In this study, all 4 patients with a borderline size appendix with appendicitis showed negative T1 bright appendix sign [44]. The addition of DWI showed no significant improvement to MRI detection of appendicitis in a retrospective study of 125 pregnant patients [45]. Evaluation of urinary causes of pain in pregnant patients can be performed with static-fluid MR urography without gadolinium administration. Physiological hydronephrosis can be diagnosed by extrinsic compression of the middle third of the ureter by a gravid uterus, no filling defect, and a collapsed ureter below it; whereas ureteral obstruction by a calculus can demonstrate renal edema or perirenal/periureteral fluid, and in cases with distal calculi, MR urography would show a double kink sign with constriction at the pelvic brim and at the vesicoureteral junction with a standing column of urine in the pelvic ureter. Small calculi were only identified using high resolution T2- weighted sequences [46]. Evaluation for pelvic deep vein thrombosis is limited with Doppler US, as demonstrated in a small study of 27 patients with median gestational age of 29 weeks in which 3 cases of pelvic deep vein thrombosis were diagnosed with time-of-flight MRI sequences after normal US. Deep vein thrombosis was extending more cranially into the pelvis in 65% of women than on the US, suggesting that MRI has an important role as a complementary technique in diagnosing deep vein thrombosis during pregnancy [47]. Acute Pelvic Pain in the Reproductive Age Group US Abdomen and Pelvis Transabdominal A combined transabdominal and transvaginal approach is typically used for pelvic US imaging and both should be performed when possible. A transabdominal-only approach for the pelvis could serve as an alternative if the transvaginal approach is not feasible. The sensitivity, specificity, and accuracy of abdominal US for the diagnosis of appendicitis in 38 pregnant patients were 61.2%, 80%, and 63.8%, respectively [48].
Acute Pelvic Pain in the Reproductive Age Group. In this study, all 4 patients with a borderline size appendix with appendicitis showed negative T1 bright appendix sign [44]. The addition of DWI showed no significant improvement to MRI detection of appendicitis in a retrospective study of 125 pregnant patients [45]. Evaluation of urinary causes of pain in pregnant patients can be performed with static-fluid MR urography without gadolinium administration. Physiological hydronephrosis can be diagnosed by extrinsic compression of the middle third of the ureter by a gravid uterus, no filling defect, and a collapsed ureter below it; whereas ureteral obstruction by a calculus can demonstrate renal edema or perirenal/periureteral fluid, and in cases with distal calculi, MR urography would show a double kink sign with constriction at the pelvic brim and at the vesicoureteral junction with a standing column of urine in the pelvic ureter. Small calculi were only identified using high resolution T2- weighted sequences [46]. Evaluation for pelvic deep vein thrombosis is limited with Doppler US, as demonstrated in a small study of 27 patients with median gestational age of 29 weeks in which 3 cases of pelvic deep vein thrombosis were diagnosed with time-of-flight MRI sequences after normal US. Deep vein thrombosis was extending more cranially into the pelvis in 65% of women than on the US, suggesting that MRI has an important role as a complementary technique in diagnosing deep vein thrombosis during pregnancy [47]. Acute Pelvic Pain in the Reproductive Age Group US Abdomen and Pelvis Transabdominal A combined transabdominal and transvaginal approach is typically used for pelvic US imaging and both should be performed when possible. A transabdominal-only approach for the pelvis could serve as an alternative if the transvaginal approach is not feasible. The sensitivity, specificity, and accuracy of abdominal US for the diagnosis of appendicitis in 38 pregnant patients were 61.2%, 80%, and 63.8%, respectively [48].