A two-stage imaging protocol for evaluating women presenting with acute pelvic pain

Amal Amin Abu El Maati, Enas Ibrahim, Fatma Zeinhom Mokhtar
In: The Egyptian Journal of Radiology and Nuclear Medicine · 2013 · vol. 44(4) , pp. 923–936 · doi:10.1016/j.ejrnm.2013.06.011 · W2043196608
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A two-stage imaging protocol using ultrasound followed by MRI for inconclusive cases accurately diagnosed gynecological causes of acute pelvic pain in women.

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Abstract

To evaluate a two-stage imaging protocol for diagnosing women presenting with acute pelvic pain. Forty-nine female patients aged 20–49 years (mean 29.5 years) who were presenting with acute pelvic pain underwent US examination of the pelvis. MRI of the pelvis was done for seventeen patients with indeterminate ultrasound findings. Data from both MRI and US were obtained, and the definite diagnosis was established with laparoscopic or surgical findings and results of clinical follow-up as the reference standard. Positive pelvic US and MRI findings for gynecological causes were seen in thirty-six out of forty-nine cases (36/49). Final diagnoses of our positive cases (36) were as follows: hemorrhagic ovarian cyst seven cases (19%), ovarian torsion five cases (14%), endometriosis five cases (14%), teratodermoid four cases (11%), ectopic pregnancy four cases (11%), tubo-ovarian abscess three cases (8%), degenerating fibroid three cases (8%), adenomyosis two cases (6%), pedunculated prolapsed submucosal fibroid one case (3%), uterine AVM one case (3%) and pelvic hematoma one case (3%), Thirteen cases (13/49) were excluded from the study as they had other non gynecological causes of pelvic pain like appendicitis, lower ureteric stones, crohn’s disease and diverticulitis. In 19 cases the diagnosis was established with US alone and so MRI was done for the remaining 17 cases where US was inconclusive. A two-stage protocol for evaluating women presenting with acute pelvic pain with the use of ultrasonography first, and then MRI for cases with inconclusive ultrasound findings, will optimize diagnostic accuracy.

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endometriosisadenomyosis

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