Aytekin Oto MD, Abstract Co-Author: Nothing to Disclose

Randy Devereux Ernst MD, Abstract Co-Author: Nothing to Disclose

Labib Ghulmiyyah, Abstract Co-Author: Nothing to Disclose

Douglas Eugene Hughes MD, Presenter: Nothing to Disclose

Thomas K. Nishino PhD, Abstract Co-Author: Nothing to Disclose

George Saade MD, Abstract Co-Author: Nothing to Disclose

To retrospectively assess the performance of MR imaging in the evaluation and triage of pregnant patients presenting with acute abdominal or pelvic pain.

MRI studies of pregnant patients who were referred for acute abdominal pain between 2001 and 2007 were included. Pregnant patients who had trauma, MRA or MRCP were excluded from the study. MR images were retrospectively reviewed and compared with surgical and pathologic findings and clinical follow-up data.

118 pregnant patients were included. MR findings were inconclusive in 2 and were positive for acute appendicitis in 11 patients (n=9 confirmed by surgery, n=2 improved without surgery).1 patient with inconclusive MR had surgically confirmed appendicitis. Other surgical/interventional diagnosis suggested by MR imaging were adnexal torsion (n=4), abscess (n=4), acute cholecystitis (n=1) and gastric volvulus (n=1). 2 patients with MR diagnosis of torsion improved without surgery.1 patient with inconclusive MR had surgically confirmed torsion.1 patient with MR diagnosis of abscess had biliary cystadenoma in 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 and negative predictive values of MR imaging for acute appendicitis and surgical/ interventional diagnosis were 90.0 vs 84.2%, 98.1 vs 94.9%,97.5 vs 93.2%, 81.8 vs76.2%, 99.1 vs 96.9% respectively.

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.

MR imaging can be used in the triage of pregnant patients presenting with acute abdominal pain.

Oto, A, Ernst, R, Ghulmiyyah, L, Hughes, D, Nishino, T, Saade, G, MR Imaging in Triage of Pregnant Patients with Acute Abdominal and Pelvic Pain.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5011155.html