MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain

Aytekin Oto, Randy D. Ernst, Labib M. Ghulmiyyah, Thomas K. Nishino, Douglas Hughes, Gregory Chaljub, George Saade

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Purpose: To retrospectively assess the performance of MR imaging in the evaluation and triage of pregnant patients presenting with acute abdominal or pelvic pain. Method and materials: MRI studies of pregnant patients who were referred for acute abdominal pain between 2001 and 2007 were included. MR images were retrospectively reviewed and compared with surgical and pathologic findings and clinical follow-up data. Analysis of imaging findings included evaluation of the visceral organs, bowel and mesentery, appendix (for presence of appendicitis), ovaries (detection and adnexal masses were evaluated), focal inflammation, presence of abscesses, and any other abnormal findings. Results: A total of 118 pregnant patients were included. MR findings were inconclusive in 2 patients and were positive for acute appendicitis in 11 patients (n = 9 confirmed by surgery, n = 2 improved without surgery). One patient with inconclusive MR had surgically confirmed appendicitis; the other patient with inconclusive MR had surgically confirmed adnexal torsion. Other surgical/interventional diagnoses suggested by MR imaging were adnexal torsion (n = 4), abscess (n = 4), acute cholecystitis (n = 1), and gastric volvulus (n = 1). Two patients with MR diagnosis of torsion improved without surgery. One patient with MR diagnosis of abscess had biliary cystadenoma at surgery. The rest of the MR diagnoses above were confirmed surgically or interventionally. MR imaging was normal in 67 patients and demonstrated medically treatable etiology in 28 patients: adnexal lesions (n = 9), urinary pathology (n = 6), cholelithiasis (n = 4), degenerating fibroid (n = 3), DVT (n = 2), hernia (n = 1), colitis (n = 1), thick terminal ileum (n = 1), rectus hematoma (n = 1). Three of these patients had negative surgical exploration and one had adnexal mass excision during pregnancy. Other patients were discharged with medical treatment. The sensitivity, specificity, accuracy, positive predictive values (ppv), and negative predictive values (npv) of MR imaging for acute appendicitis, and surgical/ interventional diagnoses were 90.0% vs. 88.9%, 98.1% vs. 95.0%, 97.5% vs. 94.1%, 81.8% vs. 76.2%, 99.1% vs. 97.9%, respectively. Conclusion: MR imaging is an excellent modality for diagnosis of acute appendicitis and exclusion of diseases requiring surgical/interventional treatment. Therefore MR imaging is useful for triage of pregnant patients with acute abdominal and pelvic pain.

Original languageEnglish (US)
Pages (from-to)243-250
Number of pages8
JournalAbdominal Imaging
Volume34
Issue number2
DOIs
StatePublished - Apr 2009

Fingerprint

Pelvic Pain
Triage
Acute Pain
Abdominal Pain
Appendicitis
Abscess
Stomach Volvulus
Cystadenoma
Acute Cholecystitis
Mesentery
Cholelithiasis
Appendix
Leiomyoma
Colitis
Hernia
Ileum
Hematoma
Ovary

Keywords

  • Abdominal pain
  • Acute abdomen
  • Appendicitis
  • MR
  • Pregnancy

ASJC Scopus subject areas

  • Gastroenterology
  • Urology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Oto, A., Ernst, R. D., Ghulmiyyah, L. M., Nishino, T. K., Hughes, D., Chaljub, G., & Saade, G. (2009). MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdominal Imaging, 34(2), 243-250. https://doi.org/10.1007/s00261-008-9381-y

MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. / Oto, Aytekin; Ernst, Randy D.; Ghulmiyyah, Labib M.; Nishino, Thomas K.; Hughes, Douglas; Chaljub, Gregory; Saade, George.

In: Abdominal Imaging, Vol. 34, No. 2, 04.2009, p. 243-250.

Research output: Contribution to journalArticle

Oto, A, Ernst, RD, Ghulmiyyah, LM, Nishino, TK, Hughes, D, Chaljub, G & Saade, G 2009, 'MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain', Abdominal Imaging, vol. 34, no. 2, pp. 243-250. https://doi.org/10.1007/s00261-008-9381-y
Oto A, Ernst RD, Ghulmiyyah LM, Nishino TK, Hughes D, Chaljub G et al. MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdominal Imaging. 2009 Apr;34(2):243-250. https://doi.org/10.1007/s00261-008-9381-y
Oto, Aytekin ; Ernst, Randy D. ; Ghulmiyyah, Labib M. ; Nishino, Thomas K. ; Hughes, Douglas ; Chaljub, Gregory ; Saade, George. / MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. In: Abdominal Imaging. 2009 ; Vol. 34, No. 2. pp. 243-250.
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