Acute pelvic inflammatory disease: diagnostic performance of CT

To evaluate retrospectively the performance of computed tomography (CT) for the diagnosis of acute pelvic inflammatory disease (PID) by the use of clinical and laboratory data as the reference standard.

The study was approved by the institutional review board. A total of 190 women of reproductive age (age range, 16-49 years; mean age, 29.3 ± 7.6 years) with complaints of non-traumatic acute lower abdominal pain underwent subsequent abdominopelvic CT. The diagnosis of acute PID was confirmed by the clinical and laboratory findings. Two radiologists performed a blinded, independent, retrospective review of the CT findings of acute PID. Discordant findings were resolved by a consensus review with a third radiologist. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each CT finding for the diagnosis of acute PID were determined. Kappa statistics were used to estimate agreement between readers.

Pelvic inflammatory disease was present in 48 (25.3%) of the 190 patients. The most specific CT finding for the diagnosis of acute PID was tubal thickening of both fallopian tubes (95.1%). The most sensitive CT finding was mid-pelvic fat stranding (60.4%).

The CT finding of tubal thickening is highly specific for the diagnosis of acute PID, although overall CT sensitivity is poor.