MRI with DWI and contrast-enhanced sequences showed a sensitivity of 83.3% for ovarian torsion, 100% for endometriotic cysts, 100% for hemorrhagic cysts, 83.3% for TOA, and 87.5% for dermoid cysts in a prospective study on 74 patients evaluated with TVUS and MRI. Overall sensitivity of MRI in these pathological entities was 94.6% [26]. A TOA is characterized by an ill-defined adnexal mass with thick regular or irregular enhanced walls containing fluid. The signal intensity was variable from low signal intensity on T1-weighted images to intermediate or high signal intensity on T2-weighted images. The solid component (if present) may include thickened septa or wall, papillary projection, and various degrees of solid portions, which enhance after contrast injection. The sensitivity, specificity, PPV, NPV, and accuracy of MRI findings for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6%, respectively, in the absence of DWI and apparent diffusion coefficient (ADC) values [27]. Deep pelvic endometriosis may be identified as T2 hypointense fibrosis, most commonly seen at the torus uterinus and along the uterosacral ligaments, which may or may not contain T1 hyperintense hemorrhagic foci or T2 hyperintense glands. Other findings may include T2 hypointense obliteration of the fat planes anteriorly to the rectum/sigmoid colon, posteriorly to the vaginal wall or cervix, and obliteration the pouch of Douglas. The sensitivity, specificity, PPV, NPV, and accuracy of MRI for deep pelvic endometriosis were 90.3%, 91%, 92.1%, 89%, and 90.8%, respectively [28]. US Duplex Doppler Pelvis Doppler US imaging is integral for evaluation of abnormal vascularity (in case of inflammation) or lack of vascularity (in case of ovarian torsion). This document considers Doppler imaging to be a standard component of pelvic US.
Acute Pelvic Pain in the Reproductive Age Group. MRI with DWI and contrast-enhanced sequences showed a sensitivity of 83.3% for ovarian torsion, 100% for endometriotic cysts, 100% for hemorrhagic cysts, 83.3% for TOA, and 87.5% for dermoid cysts in a prospective study on 74 patients evaluated with TVUS and MRI. Overall sensitivity of MRI in these pathological entities was 94.6% [26]. A TOA is characterized by an ill-defined adnexal mass with thick regular or irregular enhanced walls containing fluid. The signal intensity was variable from low signal intensity on T1-weighted images to intermediate or high signal intensity on T2-weighted images. The solid component (if present) may include thickened septa or wall, papillary projection, and various degrees of solid portions, which enhance after contrast injection. The sensitivity, specificity, PPV, NPV, and accuracy of MRI findings for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6%, respectively, in the absence of DWI and apparent diffusion coefficient (ADC) values [27]. Deep pelvic endometriosis may be identified as T2 hypointense fibrosis, most commonly seen at the torus uterinus and along the uterosacral ligaments, which may or may not contain T1 hyperintense hemorrhagic foci or T2 hyperintense glands. Other findings may include T2 hypointense obliteration of the fat planes anteriorly to the rectum/sigmoid colon, posteriorly to the vaginal wall or cervix, and obliteration the pouch of Douglas. The sensitivity, specificity, PPV, NPV, and accuracy of MRI for deep pelvic endometriosis were 90.3%, 91%, 92.1%, 89%, and 90.8%, respectively [28]. US Duplex Doppler Pelvis Doppler US imaging is integral for evaluation of abnormal vascularity (in case of inflammation) or lack of vascularity (in case of ovarian torsion). This document considers Doppler imaging to be a standard component of pelvic US.