Skip to main content
Log in

Emergency MRI of acute pelvic pain: MR protocol with no oral contrast

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript


The aim of this study was to evaluate the efficacy of magnetic resonance (MR) without oral contrast in the assessment of suspected acute pathologies of the pelvis in pregnant and non-pregnant patients. Sixty-seven patients who had MR of the lower abdomen and pelvis for acute abdomen were included in the study. The MR examinations were evaluated for indication of the study, type of MR sequences, and sensitivity of MR in diagnosing the disease. T2 single shot fast spin echo (SS-FSE), T2 FSE, short tau inversion recovery, pre-gadolinium T1, and post-gadolinium T1 sequences were utilized. There were 30 pregnant and two postpartum women in the study group. Positive pelvic MR findings were seen in 73% (49/67). Final diagnoses were acute appendicitis (n = 12), ovarian torsion (n = 6), abscess (n = 3), tubo-ovarian abscess (n = 2), ovarian tumor (n = 2), degenerating fibroid (n = 3), and perianal fistula (n = 2). For acute appendicitis, sensitivity was 100% (12/12), and positive predictive value was 92% (12/13). Post-gadolinium T1-weighted sequences and T2 SS-FSE with FS were the sequences, which were most likely to best demonstrate the acute appendicitis. For ovarian torsion, the sensitivity was 86% (6/7), and positive predictive value was 100% (6/6). MR imaging is an efficacious means of diagnosing acute appendicitis, ovarian torsions, and other adnexal diseases in the acute setting. The four sequence protocol without oral contrast offers an excellent means of investigating the cause of acute lower abdominal and pelvic pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others


  1. Ciesla DJ, Moore JB, Johnson JL, Cothren CC, Burch JM (2005) The academic trauma center is a model for the future trauma and acute care surgeon. J Trauma 58:657–662 doi:10.1097/01.TA.0000159241.62333.94

    Article  PubMed  Google Scholar 

  2. Committee to Assess the Health Risks from Exposure to Low Levels of Ionizing Radiation, BEIR VII: health risks from exposure to low levels of ionizing radiation

  3. Oto A, Ernst RD, Shah R, Koroglu M, Chaljub G, Gei AF et al (2005) Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging-initial experience. Radiology 234(2):445–451 doi:10.1148/radiol.2341032002

    Article  PubMed  Google Scholar 

  4. Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC (2005) MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol 184(2):452–458

    PubMed  Google Scholar 

  5. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM (2006) MR imaging of acute appendicitis in pregnancy. Radiology 238(3):891–899 doi:10.1148/radiol.2383050146

    Article  PubMed  Google Scholar 

  6. Hormann M, Puig S, Prokesch SR, Partik B, Helbich TH (2002) MR imaging of the normal appendix in children. Eur Radiol 12(9):2313–2316

    PubMed  CAS  Google Scholar 

  7. Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F (1997) Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol 168(3):669–674

    PubMed  CAS  Google Scholar 

  8. Hormann M, Paya K, Eibenberger K, Dorffner R, Lang S, Kreuzer S et al (1998) MR imaging in children with nonperforated acute appendicitis: value of unenhanced MR imaging in sonographically selected cases. AJR Am J Roentgenol 171(2):467–470

    PubMed  CAS  Google Scholar 

  9. Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21(2):156–165 doi:10.1002/jmri.20241

    Article  PubMed  Google Scholar 

  10. Cappell MS, Friedel D (2003) Abdominal pain during pregnancy. Gastroenterol Clin North Am 32:1–58 doi:10.1016/S0889-8553(02)00064-X

    Article  PubMed  Google Scholar 

  11. Ghossain MA, Hachem K, Aoun NJ, Haddad-Zebouni S, Mansour F, Suidan JS et al (2006) Spontaneous detorsion of the ovary: can it be diagnosed by MRI? J Magn Reson Imaging 24(4):880–885 doi:10.1002/jmri.20711

    Article  PubMed  Google Scholar 

  12. Ghossian MA, Hachem K, Buy JN et al (2004) Adnexal torsion: magnetic resonance findings in viable adnexa with emphasis on stromal ovarian appearance. J Magn Reson Imaging 20(3):451–462 doi:10.1002/jmri.20131

    Article  Google Scholar 

  13. Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J (1994) Ovarian torsion: CT and MR imaging appearances. Radiology 190:337–341

    PubMed  CAS  Google Scholar 

  14. Kawakami K, Murata K, Kawaguchi N et al (1993) Hemorrhagic infarction of the diseased ovary: a common MR finding in two cases. Magn Reson Imaging 11:595–597 doi:10.1016/0730-725X(93)90479-W

    Article  PubMed  CAS  Google Scholar 

  15. Okizuka H, Sugimura K, Takemori M, Obayashi C, Kitao M, Ishida T (1993) MR detection of degenerating uterine leiomyomas. J Comput Assist Tomogr 17:760–766 doi:10.1097/00004728-199309000-00018

    Article  PubMed  CAS  Google Scholar 

  16. Yamashita Y, Torashima M, Takahashi M, Tanaka N, Katabuchi H, Miyazaki K et al (1993) Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications. Radiology 189(3):721–725

    PubMed  CAS  Google Scholar 

  17. Kawakami S, Togashi K, Konishi I et al (1994) Red degeneration of uterine leiomyoma: MR appearance. J Comput Assist Tomogr 18:925–928 doi:10.1097/00004728-199403000-00020

    Article  PubMed  CAS  Google Scholar 

  18. Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T (1999) Paavonen j. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 210:209–216

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ajay K. Singh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, A.K., Desai, H. & Novelline, R.A. Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol 16, 133–141 (2009).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: