntopy. Adjacent to the right ureter: in front - the duodenum, the parietal peritoneum of the right mesenteric sinus and the right colic vessels (a. et v. colica dextra), the root of the mesentery of the small intestine and ileocolic vessels (a. et v. ileocolica), testicular (ovarian) vessels vasa testicularia (ovarica); laterally – ascending colon; medially – inferior vena cava. Adjacent to the left ureter: in front - the parietal peritoneum of the left mesenteric sinus and the left colic vessels (a. et v. colica sinistra), the root of the mesentery of the sigmoid colon, sigmoid and superior rectal vessels (a. et v. sigmoidea et rectalis superior), testicular ( ovarian) vessels; laterally – descending colon; medially - aorta.

Blood supply along aa. renalis, testicularis (ovarica) - pars abdominalis: aa. rectalis media, vesicularis inferior - pars pelvina. Blood flows through vv. testiculares (ovariсae), iliaca interna. Innervation: Pars abdominalis - plexus renalis; pars pelvina – plexus hypogastricus. Lymphatic drainage: From pars abdominalis - to nodi lymphatici aortales abdominales; from pars pelvina - b nodi lymphatici iliaci.

Features of the size, shape and position of the retroperitoneal organs in children.

In newborns, the kidneys are relatively large and have a lobular structure. The left kidney is usually slightly larger than the right. The average weight of a kidney is 12 g. Both surfaces of the kidneys (front and back) are convex and uneven. They show grooves delimiting the renal lobes. Their outer edge is convex, the inner one is concave. The central part of the inner edge corresponds to the hilum of the kidney. Most of the pelvis is located extrarenally. The longitudinal axes of the kidneys are parallel to the spine or even have a divergent direction. The upper end of the left kidney is located at the level of the XII thoracic vertebra, the lower - at the level of the IV lumbar vertebra, the XII rib crosses the upper end of the kidney. In the right kidney, the upper end corresponds to the lower edge of the XII thoracic vertebra, the lower end can reach the upper edge of the V lumbar vertebra. The gate of the left kidney is located at the level of the upper edge of the II, and the gate of the right kidney is located at the level of the upper edge of the III lumbar vertebra. Due to the growth of the spinal column, in particular its lumbar region, the projection of the kidneys changes. If in children 3 years old the lower end of the right kidney is projected at the border of the IV-V lumbar vertebrae, then in children under 7 years old - at the middle of the IV lumbar vertebra, and in children over 10 years old - already at the level of the I-II lumbar vertebrae. It should be remembered that the fixing apparatus of the kidneys in a newborn and children of the first 3 years of life is poorly expressed. Therefore, in the same child, the level of kidney location is not constant and depends on the phase of breathing, body position and other factors. In this case, the amount of displacement of the kidneys can reach the height of a vertebra or more. The position of the kidneys also changes in relation to the iliac crest. If in a newborn the lower ends of the kidneys are located below this level in 50% of cases, then by the age of three they are projected 3-10 mm above it. By the age of 5, the upper ends of the kidneys come closer together, and the lower ones, on the contrary, diverge, with the upper ends moving posteriorly and the lower ones moving anteriorly. The kidneys are surrounded by three membranes. As noted above, the outer shell (fascia renalis) is formed by thin sheets of retroperitoneal fascia. The fat capsule (capsula adiposa) is almost absent in newborns. Fibrous (capsula fibrosa) - thin, directly adjacent to the kidney parenchyma, from which it is easily removed. Lymphatic system in the kidneys of newborn children it is better developed, and the valve apparatus, on the contrary, is less pronounced than in adults.

In a newborn, the ureters are 5-7 cm long. Their lumen is somewhat narrowed at the ends (up to 1-1.5 mm) and expanded in the middle section (up to 3 mm). They have a tortuous course, especially in the pelvic area. Throughout their entire length they lie retroperitoneally, on the anterior surface they are covered with peritoneum, to which they are loosely fused.

The adrenal glands in newborns are relatively large. Their average length is 3.5 cm, width -2.2 cm, thickness -1.25 cm, weight is about 7 g, which is more than half the mass of the adrenal glands of an adult. The right adrenal gland has a triangular shape, the left one until 7 years of age is quadrangular, and then semilunar. In newborns, the adrenal arteries are relatively short and have a straight course.

Surgical anatomy birth defects development.

Under congenital displacement of the kidney(dystopia renis congnitа) refers to its location below the normal level. In these cases, the renal artery begins from vessels located at the same level. The following types of kidney dystopias are distinguished:

1. Dystopia renis iliaca(iliac dystopia of the kidney): usually the kidney is located in the iliac fossa; The renal artery arises either from the distal aorta or from one of the iliac arteries.

2.Dystopia renis relvina(pelvic dystopia of the kidney): the kidney lies in the small pelvis.

3.Dystopia renis abdominalis(celiac dystopia): the kidney lies at the level of the lower lumbar vertebrae and, like previous forms, is firmly fixed by the vessels of this area.

In relation to the midline of the body, several variations of pelvic dystopias are distinguished:

A) dystopia renis rnonolateralis- if the kidney is located on the side where it should be;

b) dystopia renis rnediana- if it is located along the midline of the body;

V) dystopia renis alterolateralls- if the kidney is moved from its side to the opposite.

4. Dystopia cruciata– cross dystopia – the location of two kidneys on one side, one above the other; the ureters are crossed.

Horseshoe kidney. Ren arcuatus inferior is a horseshoe-shaped kidney with fusion of the lower poles. If the metanephrogenic tissue of both sides is located near the spine and the lower poles of this tissue come into contact, a horseshoe-shaped kidney develops with the lower isthmus. Ren areuatus superior is a horseshoe-shaped kidney with an upper isthmus. Here the metanephrogenic tissue merges with its upper poles.

Narrowing (stricture) of the ureter observed in 0.5-0.7% of children. Most often, the anomaly is localized in the vesicoureteral segment, then in the ureteropelvic segment, but can be observed in any part of the ureter. The narrowing can be one- or two-sided, single or multiple. Above the narrowing of the ureter and the collecting system expands due to a constant increase in pressure and stagnation of urine. If the obstruction is localized in the ureteropelvic segment, hydronephrosis develops. When the narrowing is located in the prostatic part, in the middle third of the ureter, it expands significantly and lengthens above the obstruction. The ureter becomes long, tortuous, and can be as thick as the colon.

Kidney duplication is accompanied by doublingureter. Most often, both ureters open into two orifices in the bladder, with the orifice of the ureter of the superior pelvis entering the bladder below the orifice of the ureter of the inferior pelvis, or one of the orifices may be ectopic. Sometimes there is a combination of a double ureter in the pelvic part with one opening in the bladder - a split ureter.

Congenital hydronephrosis- expansion of the renal pelvis and calyces. Develops due to difficulty in the outflow of urine due to: stenosis of the ureteropelvic segment; compression of the ureter by the accessory renal artery approaching the lower pole of the kidney; kinking or compression of the ureter by adhesions; the presence of a valve, which is a fold of the mucous membrane of the ureter.

Vessels and nerves of the retroperitoneal space.

Abdominal aorta(pars abdominalis aortae) lies on the anterior surface of the spine, to the left of the median sagittal plane, from the XII thoracic to the IV-V lumbar vertebrae, where it divides into its terminal branches - the right and left common iliac arteries (aa. iliaca communis dextra et sinistra).Common the iliac artery from the aortic bifurcation goes to the sacroiliac joint (articulatio sacroiliaca), where it divides into the external and internal iliac arteries (aa. iliaca externa et interna). Adjacent to the abdominal part of the aorta are: behind – the bodies of Th X1I -L IV; in front - the parietal peritoneum of the posterior wall of the omental bursa, the pancreas, the ascending part of the duodenum and the root of the mesentery of the small intestine; on the right – the inferior vena cava; on the left - the left adrenal gland, the inner edge of the left kidney, the lumbar nodes of the left sympathetic trunk. The following branches arise from the abdominal aorta.

Parietal: the lower phrenic artery (a. phrenica inferior) is steamy, departs at the level of the XII thoracic vertebra; lumbar arteries (aa. lumbales) 4 paired arteries, extending from the lateral surfaces of the aorta; median sacral artery (a. sacralis mediana), departs at the level of L V.

Visceral: the celiac trunk (truncus coeliacus) departs at the level of Th X1I, is divided into the splenic, common hepatic and left gastric arteries (aa. lienalis, hepatica communis et gastrica sinistra);

middle adrenal artery (a. suprarenalis media) paired, arises at the level of the first lumbar vertebra;

the superior mesenteric artery (a. mesenterica superior) is unpaired, departs just below the previous artery at the level of L 1;

renal artery (a. renalis), steam room, departs at the level L 1 - L II,;

the artery of the testicle (ovary) is paired, departing from the anterior surface of the aorta at the level L II I - L IV;

the inferior mesenteric artery (a. mesenterica inferior) is unpaired, departs at the level of L II I.

Inferior vena cava(v. cava inferior) is formed on the anterior surface of the spine to the right of the midsagittal line at the level L IV -L V at the confluence of the common iliac veins (vv. ilacae communes) and leaves the abdominal cavity through the opening of the diaphragm of the same name. Adjacent to the inferior vena cava are: behind – bodies Th X1I - L IV; in front - the liver, peritoneum, limiting the omental foramen behind, the head of the pancreas and the portal vein, the lower horizontal part of the duodenum and the root of the mesentery of the small intestine; on the left – the abdominal part of the aorta; on the right - the right adrenal gland, the inner edge of the right kidney, the right ureter, the lumbar nodes of the right sympathetic trunk. The following flow into the inferior vena cava: lumbar veins (vv. lumbales) - 4 paired veins; right testicular (ovarian) vein, left testicular (ovarian) vein flows into the left renal vein (v. renalis sinistra), renal veins (vv. renales) at the level of the I-II lumbar vertebrae; right adrenal vein (v. suprarenalis), the left flows into the renal vein; hepatic veins (vv. hepaticae); inferior phrenic veins (vv. phrenicae inferiores).

Unpaired(v. azygos) and semi-unary(v.hemiazygos ) veins rise along the anterolateral surfaces of the spine, being a continuation of the ascending lumbar veins (vv. lumbales ascendens ) . They pass into the corresponding veins of the chest cavity .

Thoracic duct behind the right edge of the abdominal aorta rises up and through the aortic opening of the diaphragm enters the chest cavity, where it is located in the groove between the aorta and the azygos vein (v. azygos). The thoracic duct flows into the left subclavian vein (v. subclavia) near the venous jugular angle (angulus venosus juguli).

Lumbar plexus(plexus lumbalis) - the upper part of the lumbosacral plexus. This plexus of somatic nerves is formed by the anterior branches of the spinal nerves from segments Th X1I - L IV. The branches of the plexus innervate the muscles of the abdominal wall and thigh, provide sensitivity to the parietal peritoneum and the skin of the hypogastrium and thigh.

Iliohypogastric nerve(n. iliohypogastricus) (Th X1I -L I) appears from under the lateral edge of the psoas major muscle, passes along the anterior surface of the quadratus lumborum muscle, along the inner surface of the transverse muscle, pierces it and lies between the internal oblique and transverse muscles, providing sensory and motor phases of the abdominal reflex. Has 2 branches. The lateral cutaneous branch (r. cutaneus lateralis) provides sensitivity in the superolateral part of the gluteal region. Medial cutaneous branch (r. cutaneus medialis) – motor innervation of the internal oblique and transverse abdominal muscles, sensitive innervation of the skin and parietal peritoneum of the hypogastric region.

Ilioinguinal nerve(n. ilioinguinalis) follows the course of the iliohypogastric nerve, located parallel to and below it. The terminal branches - the anterior scrotal (labial) nerves - pass through the inguinal canal to the scrotum (labia majora) and the skin of the thigh. The ilioinguinal nerve provides motor innervation to the internal oblique and transverse abdominis muscles and sensory innervation to the upper medial thigh, root of the penis, and the anterior scrotum or anterior labia majora.

Femorogenital nerve(n. genitofemoralis) (L I -L II) pierces the psoas major muscle, the lumbar fascia and descends along its anterior surface to the inguinal ligament, where it divides into the genital and femoral branches. The genital branch (r. genitalis) passes through the inguinal canal. It provides motor innervation to the muscle that lifts the testicle (m. cremaster) and sensory innervation to the anterior part of the scrotum or the anterior part of the labia majora. The femoral branch (r. femoralis) passes to the thigh under the inguinal ligament, along the anterior surface of the psoas muscle. This sensory branch to the anterosuperior part of the thigh provides the sensitive part of the cremasteric reflex in men.

Lateral cutaneous nerve of the thigh(n. cutaneus femoris lateralis) (L II -L III) comes out from under the lateral edge of m. psoas, crosses the iliac fossa, passes under the inguinal ligament, provides sensitivity to the lateral surface of the thigh.

Femoral nerve(n. femoralis) (L II -L IV) passes between the psoas major and iliacus muscles, appears from under the edge of the psoas major muscle and exits into the thigh through the muscle lacuna (lacuna musculorum). It provides motor innervation to the anterior thigh muscles and sensory innervation to the anterior and medial surfaces of the thigh.

Obturator nerve(n. obturatorius) (L II -L IV) appears from under the medial edge of the psoas major muscle, passes behind the external iliac vessels into the subperitoneal cavity of the pelvis and exits onto the thigh through the obturator canal. Provides motor innervation to the medial thigh muscle group and sensory innervation to the upper part of the medial thigh.

Sympathetic trunk(truncus sympaticus) paired, consists of nodes (ganglii trunci sympatici) and internodal branches (rami interganglionares). The lumbar nodes (ganglia lumbalia) are located in the depression between the psoas major muscle (m. psoas major) and the spine. Connecting branches (rr. communicantes) provide communications between the spinal cord and the nodes of the sympathetic trunk. All nodes of the sympathetic trunk give off the gray connecting branch (r. communicant griseus) of unmyelinated postnodal sympathetic nerve fibers, which join the corresponding spinal nerves to regulate peripheral autonomic functions (vascular tone, hair movement, sweating).

Autonomic nerve plexuses. The powerful abdominal aortic plexus (plexus aorticus abdominalis) descends along the abdominal aorta. Its derivatives are the autonomic plexuses of the abdominal cavity and retroperitoneal space. The branches of these plexuses provide pain sensitivity, regulate vascular tone and organ function.

Celiac plexus(plexus coeliacus) - on the sides of the celiac trunk has two crescent-shaped nodes - celiac nodes (ganglia coeliaca). The celiac nodes are approached by fibers consisting of the large splanchnic nerve (n. splanchnicus major) and partly the small splanchnic nerve (n. splanchnicus minor), from the thoracic aortic plexus, from the vagus nerves (nn. vagi), fibers from the right phrenic nerve (n. phrenicus dexter). The branches of the plexus after the branching of the celiac trunk form secondary plexuses: hepatic (plexus hepaticus), splenic (plexus lienalis), gastric (plexus gastrici), pancreatic (plexus pancreaticus), through the vessels reaching the corresponding organs.

Superior mesenteric plexus(plexus mesentericus superius) unpaired, located on the artery of the same name and its branches. The superior mesenteric ganglion (ganglion mesentericus superius) is located at the beginning of the superior mesenteric artery. Fibers from the large, small and lower splanchnic nerves (n. splanchnicus major, minor et imus), and from the vagus nerves (nn. vagi) approach the superior mesenteric plexus.

Renal plexus(plexus renalis) paired, accompanies the renal arteries, has aortorenal nodes (ganglia aortorenalia), lying on the lateral surface of the aorta at the beginning of the renal artery, and renal nodes (ganglia renalia), lying on the renal artery. The fibers of the small and lower splanchnic nerves (nn. splanchnici minor et imus), lumbar splanchnic nerves, and vagus nerves (nn. vagi) approach the plexus.

Ureteral plexus(plexus uretericus) in the upper sections is formed from fibers of the renal plexus, in the lower sections - from fibers of the pelvic splanchnic nerves and branches of the lower hypogastric plexus.

Ovarian (testicular) plexus formed by fibers of the renal plexus, along the vessels of the same name it reaches the ovary (testicle).

Intermesenteric plexus(plexus intermesentericus) is located on the aorta between the mesenteric arteries.

Inferior mesenteric plexus(plexus mesentericus inferior) is located on the artery of the same name and its branches, has a lower mesenteric node (ganglion mesentericus inferior), located on the aorta at the origin of the lower mesenteric artery. The fibers of the small and inferior splanchnic nerves and the lumbar splanchnic nerves approach the inferior mesenteric plexus. Through the branches of the inferior mesenteric artery they reach the descending colon, sigmoid colon and upper part of the rectum.

Lymphatic vessels and regional lymph nodes.

Lumbar lymph nodes(nodi lymphatici lumbales) collect lymph from the posterior wall of the abdomen and common iliac lymph nodes (nodi lymphatici iliaci communes), located in the retroperitoneal space along the abdominal aorta and inferior vena cava. There are several groups of lumbar lymph nodes.

Left lumbar lymph nodes(nodi lymphatici lumbales sinistri): lateral aortic lymph nodes (nodi lymphatici aortici laterales); preaortic lymph nodes (nodi lymphatici praeaortici); postaortic lymph nodes (nodi lymphatici postaortici).

Right lumbar lymph nodes(nodi lymphatici lumbales dextri): lateral caval lymph nodes (nodi lymphatici cavales laterales); precaval lymph nodes (nodi lymphatici praecavales); postcaval lymph nodes (nodi lymphatici postcavales).

The right and left lumbar lymph nodes give rise to the right and left lumbar trunks (truncus lumbalis dexter et sinister). When these trunks merge, the thoracic duct (ductus thoracicus) is formed, in the initial part of which there is an extension - the lacteal cistern (cisterna chili).

Milky tank has a length of 1-6 cm and a diameter of 1-2 cm and is located most often at the level L 1 - L II. It receives lymph from the intestinal trunks, celiac (nodi lymphatici coeliaci) and superior mesenteric (nodi lymphatici mezenterici superiores) lymph nodes.

We’ll also insert the graphs

“I have pain somewhere in the abdomen,” patients turn to the doctor every day with this complaint. We have many organs in our abdomen that can cause discomfort if pathology develops in them. The feeling of pain is the first sign that an organ is asking for help. In this case, MRI of the retroperitoneal space becomes an effective method for diagnosing the condition of the body.

What is MRI?

MRI (magnetic resonance imaging) is one of the most effective methods non-invasive diagnostics of vascular condition and internal organs person. About application magnetic field The American chemist Paul Lauterbur first thought about obtaining images. He wrote an article about this in the journal Nature in 1973. There he explained in detail how, using the effect of nuclear magnetic resonance (NMR), one can obtain an image of a slice (projection in one direction) of the human body.

The MRI device was developed later through the joint work of Lauterbur and British physicist Peter Mansfield. For this breakthrough in the field of medicine they were awarded Nobel Prize in 2003.

Basics of the MRI method

Conducting an MRI study of the human body is possible thanks to the effect of nuclear magnetic resonance (NMR). When exposed to the magnetic field created by the tomograph, hydrogen atoms, which are found in the vast majority of organic molecules, begin to vibrate in response to this influence. During vibrations, hydrogen atoms emit excess energy, which can subsequently be detected. That is, the device detects the resonant vibration frequency of the hydrogen atom.

Thanks to this MRI method, it is possible to examine the internal organs of the abdominal cavity, retroperitoneal space, blood vessels, and brain.

The retroperitoneal space includes the kidneys and adrenal glands.

The image obtained during scanning is a slice of the human body. The thickness of such a “photo” is several microns. To obtain a complete study of an average-sized person, about 10,000 images are required. These images are processed by a computer, overlaying them to create a three-dimensional model. When his work is completed, the doctor can literally rotate the internal organs in any direction. This provides an excellent opportunity to look at it from all sides.

Advantages and disadvantages of the MRI method

The MRI method has many advantages:

• the research time is relatively short (on average up to 30 - 40 minutes, less often - an hour), the results are ready almost immediately after it, detailed description it takes no more than two days to prepare;
• contrasting, informative images obtained in different sections, the possibility of computer modeling of internal organs and vessels up to a three-dimensional model;
• To obtain images, it is not necessary to use X-rays, which are harmful and have an adverse effect on the body. The tomograph creates a magnetic field that is used to scan the human body and does not harm it, despite the fact that its magnitude exceeds the Earth’s own magnetic field by tens of times. To put it simply, an MRI is a big magnet;
• this is a non-invasive method, that is, there is no need to make incisions on the patient’s body and put him in a state artificial sleep which is harmful to the heart;
• MRI can be done in many public and private clinics;
• the widespread distribution of MRI machines leads to a reduction in the cost of research and a reduction in the waiting time for scanning in line;
• There are no restrictions on the number of scans performed on one patient, especially if surgical intervention and follow-up are required.

The MRI method also has a number of serious limitations. If the patient ignores these restrictions or deliberately hides at least one of the factors listed below from the doctor, the consequences can be dire, even fatal. Here are the main points to consider:

• Patients who have pacemakers are not allowed to scan artificial valves, metal prostheses and rods in bones. Like a magnet, the MRI machine will attract any metal object to itself, even if it has to be torn out of the human body;
• tattoos with a ferromagnetic component will leave a burn on the skin;
• you need to lie still for at least half an hour to get clear pictures;
• psychological discomfort from the belts on the couch, which slides into the tomograph, closed space and the noise from the operating device;
• children most often undergo an MRI under anesthesia in the presence of an anesthesiologist due to the fact that they cannot lie still;
• It is uncomfortable for pregnant women to lie on their back for a long time;
• the effectiveness of lung examination is reduced due to their movement during the patient’s breathing process;
• the room in which the scanning takes place must be protected from any interference;
• the size of the device itself sometimes becomes an obstacle: patients weighing more than 120 - 130 kg will not fit in the device;
• Only highly qualified specialists can work with MRI.

MRI should be performed with caution in patients with claustrophobia, those suffering from psychological disorders, people who cannot control themselves, and pregnant women, although pregnancy itself is not a contraindication. Often pregnant women are prescribed an MRI instead of an X-ray.

What organs belong to the retroperitoneal space?

The retroperitoneal space refers to the space in the human body extending from the diaphragm to the pelvis. The retroperitoneal organ (that is, located in this space) is otherwise called retroperitoneal. The retroperitoneal organs include:

Almost all of these organs are hidden behind the stomach, except for the kidneys. Therefore, their diagnosis using ultrasound methods (ultrasound) is extremely difficult. The intestines can be examined by X-ray methods and CT scans; they require the preliminary administration of a contrast agent – ​​barium sulfate. Veins and vessels can be examined when examined using CT with contrast. But CT scans use iodine-containing drugs, which have a long list of contraindications.

What contrast is used in MRI and why is it needed?

MRI is performed with contrast mainly to improve the quality of the resulting images. Using such images, the doctor will accurately measure the size of the tumor, examine the contour of its edges, and note the features of its location. Contrast helps minimize the risk of missing tumors.

Today, preparations based on salts of the rare earth metal gadolinium are used as such substances. It is extremely rare in nature and quite difficult to find. Due to this, the price of gadolinium preparations is high. Its salts have a number of advantages:

• it does not linger in the body;
• excreted by the kidneys within 1–2 days unchanged;
• does not enter into chemical interactions in organism;
• non-toxic;
• significantly improves visualization of blood vessels and internal organs.

Preparations based on gadolinium salts rarely cause side effects, therefore considered safe. But nevertheless, this is medicine. In some conditions of the body and diseases of the patient, the effect of its administration may be unpredictable. Such features and diseases include:

When is MRI of the retroperitoneum prescribed?

MRI of the retroperitoneal organs primarily involves MRI of the kidneys and adrenal glands. Often this study additionally includes an MRI of the pelvis, because the functioning of the kidneys is directly related to the functioning of the urinary system. MRI of the retroperitoneum is prescribed in the following cases:

• organ damage in case of injury;
• monitoring the condition of the kidney after a heart attack;
• infections and inflammatory processes in the organs of the retroperitoneal space;
• suspicion of a neoplasm and monitoring the rate of its growth;
• before and after surgery;
• congenital anomalies of organ structure.

If you experience abdominal pain that radiates to your back, you should consult a doctor as soon as possible and undergo an MRI scan in order to accurately determine the cause of the pain and eliminate it at the earliest stages of development.

Regular painful sensations in the kidney area may cause MRI.

How to prepare for an MRI, what is visible in the images, how often can an MRI be done?

Preparing for an MRI, even one performed with the introduction of contrast, does not change the patient’s usual rhythm of life. The only restriction is not to eat or drink at least 2 hours before the start of the study.

It is much more important to think about how to prepare for the scan psychologically. It is performed in a cramped, enclosed space of the device; during operation it hums, makes noise and rattles. And no matter what modern tomographs are installed in the clinic, you will have to lie still, while the body will be secured with belts to prevent involuntary movement. Also, before entering the office where the tomograph is located, you must remove all jewelry, clothing with metal parts, and leave your mobile phone.

So, the patient has performed an MRI study in the retroperitoneal space, what does it show the doctor as a result? The images show areas of increased density, which healthy person there shouldn't be. This indicates a neoplasm in the organ. The photographs show the outlines of all organs, which can also be used to judge their health.

As shown above, MRI with the introduction of a contrast agent is a safe procedure. But it should be performed only after a doctor’s prescription. You should not regularly undergo self-prescribed scans to reassure yourself. Everything is good in moderation.