Magnetic Resonance Imaging in Acute Pelvic Pain of Gynecological Origin in Adolescents

Background: Evaluation of acute pelvic pain (APP) in adolescents requires clinical examination on a priority basis.Imaging plays a key role in diagnosing the underlying cause so that appropriate management can be instituted at the earliest.A wide range of gynecologic and nongynecologic conditions (urinary, gastrointestinal, vascular, and other entities) are included in the differential diagnosis of APP.The correct diagnosis of APP becomes difficult due to the overlapping of symptoms in the acute setting in adolescents, and due to the close anatomical relationships of various pelvic organs.Fertility preservation also has to be given due consideration in this age-group, and cases like adnexal torsion and ectopic pregnancy need to be diagnosed early.Ultrasound remains the initial imaging modality in such patients.However, when ultrasound findings are indeterminate or require further evaluation, pelvic magnetic resonance imaging (MRI) may be performed.Objectives: In this study, we evaluated the role of MRI in the diagnosis of conditions presenting with APP of gynecological origin in adolescent girls.Methods: A retrospective analysis of adolescent girls aged 10-19 years who underwent pelvic MRI at our institute for APP, which was diagnosed to be of gynecological origin, was done over a period of 3 years, from June 2021 to May 2024.Fifty-one adolescent girls with complaints of the agegroup underwent pelvic MRI following inconclusive or initially negative ultrasound examinations.Of these, positive MRI findings of gynecological origin were noted in 36 patients.The findings at MRI were subsequently correlated with the final diagnosis, which was arrived at either based on surgery and histopathology examination or on medical management and follow-up.MRI examinations were performed using GE Architect 3T, GE Signa HDxt-1.5 T and Siemens Magnetom Avanto-1.5 T. Data from these 36 patients were evaluated retrospectively and entered in Microsoft Excel and analyzed using IBM SPSS version 23.Statistical tests were applied based on the type of variable and the normality of the data.Results: In our study, the most common cause for the APP was adnexal torsion (n = 16, 44.44%), followed by hemorrhagic ovarian cysts (n = 5, 13.88%).The other conditions diagnosed were pelvic inflammatory disease (PID) (n = 4, 11.12%), hematometra/hematocolpos (n = 4, 11.12%), ovarian cyst rupture (n = 3, 8.33%), endometriosis (n = 2, 5.55%), molar pregnancy (n = 1, 2.78%), and accessory cavitated uterine mass (ACUM) (n = 1, 2.78%).All patients with ovarian torsion, hematometra, or hematocolpos, two patients with acute hemorrhagic cysts (in view of persistent pain), and one case of ACUM underwent surgical intervention, whereas the rest were managed conservatively.Conclusion: Magnetic resonance imaging plays a key role in establishing the diagnosis of the underlying cause of APP, and thereafter in directing appropriate management, medical or surgical.This is very important as it can help decrease morbidity associated with these conditions.Furthermore, early identification of certain gynecological conditions helps to preserve fertility, which is an important consideration in adolescents.