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However, advances in magnetic resonance imaging (MRI), including accelerated acquisition, motion-robust sequences, and non-contrast protocols, have expanded its role beyond a problem-solving tool toward selective first-line imaging in specific clinical scenarios. This review provides a decision-based framework for MRI utilization in nontraumatic abdominopelvic emergencies, integrating current evidence on diagnostic performance, workflow considerations, and clinical impact. MRI offers clear advantages in radiation-sensitive populations (pregnant and pediatric patients), in biliary obstruction, and for characterizing pancreatic complications, while remaining complementary in most other emergency settings. We highlight high-yield indications where MRI may replace or precede CT, supported by comparative data, and provide practical, rapid MRI protocols (&lt;\u200915\u00a0min) adaptable to emergency workflows. Importantly, we present a balanced discussion of real-world constraints, including availability, cost, scan time, and patient tolerance, that currently limit universal adoption. MRI should therefore be viewed not as a universal replacement for CT, but as a targeted, high-value imaging strategy in selected emergency scenarios where it improves diagnostic confidence, avoids ionizing radiation, and influences management.<\/jats:p>","DOI":"10.1007\/s00261-026-05590-2","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T08:06:50Z","timestamp":1781597210000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The evolving role of MRI in abdominopelvic emergencies: from problem-solving to first-line imaging"],"prefix":"10.1007","author":[{"given":"Usha","family":"Jayagurunathan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankush","family":"Ankush","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harish","family":"Gudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriram","family":"Jaganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Childs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janardhana","family":"Ponnatapura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eswara Moorthy","family":"Sellamuthu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"issue":"7","key":"5590_CR1","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/j.ajem.2010.01.045","volume":"29","author":"RS Hastings","year":"2011","unstructured":"Hastings RS, Powers RD. 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