Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging--initial experience.
OBJECTIVE
To determine if there is a role for magnetic resonance (MR) imaging in evaluation of pregnant women with acute right-lower-quadrant pain in whom acute appendicitis is suspected.


METHODS
Informed consent and institutional review board approval were obtained. Images obtained with a 1.5-T MR imager and medical records of 23 pregnant women (age range, 19-34 years; mean age, 24.7 years) who presented with acute right-lower-quadrant pain were retrospectively reviewed. MR protocol included use of transverse, coronal, and sagittal noncontiguous T2-weighted single-shot fast spin-echo (SE) sequences; transverse fat-suppressed T2-weighted fast SE sequences; transverse T1-weighted gradient-recalled-echo sequences; and transverse and coronal short inversion time inversion-recovery sequences performed through the lower abdomen and pelvis. MR findings were evaluated by two radiologists and compared with surgical and pathologic findings and clinical follow-up data.


RESULTS
Appendix was detected in 20 (86.9%) of 23 patients. Seven patients underwent surgery; four had acute appendicitis, and three had ovarian torsion. Two patients with pelvic abscesses not related to appendicitis underwent percutaneous drainage. Fourteen patients were treated medically. Dilated thick-walled appendix and periappendiceal inflammation were detected in three (75%) of four patients with acute appendicitis. In one patient with appendicitis, the appendix could not be visualized, but inflammation was present in the right lower quadrant. In three patients with ovarian torsion, MR imaging demonstrated right adnexal mass or inflammation. MR imaging was used to correctly identify pelvic abscesses and healthy appendix in two patients. A healthy appendix was depicted in 17 (89.5%) of 19 patients without acute appendicitis.


CONCLUSIONS
MR imaging shows promise for evaluation of pregnant women in whom acute appendicitis is suspected by enabling diagnosis of other possible causes of right-lower-quadrant pain, including ovarian torsion or pelvic abscesses, and demonstrating a healthy or unhealthy appendix.
Oto
Aytekin
A
Department of Radiology, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77555-0709, USA. ayoto@utmb.edu
Ernst
Randy D
RD
Shah
Rajeev
R
Koroglu
Mert
M
Chaljub
Gregory
G
Gei
Alfredo F
AF
Zacharias
Nikolaos
N
Saade
George
G
D018784:Abdominal Abscess / Q000175:diagnosis; D015746:Abdominal Pain / Q000175:diagnosis*; D000208:Acute Disease; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010049:Ovarian Diseases / Q000175:diagnosis; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014102:Torsion Abnormality