The utility of abdominopelvic CT in pregnant patients with abdominal pain and a negative or inconclusive abdominal MRI

• Published in: Clinical imaging Vol. 59; no. 1; pp. 88 - 94
• Main Authors: Raj, Micheal H., Mullins, John N., Chi, Joan M., Choy, Andy H., Grimaldi, Gregory M., Friedman, Barak
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020; Elsevier Limited
• Subjects: Abdomen; Abdomen - diagnostic imaging; Abdominal Magnetic Resonance Imaging (MRI); Abdominal Pain - etiology; Adult; Age; Algorithms; Appendicitis; Computed tomography; Computed tomography (CT) abdomen; Computed tomography (CT) pelvis; Diagnosis, Differential; Diagnostic systems; Female; Hernias; Humans; Hypertension; Ionizing radiation; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Nondiagnostic; Pain; Patients; Pelvis; Pelvis - diagnostic imaging; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - etiology; Prenatal Diagnosis - methods; Quality; Studies; Tomography, X-Ray Computed - methods; Ultrasonic imaging; Ultrasonography; Ultrasound; Womens health; Young Adult; Nondiagnostic; Pregnancy; Abdominal Magnetic Resonance Imaging (MRI); Computed tomography (CT) abdomen; Computed tomography (CT) pelvis
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2019.10.008

Pregnant women with abdominal pain can pose a diagnostic dilemma due to the nonspecific nature of symptoms and the desire to avoid radiation to the conceptus. Many algorithms will suggest ultrasound (US) or Magnetic Resonance Imaging (MRI) as the first-line imaging choice in pregnant women with abdominal pain due to the lack of ionizing radiation. However, these studies can have limitations as well. Abdominopelvic MRI is susceptible to respiratory motion that could cause a study to be nondiagnostic (Zaitsev et al., 2015 [1]). In the current case series, we present 8 pregnant patients with abdominal pain who underwent CT abdomen and pelvis after negative or inconclusive abdominal MRI exams. To our knowledge, this is the only case series that describes CT findings in the pregnant population after negative or inconclusive MRI. •Our case series supports the use of abdominopelvic CT in pregnant patients with persistent or worsening severe abdominal pain when the MRI is inconclusive.•In this case series, abdominopelvic CT detected important findings not seen on MRI, such as internal hernia, intestinal volvulus, perforation of acute appendicitis, and hemoperitoneum.•This improved diagnostic yield suggests a role for abdominopelvic CT in the evaluation of pregnant patients with persistent severe abdominal pain.