Rapid, Free-Breathing Non-Contrast MRI for Evaluation of Gynecologic Pathologies in the Emergency Department (ED): A Retrospective Cohort Study.

Study objective: Ultrasound (US) is the gold standard for evaluation of pelvic organs, however, achieving a full bladder can be challenging for children. Recent studies have shown excellent diagnostic performance of rapid MRI for acute appendicitis. As MRI becomes more prevalent in the evaluation of right lower quadrant pain, its use for gynecologic indications should be reevaluated.

Methods: A retrospective review of patients who had rapid MRI examinations performed in the ED for right lower quadrant pain at a single institution was conducted from August 2022 through August 2023. A time-matched control group with US evaluation for the same indication was obtained. A rapid, non-contrast three-sequence free-breathing MRI protocol was utilized.

Results: Of the 376 rapid MRI exams performed for the indication of right lower quadrant pain, 49 were noted to have gynecologic pathology identified. Of the 250 time-matched US controls, 51 were noted to have gynecologic pathology. Median MRI scan time (first image to last image) was 10 minutes. Total length of stay in the ED was significantly shorter in the rapid MRI group than controls (median 338 minutes versus 442 minutes, p<0.05). Time to imaging diagnosis was significantly shorter in the rapid MRI group (201 minutes versus 285 minutes, p<0.01). Time to gynecology consult was not significantly different between groups (238 minutes versus 253 minutes, p=0.66).

Conclusions: First-line, rapid MRI for evaluation of gynecologic processes can provide imaging diagnoses faster than using US and results in lower overall lengths of stay in the ED.