Sherelle L. Laifer-Narin MD, Presenter: Nothing to Disclose

Elizabeth M. Hecht MD, Abstract Co-Author: Nothing to Disclose

Jeffrey Hooker Newhouse MD, Abstract Co-Author: Nothing to Disclose

Hen Sela, Abstract Co-Author: Nothing to Disclose

To assess the efficacy of MRI performed on the pregnant patient presenting with abdominal or pelvic pain in triaging patients for surgery, minimally invasive treatment, medical treatment, or expectant management.

A retrospective review of MRI studies of pregnant patients who were referred for acute abdominal pain between 2005 and 2012 was performed. MR reports were retrospectively reviewed and compared with surgical and pathologic findings and clinical follow-up data.  Evaluation of the visceral organs, bowel and mesentery, appendix and ovaries were performed to detect inflammation, infection, presence of masses, abscesses, vascular compromise, or other abnormalities.  

278 MRI studies were performed on 248 patients.  13 patients had 2 studies and 1 patient had 4 studies performed, each on separate days.  Patients underwent surgery for positive MRI findings in 22 cases.  Surgery was performed for acute cholecystitis (n = 3),  cul-de-sac abscess (n=1), right ovarian torsion (n= 1), cecal volvulus (n=1), and acute appendicitis (n=16).   MRI detected medically treatable conditions, conditions requiring minimally invasive treatment, or was considered normal in 257 cases. Surgical exploration for acute appendicitis was normal in one case.  3 cases of acute appendicitis were missed by MRI.  The sensitivity, specificity, positive predictive value, and negative predictive value for acute appendicitis was 83.3%, 99.3%, 93.8%, and 97.9% respectively.  The sensitivity, specificity, positive predictive value, and negative predictive value for surgical disease overall was 87.5%, 99.6%, 95.5%, and 98.8% respectively.

MR imaging is an excellent modality to assist in management of the pregnant patient with abdominal pain. Patients can be appropriately triaged for surgery, minimally invasive treatment, medical treatment, or expectant management with a high degree of accuracy.

MRI is safe and effective modality for evaluating the pregnant patient with abdominopelvic pain with a high degree of accuracy and ability to triage patients for surgery or medical management.

Laifer-Narin, S, Hecht, E, Newhouse, J, Sela, H, MRI Evaluation of Abdominopelvic Pain in the Pregnant Patient.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12034592.html