(55) Feasibility of Rapid, Free-Breathing Non-Contrast MRI for Evaluation of Gynecologic Pathologies in the Pediatric Emergency Department (ED)

Background: Although ultrasound (US) has been the gold standard for evaluation of pelvic organs in pediatric patients, transabdominal US relies on a full urinary bladder to be performed accurately. This can be challenging for children as it is time consuming, uncomfortable, and may require intravenous fluid administration for bladder distension. Recent studies have shown excellent diagnostic performance of rapid MRI when it comes to pathologies including acute appendicitis. As MRI becomes more prevalent in the evaluation of right lower quadrant pain, its usefulness for gynecologic indications should be reevaluated.

Methods: Following IRB approval, a retrospective chart review of rapid MRI examinations performed on female patients undergoing evaluation in the pediatric 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 also obtained. Rapid MRI examinations had been performed according to one of three previously developed clinical pathways (US versus MRI-first approach). A rapid, non-contrast three-sequence free-breathing MRI protocol was utilized. Diagnoses, length of MR scan time, time from ED arrival to time of gynecology consultation (if requested), and total length of stay were evaluated.

Results: Of the 378 rapid MRI exams performed for the indication of right lower quadrant pain, 54 were noted to have gynecologic pathology identified. Of the 378 time-matched US controls, 57 were noted to have gynecologic pathology. Median MRI scan time (first image to last image) was 11.4 minutes (range: 4-29.7 minutes). Mean time from ED arrival to final imaging read was 220 minutes for MRI versus 294 minutes for US (p < 0.05). Mean time from ED arrival to gynecology consultation was 251 minutes for MRI versus 252 minutes for US (p=0.97). Mean total length of ED stay was 401 minutes for MRI versus 422 minutes for US (p=0.06).

Conclusions: Rapid MRI for evaluation of gynecologic processes can provide imaging diagnoses faster than using US in the setting of the pediatric ED. Although time to gynecology consultation and total ED length of stay were not significantly different between the two groups, confounding factors such as staffing may have affected these times. Overall, the data highlights the role of MRI in first line evaluation of gynecologic pathologies. This provides the foundation for future work to determine diagnostic accuracy, cost effectiveness, and patient preferences regarding rapid MRI versus US for gynecologic pathologies.