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MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study.

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Title: MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study.
Authors: Charret, Océane1 (AUTHOR), Fournier, Laure2 (AUTHOR), Poncelet, Edouard3 (AUTHOR), Duraes, Martha4 (AUTHOR), Bobbia, Xavier5 (AUTHOR), Bazot, Marc6 (AUTHOR), Béranger, Sophie7 (AUTHOR), Chaumoître, Kathia8 (AUTHOR), Arcis, Elise9 (AUTHOR), Rousset, Pascal10 (AUTHOR), Coutureau, Juliette1 (AUTHOR), Fillias, Quentin1 (AUTHOR), Delebecq, Jessica1 (AUTHOR), Pages-Bouic, Emmanuelle1 (AUTHOR), Molinari, Nicolas11,12 (AUTHOR), Nogue, Erika11 (AUTHOR), Taourel, Patrice1,12 (AUTHOR), Millet, Ingrid1,12 (AUTHOR) i-millet@chu-montpellier.fr
Source: European Radiology. Nov2025, Vol. 35 Issue 11, p6642-6654. 13p.
Subjects: Magnetic resonance imaging, Computed tomography, Young women, Abdominal pain, Clinical trials, Computer-assisted image analysis (Medicine), Diagnosis
Abstract: Objective: To assess the noninferiority of MRI diagnostic accuracy to CT scan as a second-line examination of acute/subacute abdominopelvic pain in a population of young women after an inconclusive ultrasound (US). Methods: This prospective, multicenter non-inferiority study included 18–40-year-old non-pregnant women with non-traumatic acute/subacute abdominal pain. They had an inconclusive US warranting the prescription of an additional CT scan. Within 6 h of the CT, all these women underwent abdomino-pelvic MRI. A retrospective reading of the CT and MR provided a diagnosis using a standardized list. The gold standard diagnosis, based on a 3-month follow-up, was done by a panel of experts. Statistical analysis was conducted to assess the noninferiority of the diagnostic accuracy of MRI compared to that of CT. The noninferiority margin was set at 10%. Inter-observer agreement and diagnostic performance of a conditional imaging strategy were estimated. Results: 133 participants were analyzed (median: 27 years). The most common diagnoses were non-specific pain (30.1%), ovarian cyst rupture (12.8%), and appendicitis (9.7%). MRI demonstrated non-inferiority diagnostic accuracy estimated between 60.9% (81/133) and 88% (117/133) compared to CT, estimated between 64.7% (86/133) and 83.5% (111/133). The conditional imaging strategy (MRI, followed by CT when the MRI was normal) had a diagnostic accuracy of 91%. Conclusion: MRI diagnostic performances are not inferior to CT for acute abdominal pain in women aged 18–40. A conditional imaging strategy based on MRI would give an accuracy of 91% and might be considered a second-line imaging modality in that context. Key Points: QuestionCan MRI serve as an alternative to CT as a second-line imaging modality for acute abdominopelvic pain in young women (18–40) after an inconclusive ultrasound? FindingsMRI accuracy after inconclusive US ranged from 60.9 to 88%. A conditional strategy (MRI first, CT if normal) reached 91% accuracy, avoiding 59% of CTs. Clinical relevanceMRI is not inferior to CT for diagnosing uncategorized causes of acute abdomino-pelvic pain in young non-pregnant women. A conditional imaging strategy based on MRI as a second-line imaging modality would give an accuracy of 91%. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: MRI as an alternative to CT after inconclusive ultrasound in subacute/acute abdominal pain in young women: a prospective multicenter noninferiority study.
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Nov2025, Vol. 35 Issue 11, p6642-6654. 13p.
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  Data: Objective: To assess the noninferiority of MRI diagnostic accuracy to CT scan as a second-line examination of acute/subacute abdominopelvic pain in a population of young women after an inconclusive ultrasound (US). Methods: This prospective, multicenter non-inferiority study included 18–40-year-old non-pregnant women with non-traumatic acute/subacute abdominal pain. They had an inconclusive US warranting the prescription of an additional CT scan. Within 6 h of the CT, all these women underwent abdomino-pelvic MRI. A retrospective reading of the CT and MR provided a diagnosis using a standardized list. The gold standard diagnosis, based on a 3-month follow-up, was done by a panel of experts. Statistical analysis was conducted to assess the noninferiority of the diagnostic accuracy of MRI compared to that of CT. The noninferiority margin was set at 10%. Inter-observer agreement and diagnostic performance of a conditional imaging strategy were estimated. Results: 133 participants were analyzed (median: 27 years). The most common diagnoses were non-specific pain (30.1%), ovarian cyst rupture (12.8%), and appendicitis (9.7%). MRI demonstrated non-inferiority diagnostic accuracy estimated between 60.9% (81/133) and 88% (117/133) compared to CT, estimated between 64.7% (86/133) and 83.5% (111/133). The conditional imaging strategy (MRI, followed by CT when the MRI was normal) had a diagnostic accuracy of 91%. Conclusion: MRI diagnostic performances are not inferior to CT for acute abdominal pain in women aged 18–40. A conditional imaging strategy based on MRI would give an accuracy of 91% and might be considered a second-line imaging modality in that context. Key Points: QuestionCan MRI serve as an alternative to CT as a second-line imaging modality for acute abdominopelvic pain in young women (18–40) after an inconclusive ultrasound? FindingsMRI accuracy after inconclusive US ranged from 60.9 to 88%. A conditional strategy (MRI first, CT if normal) reached 91% accuracy, avoiding 59% of CTs. Clinical relevanceMRI is not inferior to CT for diagnosing uncategorized causes of acute abdomino-pelvic pain in young non-pregnant women. A conditional imaging strategy based on MRI as a second-line imaging modality would give an accuracy of 91%. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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