Oto Aytekin, Ernst Randy D, Ghulmiyyah Labib M, Nishino Thomas K, Hughes Douglas, Chaljub Gregory, Saade George
Department of Radiology, The University of Chicago, 5841 S Maryland Avenue, MC 2026, Chicago, IL 60637, USA.
Abdom Imaging. 2009 Mar-Apr;34(2):243-50. doi: 10.1007/s00261-008-9381-y.
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. 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.
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.
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.
回顾性评估磁共振成像（MR成像）在评估和分诊出现急性腹痛或盆腔疼痛的孕妇中的表现。
纳入2001年至2007年间因急性腹痛转诊的孕妇的MR成像研究。对MR图像进行回顾性分析，并与手术和病理结果以及临床随访数据进行比较。成像结果分析包括对内脏器官、肠管和肠系膜、阑尾（是否存在阑尾炎）、卵巢（检测及评估附件肿块）、局灶性炎症、脓肿的存在以及任何其他异常发现的评估。
共纳入118例孕妇。2例患者的MR成像结果不明确，11例患者的MR成像结果显示急性阑尾炎阳性（9例经手术证实，2例未经手术病情好转）。1例MR成像结果不明确的患者经手术证实为阑尾炎；另1例MR成像结果不明确的患者经手术证实为附件扭转。MR成像提示的其他手术/介入诊断为附件扭转（4例）、脓肿（4例）、急性胆囊炎（1例）和胃扭转（1例）。2例MR诊断为扭转的患者未经手术病情好转。1例MR诊断为脓肿的患者手术时发现为胆管囊腺瘤。上述其余MR诊断均经手术或介入证实。67例患者的MR成像结果正常，28例患者的MR成像结果显示病因可通过内科治疗：附件病变（9例）、泌尿系统病变（6例）、胆结石（4例）、变性肌瘤（3例）、深静脉血栓形成（2例）、疝气（1例）、结肠炎（1例）、回肠末端增厚（1例）、腹直肌血肿（1例）。其中3例患者手术探查结果为阴性，1例患者在孕期进行了附件肿块切除术。其他患者经内科治疗后出院。MR成像对急性阑尾炎及手术/介入诊断的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为90.0%对88.9%、98.1%对95.0%、97.5%对94.1%、81.8%对76.2%、99.1%对97.9%。
MR成像是诊断急性阑尾炎和排除需要手术/介入治疗疾病的极佳方法。因此，MR成像对分诊出现急性腹痛和盆腔疼痛的孕妇很有用。
