MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study.

作者信息

Charret Océane, Fournier Laure, Poncelet Edouard, Duraes Martha, Bobbia Xavier, Bazot Marc, Béranger Sophie, Chaumoître Kathia, Arcis Elise, Rousset Pascal, Coutureau Juliette, Fillias Quentin, Delebecq Jessica, Pages-Bouic Emmanuelle, Molinari Nicolas, Nogue Erika, Taourel Patrice, Millet Ingrid

机构信息

Department of Medical Imaging, Lapeyronie Hospital, CHU Montpellier, Univ Montpellier, Montpellier, France.

Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, Department of Radiology, PARCC UMRS 970, INSERM, Paris, France.

出版信息

Eur Radiol. 2025 Apr 30. doi: 10.1007/s00330-025-11629-7.

DOI:10.1007/s00330-025-11629-7

PMID:40307528

Abstract

OBJECTIVE

To assess the noninferiority of MRI diagnostic accuracy to CT scan as a second-line examination of acute/subacute abdominopelvic pain in a population of young women after an inconclusive ultrasound (US).

METHODS

This prospective, multicenter non-inferiority study included 18-40-year-old non-pregnant women with non-traumatic acute/subacute abdominal pain. They had an inconclusive US warranting the prescription of an additional CT scan. Within 6 h of the CT, all these women underwent abdomino-pelvic MRI. A retrospective reading of the CT and MR provided a diagnosis using a standardized list. The gold standard diagnosis, based on a 3-month follow-up, was done by a panel of experts. Statistical analysis was conducted to assess the noninferiority of the diagnostic accuracy of MRI compared to that of CT. The noninferiority margin was set at 10%. Inter-observer agreement and diagnostic performance of a conditional imaging strategy were estimated.

RESULTS

133 participants were analyzed (median: 27 years). The most common diagnoses were non-specific pain (30.1%), ovarian cyst rupture (12.8%), and appendicitis (9.7%). MRI demonstrated non-inferiority diagnostic accuracy estimated between 60.9% (81/133) and 88% (117/133) compared to CT, estimated between 64.7% (86/133) and 83.5% (111/133). The conditional imaging strategy (MRI, followed by CT when the MRI was normal) had a diagnostic accuracy of 91%.

CONCLUSION

MRI diagnostic performances are not inferior to CT for acute abdominal pain in women aged 18-40. A conditional imaging strategy based on MRI would give an accuracy of 91% and might be considered a second-line imaging modality in that context.

KEY POINTS

Question Can MRI serve as an alternative to CT as a second-line imaging modality for acute abdominopelvic pain in young women (18-40) after an inconclusive ultrasound? Findings MRI accuracy after inconclusive US ranged from 60.9 to 88%. A conditional strategy (MRI first, CT if normal) reached 91% accuracy, avoiding 59% of CTs. Clinical relevance MRI is not inferior to CT for diagnosing uncategorized causes of acute abdomino-pelvic pain in young non-pregnant women. A conditional imaging strategy based on MRI as a second-line imaging modality would give an accuracy of 91%.

摘要