Acute pelvic pain: A pictorial review with magnetic resonance imaging

Abstract

Acute uterine emergencies constitute both obstetric and gynecologic conditions. The superior image resolution, superior soft-tissue characterization, and lack of ionizing radiation make magnetic resonance imaging (MRI) preferable over ultrasonography (USG) and computed tomography (CT) in investigating uterine emergencies. Although USG is the first-line imaging modality and is easily accessible, it has limitations. USG is an operator dependent and limited by patient factors such as obesity and muscle atrophy. CT is limited by its risk of teratogenicity in pregnant females, poor tissue differentiation, and radiation effect. The non-specific findings on CT may lead to misinterpretation of the pathology. MRI overcomes all these limitations and is emerging as the most crucial imaging modality in the emergency room (ER). The evolving 3D MR sequences further reduce the acquisition times, expanding its ER role. Although MRI is not the first-line imaging modality, it is a problem-solving tool when the ultrasound and CT are inconclusive. This pictorial review discusses the various MRI techniques used in uterine imaging and the appearances of distinct etiologies of uterine emergencies across different MRI sequences.

Endometrioma Unveiled: A Comprehensive Review of the Pathogenesis, Diagnosis, and Current Management Strategies of Ovarian Endometriosis

“…Pelvic pain can be classified into two main groups: gynecological and non-gynecological reasons. 27 Patients may experience either acute or chronic pelvic pain. This section includes some of the potential diagnoses for acute pelvic pain.…”

“…In the early stages of ectopic pregnancy, ultrasonography will reveal a small gestational sac without fetal cardiac motion and an adnexal mass. 27,28 The second cause of acute pelvic pain is pelvic inflammatory diseases (PIDs). PIDs are sexually transmitted infections that affect the female internal genitalia.…”

“…MRI scan is used to diagnose PIDs. 27,28 Endometriosis is characterized by endometrial tissue outside of the uterus. The symptoms include dysmenorrhea, pain during sexual activity, and constipation.…”

Preliminary Study on Gynecological Disease in District Buner Khyber Pakhtunkhwa, Pakistan

“…Pelvic Inflammatory Disease (PID), an infection-driven inflammatory process extending from the cervix to the peritoneal cavity, is particularly concerning due to its association with fallopian tube inflammation (11,12). This condition can lead to severe reproductive consequences, including infertility, ectopic pregnancy, and chronic pelvic pain (13,14). The etiology of female infertility is multifactorial, encompassing tubal, peri-tubal, uterine, cervical, and ovarian disorders.…”

Gynaecological Causes of Acute Pelvic Pain: Common and Not-So-Common Imaging Findings

“…Computed tomography (CT) may be performed if ultrasound findings are equivocal, if a gynaecologic disease is not initially suspected, or if it extends beyond the field of view achievable with US examination [15,17]. Magnetic resonance imaging (MRI) is an extremely useful second-line technique for the further characterisation after US or CT [18,19].…”