Magnetic Resonance Imaging of Abdominal and Pelvic Pain in the Pregnant Patient

Baheti, Akshay D.; Nicola, Refky; Bennett, Genevieve L.; Bordia, Ritu; Moshiri, Mariam; Katz, Douglas S.; Bhargava, Puneet

doi:10.1016/j.mric.2015.11.007

Cited by 19 publications

(10 citation statements)

References 72 publications

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“…Nevertheless, the unusual visualization of one adrenal gland should suggest its swelling, as in two of our cases. Because of its efficiency and safety, non-enhanced MRI should be the preferred second-line modality for pregnant women [1]. It typically demonstrates restricted diffusion of the swollen gland and an increased T2 signal intensity, with surrounding edema without T1 hyperintensity.…”

Section: Discussionmentioning

confidence: 99%

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Non-Hemorrhagic Adrenal Infarction during Pregnancy: The Diagnostic Imaging Keys

et al. 2021

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Background: non-hemorrhagic adrenal infarction (NHAI) is a rare cause of acute abdominal/flank pain during pregnancy; in order to ensure prompt and appropriate treatment, this diagnosis should not be overlooked. This case series highlights pertinent imaging findings, including ultrasounds (USs), computed tomography (CT), and magnetic resonance imaging (MRI) of recent NHAI cases. Methods: we compiled all consecutive NHAI cases from two university hospitals over a two-year period and checked the relevant clinical, laboratory, and imaging findings. Relevant articles on NHAI published from January 2010 to March 2021 were analyzed. Results: six cases were found in our database. CT-scans typically showed enlarged, hypodense, and non-enhanced adrenal glands. Unenhanced MRIs allowed for diagnoses and showed enlarged adrenal glands in the signal hyperintensity on T2 and diffusion-weighted imaging, without any signal hyperintensity on T1. In two of our six cases, USs showed swollen adrenal glands with fluid collection. Conclusion: NHAI and its differential diagnosis—in cases of acute pain during pregnancy—highlight the crucial roles of integrated radiological examination and cooperation between obstetricians and radiologists, both of whom should consider the location of the pain, the accessibility and tolerance of MRI, and the radiation exposure of CT. Despite its supposed poor sensitivity, an US performed because the patient reports pain should also be used to examine the adrenal gland regions. Non-enhanced MRI is clearly of value and access to it in emergencies is important to avoid radiation exposure

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Section: Discussionmentioning

confidence: 99%

“…Tomography 2021, 7 534 to be a good, non-irradiating alternative to establish the cause of pain [1]. Among several differential diagnoses, NHAI, a rare clinical entity, should not be overlooked, in order to ensure prompt treatment [2].…”

Section: Introductionmentioning

confidence: 99%

Non-Hemorrhagic Adrenal Infarction during Pregnancy: The Diagnostic Imaging Keys

et al. 2021

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“…The diagnosis of acute abdomen in pregnancy (AAP) involves unique diagnostic and therapeutic challenges. The diagnosis can be challenging due to altered anatomy secondary to an enlarged uterus, physiological changes associated with pregnancy, and the limited use of radiological modalities due to fear of exposing the fetus to radiation [ 1 ]. The nonspecific presentations of AAP may lead to delays in diagnosis and treatment that put both the mother and fetus at risk of fatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Adrenal Infarction in Pregnancy Secondary to Elevated Plasma Factor VIII Activity

Mathew¹,

Ali²,

Sanders³

et al. 2021

Cureus

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Unilateral adrenal infarction is a rare cause of acute abdomen in pregnancy (AAP). Its presentation is non-specific and requires a high index of suspicion with a low threshold to obtain radiographic imaging for diagnosis. Evaluating AAP is challenging as diagnostic radiographic imaging is often limited in relation to radiation exposure to the developing fetus. We describe a case of a 24-year-old pregnant female who presented with severe acute abdominal pain. The patient’s pain was refractory to intravenous analgesics and ultrasonography was inconclusive. Computed tomography (CT) scan was not obtained due to the risk of radiation exposure to the developing fetus. Due to the persistence of pain and suspicions for other serious etiologies, magnetic resonance imaging (MRI) was completed and the patient was diagnosed with acute unilateral adrenal infarction. In this case report, unilateral adrenal infarction was likely secondary to elevated plasma factor VIII levels. Even with the physiological elevation of factor VIII levels during pregnancy, levels greater than 150 IU/dL confer greater than five-fold increased risk of venous thrombosis. Once hemorrhage is excluded, patients should be started on therapeutic anticoagulation to prevent progression of adrenal infarct or infarction of the contralateral adrenal gland. Prompt recognition and treatment of acute adrenal infarction during pregnancy are of paramount importance to prevent adverse outcomes for both the mother and fetus.

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“…6 Consequently, MRI is recommended for acute abdominal pain in pregnant patients. 7,8 The use of MRI in patients with acute abdominal pain was previously limited to patients with biliary and gynecological disease that could not be diagnosed using CT; however, several studies reported that MRI is helpful for diagnosing acute abdominal pain caused by not only acute appendicitis [9][10][11][12] but also other diseases. [13][14][15] MRI has potentially high-contrast resolution, and it can illuminate ischemic changes caused by acute mesenteric ischemia.…”

Section: Introductionmentioning

confidence: 99%

MR Imaging-based Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits

et al. 2020

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Purpose: This study assessed the MRI findings of strangulated small bowel obstruction (SBO) and mesenteric venous occlusion (MVO) in a rabbit model using 3T MRI. Materials and Methods:Twenty rabbits were included in this study. The strangulated SBO and MVO models were generated via surgical procedures in nine rabbits, and sham surgery was performed in two rabbits. The success of generating the models was confirmed via angiographic, macroscopic, and microscopic findings after the surgical procedure. MRI was performed before and 30 min after inducing mesenteric ischemia. T 1 -weighted images (T 1 WIs), T 2 -weighted images (T 2 WIs), and fat-suppressed T 2 WIs (FS-T 2 WIs) were obtained using the BLADE technique, and fat-suppressed T 1 WIs (FS-T 1 WIs) were obtained. The signal intensities of the affected bowel before and after the surgical procedures were visually categorized as high, iso, and low intense compared with the findings for the normal bowel wall on all sequences. Bowel wall thickness was measured, and the signal intensity ratio (SI ratio) was calculated using the signal intensities of the bowel wall and psoas muscle.Results: Angiographic, macroscopic, and microscopic findings confirmed that all surgical procedures were successful. The ischemic bowel wall was thicker than the normal bowel. The bowel wall was thicker in the MVO model (3.17 ± 0.55 mm) than in the strangulated SBO model (2.26 ± 0.46 mm). The signal intensity and SI ratio of the bowel wall were significantly higher after the procedure than before the procedure on all sequences in both models. The mesentery adjacent to the ischemic bowel loop exhibited a high signal intensity in all animals on FS-T 2 WIs. Conclusion:Non-contrast MRI can be used to evaluate mesenteric ischemia caused by strangulated SBO and MVO. FS-T 2 WIs represented the best modality for depicting the high signal intensity in the bowel wall and mesentery caused by ischemia.

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Magnetic Resonance Imaging of Abdominal and Pelvic Pain in the Pregnant Patient

Cited by 19 publications

References 72 publications

Non-Hemorrhagic Adrenal Infarction during Pregnancy: The Diagnostic Imaging Keys

Non-Hemorrhagic Adrenal Infarction during Pregnancy: The Diagnostic Imaging Keys

Adrenal Infarction in Pregnancy Secondary to Elevated Plasma Factor VIII Activity

MR Imaging-based Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits

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