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. 2025 Apr 30.
doi: 10.1007/s00330-025-11629-7. Online ahead of print.

MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study

Océane Charret  1 , Laure Fournier  2 , Edouard Poncelet  3 , Martha Duraes  4 , Xavier Bobbia  5 , Marc Bazot  6 , Sophie Béranger  7 , Kathia Chaumoître  8 , Elise Arcis  9 , Pascal Rousset  10 , Juliette Coutureau  1 , Quentin Fillias  1 , Jessica Delebecq  1 , Emmanuelle Pages-Bouic  1 , Nicolas Molinari  11   12 , Erika Nogue  11 , Patrice Taourel  1   12 , Ingrid Millet  13   14
Affiliations

MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study

Océane Charret et al. Eur Radiol. .

Abstract

Objective: To assess the noninferiority of MRI diagnostic accuracy to CT scan as a second-line examination of acute/subacute abdominopelvic pain in a population of young women after an inconclusive ultrasound (US).

Methods: This prospective, multicenter non-inferiority study included 18-40-year-old non-pregnant women with non-traumatic acute/subacute abdominal pain. They had an inconclusive US warranting the prescription of an additional CT scan. Within 6 h of the CT, all these women underwent abdomino-pelvic MRI. A retrospective reading of the CT and MR provided a diagnosis using a standardized list. The gold standard diagnosis, based on a 3-month follow-up, was done by a panel of experts. Statistical analysis was conducted to assess the noninferiority of the diagnostic accuracy of MRI compared to that of CT. The noninferiority margin was set at 10%. Inter-observer agreement and diagnostic performance of a conditional imaging strategy were estimated.

Results: 133 participants were analyzed (median: 27 years). The most common diagnoses were non-specific pain (30.1%), ovarian cyst rupture (12.8%), and appendicitis (9.7%). MRI demonstrated non-inferiority diagnostic accuracy estimated between 60.9% (81/133) and 88% (117/133) compared to CT, estimated between 64.7% (86/133) and 83.5% (111/133). The conditional imaging strategy (MRI, followed by CT when the MRI was normal) had a diagnostic accuracy of 91%.

Conclusion: MRI diagnostic performances are not inferior to CT for acute abdominal pain in women aged 18-40. A conditional imaging strategy based on MRI would give an accuracy of 91% and might be considered a second-line imaging modality in that context.

Key points: Question Can MRI serve as an alternative to CT as a second-line imaging modality for acute abdominopelvic pain in young women (18-40) after an inconclusive ultrasound? Findings MRI accuracy after inconclusive US ranged from 60.9 to 88%. A conditional strategy (MRI first, CT if normal) reached 91% accuracy, avoiding 59% of CTs. Clinical relevance MRI is not inferior to CT for diagnosing uncategorized causes of acute abdomino-pelvic pain in young non-pregnant women. A conditional imaging strategy based on MRI as a second-line imaging modality would give an accuracy of 91%.

Keywords: Abdominal pain; Magnetic resonance; Pelvic pain; Young adult.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Prof. Ingrid Millet. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: One of the authors has significant statistical expertise. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: No study subjects or cohorts have been previously reported. Methodology: Prospective Diagnostic or prognostic study Multicenter study

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References

    1. Murata A, Okamoto K, Mayumi T, Maramatsu K, Matsuda S (2014) Age-related differences in outcomes and etiologies of acute abdominal pain based on a national administrative database. Tohoku J Exp Med 233:9–15. https://doi.org/10.1620/tjem.233.9 - PubMed
    1. Bhosale PR, Javitt MC, Atri M et al (2016) ACR Appropriateness Criteria® acute pelvic pain in the reproductive age group. Ultrasound Q 32:108–115. https://doi.org/10.1097/ruq.0000000000000200 - PubMed
    1. Wolfe C, Halsey-Nichols M, Ritter K, McCoin N (2022) Abdominal pain in the emergency department: how to select the correct imaging for diagnosis. Open Access Emerg Med 14:335–345. https://doi.org/10.2147/oaem.s342724 - PubMed - PMC
    1. Stoker J, van Randen A, Laméris W, Boermeester MA (2009) Imaging patients with acute abdominal pain. Radiology 253:31–46. https://doi.org/10.1148/radiol.2531090302 - PubMed
    1. Pandharipande PV, Reisner AT, Binder WD et al (2016) CT in the emergency department: a real-time study of changes in physician decision making. Radiology 278:812–821. https://doi.org/10.1148/radiol.2015150473 - PubMed

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