Purpose: To evaluate and quantify the benefit of abdominal MRI in pregnant patients presenting with acute abdominal pain.
Methods: Pregnant patients presenting with acute abdominal pain to the emergency department were evaluated using abdominal MRI. The MRI included rapid sequences without gadolinium administration for the most part, including TRUFI, HASTE, and T1 M-DIXON in the axial and coronal planes. Radiological diagnoses were compared to clinical and surgical outcomes using hospital databases. Endpoint included surgery or patient discharge. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated.
Results: Fifty-two MRI exams were performed on fifty pregnant patients ages 21 to 40 with acute abdomen between 9/2011 to 07/2019. The vast majority of the women presented in the second trimester (48.1%). Right lower quadrant pain was the leading clinical manifestation (42.3%). Thirty scans (57.7%) had pathological findings in their imaging results, with 19 leading to surgery during that hospitalization period. One patient with a diagnosis of acute appendicitis refused surgery and was successfully treated conservatively. Of the surgical cases, there was one discrepancy with the radiological diagnosis of ovarian torsion. Ten other diagnoses were confirmed by means other than surgery such as other modalities, lab results, or clinical response to treatment. None of the patients with non-surgical abdominal MRI findings or with normal MRI reports underwent surgery during that same hospitalization period. Sensitivity, specificity, PPV, and NPV were 100%, 95.7%, 96.7%, and 100% respectively.
Conclusion: Abdominal MRI of pregnant patients with acute abdominal pain is a promising modality that improves patient outcome by either diagnosing or ruling out potential causes of acute abdomen.
