Revisiting the role of MRI in gynecological emergencies – An institutional experience

Abstract

Objective: Gynecological emergencies continue to be a diagnostic challenge. Although ultrasound is an excellent first line imaging modality, there are many instances where sonographic findings are indeterminate. The purpose of this study was to assess the emerging role of MRI in gynecological emergencies. Methods: 88 patients with acute pelvic pain or bleeding per vagina who underwent MRI at our imaging department between October 2012 and September 2014 were reviewed. The final diagnosis was established by surgical findings in 69 cases, endovascular intervention & biopsy in 1 respectively. The remaining 17 cases underwent follow-up MRI. Results: MRI was diagnostic in 84 (95.5%) out of 88 patients and non-diagnostic in 4 cases. The commonest gynecological emergency was pelvic inflammatory disease. Imaging findings in 71 (80.7%) patients were correlated with surgery or biopsy. The overall sensitivity and PPV of MRI in acute gynecological pathologies was 96.6% and 98.8%. Conclusion: Women presenting to the emergency room with acute pelvic pathology require prompt diagnosis to ensure timely management. MRI is superior to ultrasound in pelvic lesion characterization and is the problem solving modality when initial ultrasound is inconclusive. Our study demonstrated that MRI can play a significant role in providing accurate diagnosis in gynecological emergencies.

Keywords

• Gynecological emergencies
• Magnetic resonance imaging
• Adnexal masses