The acute pelvis - does MRI have a role?
Dr Sarah Natas
Ultrasound is usually the primary imaging modality for assessing acute pelvic pain in female patients, however, cross sectional imaging may be necessary for further evaluation.
CT lacks soft tissue contrast within the gynaecological organs and radiation dose is an obvious concern. MRI, with its excellent soft tissue contrast, can act as a useful problem solving tool in the evaluation of acute pelvic and abdominal pain.
MRI is useful in evaluating; infection, torsion, acute complications of fibroids, and for characterising adnexal masses prior to surgery.
MRI is also of use in early pregnancy haemorrhage to evaluate the primary site of a vascular mass. A primary endometrial mass suggests RPOC. AVM is rare but is usually a vascular mass based within the myometrium. The presence of persistently elevated BHCG should raise suspicion of invasive mole.
• To understand the role of MRI in imaging acute pelvic pain in the female patient
• To gain experience of MRI in the evaluation of early pregnancy haemorrhage
• To see examples of a range of common acute pathologies affecting the uterus and adnexa, and their MR appearances
• To understand the utility of MRI in diagnosing non-
gynaecological acute pathologies that may mimic, or occur in conjunction with gynaecological disease
• To discuss the role of MRI in the clinical diagnosis of gestational trophoblastic disease, retained products of conception (RPOC), arteriovenous malformation (AVM) and subinvolution of the placental site
• Singh AJ et al. MR Imaging of the Acute Abdomen and Pelvis: Acute Appendicitis and Beyond. Radiographics. 2007 Sep-Oct; 27(5):1419-31.
• Thomassin-Naggara et al. Gynecological Pelvic Infection. What is the role of Imaging? Diagnostic and Interventional Imaging. 2012 (93), 491-499.
• Sellmyer MA et al. Physiologic, Histologic, and Imaging Features of Retained Products of Conception. RadioGraphics. 2013; 33:781–796.
0.5 CPD credit
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Dr Sarah Natas
Consultant Radiologist, Guy’s and St Thomas’ NHS Foundation
Dr Sarah Natas completed her undergraduate MBBS medical
training at St Bartholomew’s and the Royal London Hospital
Medical School and obtained her BSc degree at UCL Medical
School and MRCP in 2001. She undertook her radiology
training at Guy’s and St Thomas’ Hospital followed by
completing her FRCR in 2005. She was appointed as a
Consultant Radiologist at Guy’s and St Thomas’ NHS
Foundation Trust in 2010 with special interest in
gynaecological and oncological imaging.
Guy’s and St Thomas’ is the tertiary referral centre for
gynaecological oncology for South East London. The Trust has
a large gynaecological and obstetric unit acting as referral
centre for complex patients.