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Objective <p>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).</p> Methods <p>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.</p> Results <p>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%.</p> Conclusion <p>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.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>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?</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>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.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>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%.</i></p> Graphical Abstract <p></p>

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

  • 期刊论文

  • 发表日期：

    2025年4月30日

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  • Océane Charret,
  • Laure Fournier,
  • Edouard Poncelet,
  • Martha Duraes,
  • Xavier Bobbia,
  • Marc Bazot,
  • Sophie Béranger,
  • Kathia Chaumoître,
  • Elise Arcis,
  • Pascal Rousset,
  • Juliette Coutureau,
  • Quentin Fillias,
  • Jessica Delebecq,
  • Emmanuelle Pages-Bouic,
  • Nicolas Molinari,
  • Erika Nogue,
  • Patrice Taourel,
  • Ingrid Millet

摘要

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%.

Graphical Abstract