Be vigilant for retained placental products …and more

“WHEN CAN MRI MAKE THE DIFFERENCE FOR YOU IN DIAGNOSING A GYN ABNORMALITY?”
DEBORAH LEVINE, MD (JULY 2012)

Don’t jump to expensive technology unless you have fully utilized the basics

I read with great interest Dr. Levine’s article, which happened to drop into my email inbox the very same day that I ordered magnetic resonance imaging (MRI) for a 17-year-old girl who had a pelvic abscess (partially drained through interventional radiology).

Dr. Levine presented an MRI image of a 10-cm fatty tumor that had been misread as a 3.4-cm ovary via ultrasonographic (US) imaging. In the US image, the delineation of the tumor (missed by the sonographer) is clearly visible. I would like to stress, as Dr. Levine did, the value of US in assessing the female pelvis and advise clinicians against falling into the trap of replacing sonographic skills with expensive MRI technology.

Pelvic MRI should be ordered only once it has been determined that the pathology was not, or could not have been, well evaluated by US. That means that one should consider repeating the US with the aid of a skilled sonographer or radiologist or with a gynecologist (yourself, ideally) present in the room, watching the scan “live” rather than looking at still images later. Some clinical pearls can only be discovered during the performance of US and cannot be reproduced in a still image—for example, pain during the scan, or movement of structures.

To better utilize our health-care dollars, we really should think about maximizing our clinical skills and getting the most from basic technology before jumping into expensive, high-tech studies.

Jose Carugno, MD
Orlando, Florida

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