Findings of irregular peripherally enhancing adnexal cyst usually accompanied by hemorrhagic pelvic free fluid might also indicate a ruptured hemorrhagic cyst. Acute Pelvic Pain in the Reproductive Age Group MRI Pelvis Without and With IV Contrast There is no relevant literature to support the use of pelvic MRI without and with IV contrast as the initial imaging modality for the evaluation of acute pelvic pain. However, MRI can be useful for equivocal cases of ovarian torsion, PID, TOA, and other gynecological causes of acute pelvic pain in patients of reproductive age such as fibroid torsion or necrosis or in patients that are unable to tolerate TVUS. For MRI evaluation of adnexal torsion, a meta-analysis including 18 studies (1,654 patients, 665 cases) reported a pooled sensitivity of 81% and specificity of 91% [22]. An enlarged ovary with or without an underlying mass and a twisted pedicle suggest adnexal torsion (with multiplanar MRI acquisitions potentially necessary for better detection of the twisted pedicle). Other findings may include subacute ovarian hematoma (better assessed with T1- weighted sequences with fat saturation), abnormal or absent ovarian enhancement, ascites, deviation of the uterus to the side of the twist, engorged vessels on the twisted side, and fallopian tube thickening [21]. A prospective cohort study with 187 patients evaluated with MRI for PID showed a sensitivity, specificity, PPV, negative predicative value (NPV), and accuracy with conventional MRI findings (T1-weighted, T2-weighted with fat saturation, postcontrast sequences) of 90.7%, 93.3%, 98.3%, 70.0%, and 91.2%, respectively. Adding DWI yielded a sensitivity, specificity, PPV, NPV, and accuracy of 98.4%, 93.3%, 98.4%, 93.3%, and 97.5%, respectively, with overall increased accuracy, sensitivity, and NPV [25].
Acute Pelvic Pain in the Reproductive Age Group. Findings of irregular peripherally enhancing adnexal cyst usually accompanied by hemorrhagic pelvic free fluid might also indicate a ruptured hemorrhagic cyst. Acute Pelvic Pain in the Reproductive Age Group MRI Pelvis Without and With IV Contrast There is no relevant literature to support the use of pelvic MRI without and with IV contrast as the initial imaging modality for the evaluation of acute pelvic pain. However, MRI can be useful for equivocal cases of ovarian torsion, PID, TOA, and other gynecological causes of acute pelvic pain in patients of reproductive age such as fibroid torsion or necrosis or in patients that are unable to tolerate TVUS. For MRI evaluation of adnexal torsion, a meta-analysis including 18 studies (1,654 patients, 665 cases) reported a pooled sensitivity of 81% and specificity of 91% [22]. An enlarged ovary with or without an underlying mass and a twisted pedicle suggest adnexal torsion (with multiplanar MRI acquisitions potentially necessary for better detection of the twisted pedicle). Other findings may include subacute ovarian hematoma (better assessed with T1- weighted sequences with fat saturation), abnormal or absent ovarian enhancement, ascites, deviation of the uterus to the side of the twist, engorged vessels on the twisted side, and fallopian tube thickening [21]. A prospective cohort study with 187 patients evaluated with MRI for PID showed a sensitivity, specificity, PPV, negative predicative value (NPV), and accuracy with conventional MRI findings (T1-weighted, T2-weighted with fat saturation, postcontrast sequences) of 90.7%, 93.3%, 98.3%, 70.0%, and 91.2%, respectively. Adding DWI yielded a sensitivity, specificity, PPV, NPV, and accuracy of 98.4%, 93.3%, 98.4%, 93.3%, and 97.5%, respectively, with overall increased accuracy, sensitivity, and NPV [25].