Recommendations for Best Practice: A recent survey evaluating current practice patterns among academic radiologists in the imaging of pregnant women with indeterminate ultrasound imaging showed that MRI is preferred to CT for the evaluation of acute appendicitis in the first trimester . However, in the second and third trimesters, CT is currently more commonly used as the next step in evaluation. This survey also showed the lack of a standard algorithm across academic centers in the management of pregnant patients with abdominal pain. Current recommendations for imaging strategies by the American College of Radiology and American College of Obstetricians and Gynecologists rely on physicians' assessment of risk and benefit for each imaging technique and highlight the need for additional research toward a standardized protocol. It is the recommendation of these authors that pregnant patients with suspected acute appendicitis should be evaluated with MRI when initial ultrasound findings are equivocal or indeterminate. CT should be avoided in pregnancy, if possible, given the potential teratogenic and carcinogenic effects of ionizing radiation on the developing fetus. However, in instances where MRI is not feasible (e.g., limited availability and claustrophobic patient) and CT is needed for further evaluation, imaging protocols should be modified to reduce fetal radiation exposure and radiation dose to as low as reasonably achievable. Recommendations for Further Research: The lack of robust evidence on the use of MRI in suspected appendicitis in pregnant patients is mainly the result of the low prevalence of this disease in pregnancy and issues related to MRI scanning availability on an emergent basis after hours. As a result, the reported studies suffered from a small sample size and retrospective design. In addition, variable MRI techniques were applied and inconsistent reference standards were used to assess the true-negative results on MRI. A standard definition for a true-negative MRI result is needed, with follow-up of negative MRI cases until delivery. To reach an appropriate sample size, a multicenter trial would be required. A prospective clinical trial with optimized and uniform MRI protocols across centers would allow a standardized approach to diagnosis and follow-up in a larger patient cohort. This type of study would further define the role of MRI in the evaluation of pregnant patients who present with acute abdominal pain.
- Right lower quadrant pain
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging