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Viganò S, Smedile A, Cazzella C, Marra P, Bonaffini PA, Sironi S. Abnormal Uterine Bleeding: A Pictorial Review on Differential Diagnosis and Not-So-Common Cases of Interventional Radiology Management. Diagnostics (Basel) 2024; 14:798. [PMID: 38667444 PMCID: PMC11049404 DOI: 10.3390/diagnostics14080798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Abnormal uterine bleeding (AUB) poses a multifaceted challenge in women's health, necessitating an integrated approach that addresses its diverse etiologies and clinical presentations. The International Federation of Gynecology and Obstetrics PALM-COEIN classification system provides a systematic approach to the diagnosis of AUB in non-pregnant women, based on clinical and imaging-based categorization of causes into structural (Polyps, Adenomyosis, Leiomyomas and Malignancy; PALM), and non-structural causes (Coagulopathies, Ovulatory disorders, primary Endometrial disorders, Iatrogenic and Not otherwise classified; COEIN). On the other hand, placental disorders, uterine rupture, ectopic pregnancy and retained products of conceptions are the main causes of uterine bleeding during pregnancy and in the peripartum period. Ultrasound is usually the first-line imaging technique for the differential diagnosis of causes of AUB. Computed Tomography may be useful if ultrasound findings are unclear, especially in emergency settings. Magnetic resonance imaging, when indicated, is an excellent second-line diagnostic tool for a better non-invasive characterization of the underlying cause of AUB. This pictorial review aims to illustrate the main causes of AUB from the point of view of diagnostic imaging and to show not-so-common cases that can be treated by means of interventional radiology.
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Affiliation(s)
- Sara Viganò
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Antonella Smedile
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Caterina Cazzella
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
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Bonito G, Masselli G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part I: Obstetric (Non-Fetal) Complications. Diagnostics (Basel) 2023; 13:2890. [PMID: 37761257 PMCID: PMC10528445 DOI: 10.3390/diagnostics13182890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology.
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Affiliation(s)
- Giacomo Bonito
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Gabriele Masselli
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Ren F, Liu G, Wang T, Li M, Guo Z. Unruptured ovarian ectopic pregnancy: Two case reports and literature review. Front Physiol 2022; 13:1036365. [PMID: 36388130 PMCID: PMC9641050 DOI: 10.3389/fphys.2022.1036365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/05/2022] [Indexed: 11/26/2022] Open
Abstract
In clinical practice, ovarian pregnancy is extremely rare and is always found to be ruptured. A definitive diagnosis for ruptured ovarian pregnancy is difficult to obtain. We present two cases of unruptured ovarian pregnancies detected during laparoscopy and review existing literature to better understand the clinical characteristics of ectopic pregnancies in this rare site. Intrauterine devices, assisted reproductive technology, and intrauterine operations are all high-risk factors in ovarian pregnancy. Moreover, menopause, abdominal pain, and vaginal bleeding are clinical manifestations. Ovarian pregnancy can be diagnosed using serum hCG, transvaginal ultrasound, and magnetic resonance imaging. Laparoscopy is the treatment of choice for ovarian pregnancy. It is recommended that the intact gestational sac be excised and the ovarian function be protected to the greatest extent possible during the operation. More definitive diagnosis of ovarian pregnancy must be reported in order to gain a better understanding of ovarian pregnancy.
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Affiliation(s)
- Fang Ren
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Gang Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tifang Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Meijun Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhiqiang Guo
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhiqiang Guo,
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Wu QL, Wang XM, Tang D. Ectopic pregnancy implanted under the diaphragm: A rare case report. World J Clin Cases 2021; 9:11437-11442. [PMID: 35071575 PMCID: PMC8717506 DOI: 10.12998/wjcc.v9.i36.11437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/08/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal pregnancy is a rare type of ectopic pregnancy. We describe here a case of ectopic pregnancy implanted under the surface of the diaphragm, presenting the particular features of imaging findings from ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).
CASE SUMMARY A 30-year-old woman presented with complaint of intermittent abdominal pain, that had begun 5 d earlier. She had no current or abnormal vaginal bleeding, and her serum human chorionic gonadotropin level (13372.08 IU/L) indicated pregnancy. Vaginal ultrasound showed a mixed echogenic mass in the right ovary. CT (plain) scan showed a curved high density mass beneath the subhepatic space. MRI scan showed a curved mixed signal, with restricted diffusion beneath the subhepatic space. Abdominal ultrasound demonstrated a mixed echogenic mass in the right lobe of the liver near the apex of the diaphragm, with a visible yolk sac and germ cell region with a bud. Subsequent laparoscopy visualized a dark red mass under the right diaphragm, which was resected completely. Histopathological examination of the resected mass confirmed an ectopic pregnancy. The recovery was swift and uneventful, and the patient was discharged to home.
CONCLUSION Ectopic pregnancy should be in the differential diagnostic workup (via multiple imaging modalities) of childbearing woman with unexplained abdominal pain.
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Affiliation(s)
- Qiang-Le Wu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Xiao-Man Wang
- Department of Ultrasound, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Dong Tang
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
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Diagnostic Accuracy of Preoperative Conventional MRI for Patients With Ectopic Pregnancy. Int Surg 2021. [DOI: 10.9738/intsurg-d-17-00117.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
To assess the utility of preoperative magnetic resonance imaging (MRI) in the diagnosis of tubal pregnancy.
Summary of background data
Most cases of ectopic pregnancy are tubal pregnancies. Preoperative accurate diagnosis including the location of the tubal pregnancy is important.
Method
We performed a retrospective single-center cohort study evaluating patients who underwent surgery for ectopic pregnancy from April 2004 to March 2016 and who underwent preoperative MRI. Sixty patients were enrolled in the study. Chorion confirmed at the tubal pregnancy site detected by MRI was defined as a correct diagnosis.
Results
Mean estimated gestational age at the time of MRI according to the last menstrual period was 7 weeks (median: 5 weeks; range: 3–10 weeks). Ectopic pregnancy was diagnosed by MRI in 57 cases, and all cases were either left or right tubal pregnancy. In 52 cases, the actual position matched the MRI findings. In 5 cases, the location of tubal ectopic pregnancy was different from that diagnosed by MRI, or no tubal pregnancy was observed intraoperatively. In 2 cases, no ectopic pregnancy site was observed on MRI, but tubal pregnancy was confirmed by surgery. In one case, an ectopic pregnancy site was not found, and the tube showed normal findings on MRI. The sensitivity of MRI diagnosis was 96.2%, specificity was 16.7%, positive predictive value was 91.1%, and negative predictive value was 33.3%.
Conclusion
In cases of ectopic pregnancy treated surgically, the sensitivity of MRI diagnosis, including identification of the location of ectopic pregnancy, is high.
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Kluckman ML, Schwope RB, Provagna AJ, Yauger BJ, Ramirez CI. The double corpus luteum: A novel sonographic sign of heterotopic pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:617-621. [PMID: 33761132 DOI: 10.1002/jcu.23006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Heterotopic pregnancy is a rare and highly morbid condition with simultaneous intrauterine and extra-uterine pregnancies. The early diagnosis of heterotopic pregnancy is difficult, owing to rarity of the condition and nonspecific clinical and laboratory findings. This case report introduces the "double corpus luteum" sign, a new sonographic and magnetic resonance imaging sign which is easily detectable and should raise the index of suspicion for heterotopic pregnancy. We present a surgically confirmed spontaneous heterotopic and angular pregnancy in a young woman without risk factors or assisted reproductive therapy to illustrate the utility of this novel sign.
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Affiliation(s)
- Matthew L Kluckman
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas, USA
- Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Alyssa J Provagna
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Belinda J Yauger
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Christina I Ramirez
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
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Investigation of clinical utility of contrast-enhanced MRI in the diagnosis of ectopic pregnancy. Clin Radiol 2020; 75:543-551. [PMID: 32209236 DOI: 10.1016/j.crad.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/20/2020] [Indexed: 11/22/2022]
Abstract
AIM To investigate whether contrast-enhanced (CE)-magnetic resonance imaging (MRI) improves identification of implantation site of ectopic pregnancy. MATERIALS AND METHODS This retrospective study enrolled 63 patients in whom implantation sites had been confirmed at histopathology. Two expert radiologists for gynaecological imaging and two inexpert radiologists independently reviewed non-CE MRI and a combination of non-CE and CE-MRI (non-CE+CE-MRI), then determined implantation site with a confidence level. The following MRI features were also evaluated: extrauterine gestational sac (GS)-like structure (shape, signal intensities at T1-weighted imaging [WI], T2WI, and diffusion-weighted imaging [DWI], presence of the three rings appearance, and distinct low intensity areas at T2WI, presence of tree or dot-like components, degree of contrast enhancement), fallopian tube (dilatation, dilatation with haematoma, degree of contrast enhancement, enhanced components within the tube), and ascites. These findings were compared for non-CE and non-CE+CE-MRI data, and for expert and inexpert groups. RESULTS The expert group identified implantation sites correctly in 58/63 (92%) cases for non-CE and non-CE+CE-MRI. In the inexpert group, the correct identification was improved from 54/63 (86%) using non-CE MRI to 58/63 (92%) using non-CE+CE-MRI, but was not significant (p=0.29). In comparison between non-CE and non-CE+CE-MRI, dilation of the fallopian tubes was observed more frequently (p=0.004) and the confidence level was elevated significantly in the non-CE+CE-MRI (p<0.0001) in the inexpert group. Intergroup comparison revealed that confidence level was significantly higher in the expert group than in the inexpert group using non-CE MRI (p<0.0001), although the difference was not significant at non-CE+CE MRI (p=0.49). CONCLUSION CE-MRI did not significantly improve correct identification of ectopic pregnancy implantation sites, although the addition of contrast enhancement did enable inexpert radiologists to diagnose confidently.
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Zhang N, Yang L, Wang Y, Li X, Zhang C, Xu J. Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome: A case report. Medicine (Baltimore) 2020; 99:e19649. [PMID: 32221090 PMCID: PMC7220081 DOI: 10.1097/md.0000000000019649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. This study aimed to report a case of primary hepatic pregnancy in a patient with polycystic syndrome. PATIENT CONCERNS A 30-year-old woman presented with vaginal bleeding after 63 days of amenorrhea. DIAGNOSIS The patient was initially diagnosed with liver ectopic pregnancy using abdominal ultrasound and abdominal computed tomography (CT). INTERVENTIONS The patient underwent laparoscopic exploration to reconfirm the gestational sac in the liver and abdominal surgery to remove liver gestation. The postoperative review of abdominal CT and the level of serum human chorionic gonadotropin (hCG) was performed. OUTCOMES The postoperative pathological examination revealed a fluffy tissue in the liver tissue and a blood clot. The patient's vital signs were normal, and she was advised regular follow-up after discharge from the hospital. One month later, the serum hCG level reduced to 0.32 mIU/mL (reference range 0-5 mIU/mL). LESSONS If the level of beta-human chorionic gonadotropin (β-HCG) is higher than normal in women of childbearing age and no gestational sac is found in the uterine cavity, the location of pregnancy and gestational sac should be positively confirmed. Also, the possibility of ectopic pregnancy in the abdominal cavity should be considered, and the relevant imaging and biochemical examinations should be improved to avoid delay in diagnosis and treatment.
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Affiliation(s)
- Ning Zhang
- School of Clinical Medicine, Jining Medical University
| | | | | | - Xiaoyu Li
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Chao Zhang
- School of Clinical Medicine, Jining Medical University
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Tonolini M, Foti PV, Costanzo V, Mammino L, Palmucci S, Cianci A, Ettorre GC, Basile A. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion. Insights Imaging 2019; 10:119. [PMID: 31853900 PMCID: PMC6920287 DOI: 10.1186/s13244-019-0808-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/18/2019] [Indexed: 01/06/2023] Open
Abstract
Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation. The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Valeria Costanzo
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Luca Mammino
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Varma R, Parikh B, Beyer C, Ghosh S, Du D, Aaron G, Kamath A. Magnetic resonance imaging of tubal ectopic pregnancy: correlation with intraoperative findings. Clin Imaging 2019; 58:194-200. [PMID: 31563822 DOI: 10.1016/j.clinimag.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity (ACOG Committee on Practice Bulletins, 2018 [1]). Ectopic pregnancy is occasionally diagnosed with MRI. Particularly, when ultrasound is nondiagnostic, it is essential that radiologists are able to recognize findings of ectopic pregnancy on MRI in the emergent setting. This novel case report demonstrates specific MR imaging signs recently proposed in the literature to help identify a tubal gestational sac, the most common type of ectopic pregnancy, and is the first reported case demonstrating intraoperative correlation with MRI findings of tubal ectopic pregnancy.
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Affiliation(s)
- Ross Varma
- Mount Sinai West Department of Radiology, 1000 10th Ave, New York, NY 10019, United States of America.
| | - Bijal Parikh
- Mount Sinai West Department of Obstetrics and Gynecology, United States of America
| | - Christopher Beyer
- Mount Sinai West Department of Obstetrics and Gynecology, United States of America
| | - Sharmila Ghosh
- Mount Sinai West Department of Pathology, United States of America
| | - Diane Du
- Mount Sinai West Department of Pathology, United States of America
| | - Gila Aaron
- Mount Sinai West Department of Obstetrics and Gynecology, United States of America
| | - Amita Kamath
- Mount Sinai West Department of Radiology, 1000 10th Ave, New York, NY 10019, United States of America
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Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy. Abdom Radiol (NY) 2018; 43:3425-3435. [PMID: 29713741 DOI: 10.1007/s00261-018-1604-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the MRI appearances of tubal and non-tubal implantation sites in ectopic pregnancy. CONCLUSION Transvaginal ultrasound is the primary imaging modality in ectopic pregnancy and MRI is used as a problem-solving tool in selected indications as detailed in the article. MRI features of tubal, interstitial, cervical, cesarean scar, cornual, ovarian, abdominal, and heterotopic pregnancies are provided to familiarize the radiologists with their appearances thereby assisting them in making early and accurate diagnosis.
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12
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To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study. Eur Radiol 2018; 28:2444-2454. [PMID: 29349699 DOI: 10.1007/s00330-017-5237-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the accuracy of pelvic MRI in the diagnosis of unusual ectopic pregnancy (EP), when ultrasound (US) examination is inconclusive. METHODS We retrospectively reviewed the medical records of 150 patients with suspected EP. Clinical, US and MRI features of 15 unusual EPs were analysed. Two radiologists independently reviewed each case resolving by consensus any diagnostic discrepancy. Interobserver agreement was assessed using the Cohen κ test. RESULTS MRI displayed a gestational sac-like structure surrounded by a thick wall in all cases. The thick wall displayed hyperintensity in 41 %, isointensity in 35 % and hypointensity in 24 % of cases on T1-weighted images. Diffusion- and fat saturation T1-weighted images were the most accurate sequences, as they enabled identification of 15/15 and 14/15 patients, respectively. Although US was false negative in detecting cervical and uterine infiltration underlying the caesarean scar, MRI was able to identify the invasion. Interobserver agreement was very good for all sequences (κ=0.892-1.0). CONCLUSIONS MRI plays an important role in the early diagnosis of unusual EP. It should be considered after negative US findings, providing accurate evaluation of the site and the possible infiltration of these lesions, which help in the management of these patients. KEY POINTS • MRI is being increasingly used as a problem-solving modality in ectopic pregnancy. • MRI plays an important role in early diagnosis of unusual ectopic pregnancy. • Knowledge of MRI features in EP is essential to determinate appropriate management.
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Sagawa H. [4. Magnetic Resonance Imaging of Gynecological Emergency Disease 4-1. Basic Scanning Method]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:731-738. [PMID: 30033970 DOI: 10.6009/jjrt.2018_jsrt_74.7.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Hajime Sagawa
- Clinical Radiology Service, Kyoto University Hospital
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14
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Durur-Karakaya A, Seker M, Durur-Subasi İ. Diffusion-weighted imaging in ectopic pregnancy: ring of restriction sign. Br J Radiol 2017; 91:20170528. [PMID: 29023142 DOI: 10.1259/bjr.20170528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To demonstrate the diffusion-weighted imaging (DWI) findings of ectopic pregnancy (EP) and introduce the "ring of restriction" sign by discussing possible causes. METHODS Between January 2014 and January 2017, patients with EP and examined by MRI on a 3T scanner were retrospectively evaluated. MRI and DWI findings were recorded. RESULTS A total of 40 patients were diagnosed with EP at our university hospital, 8 of whom (20%) were evaluated by MRI and DWI. All of them were haemodynamically and clinically stable and could be imaged adequately. Locations were ovary (n = 3, 37.5%), tuba (n = 2, 25%), Caesarean section scar (n = 2, 25%) and parauterine (n = 1, 12.5%). In all eight EPs, the gestational sac diameter was compatible with 7-9 weeks. With DWI, the gestational sac was seen as a thick-walled cyst-like structure. The thick wall showed diffusion restrictions in all patients (ring of restriction sign). CONCLUSIONS DWI through its cellular and molecular evidence may contribute diagnosis of EP. Advances in knowledge: Being aware of the EP wall shows diffusion restriction (ring of restriction) avoids interpretation errors especially in appropriate clinical setting with no need for contrast material.
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Affiliation(s)
- Afak Durur-Karakaya
- 1 Department of Radiology, Faculty of Medicine, Istanbul Medipol University , Istanbul, Turkey
| | - Mehmet Seker
- 1 Department of Radiology, Faculty of Medicine, Istanbul Medipol University , Istanbul, Turkey
| | - İrmak Durur-Subasi
- 2 University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology , Ankara, Turkey xs
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15
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Primary hepatic pregnancy. Clin Res Hepatol Gastroenterol 2017; 41:241-242. [PMID: 27939097 DOI: 10.1016/j.clinre.2016.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/24/2016] [Accepted: 10/24/2016] [Indexed: 02/04/2023]
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Dunn DP, Kelsey NR, Lee KS, Smith MP, Mortele KJ. Non-oncologic applications of diffusion-weighted imaging (DWI) in the genitourinary system. ACTA ACUST UNITED AC 2016; 40:1645-54. [PMID: 26109511 DOI: 10.1007/s00261-015-0471-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Diffusion-weighted imaging (DWI) has become an increasingly used tool in abdominal and pelvic magnetic resonance imaging (MRI), primarily in the oncologic setting. DWI sequences are being added to routine MRI protocols at many institutions, and as its use has spread, more non-oncologic applications have been explored. The purpose of this article is to provide a review of DWI applications in inflammatory, infectious, autoimmune-mediated, and ischemic processes affecting the genitourinary system.
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Affiliation(s)
- Dell P Dunn
- Department of Radiology, David Grant Medical Center, 101 Bodin Cir, Travis AFB, CA, 94535, USA,
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Gupta R, Bajaj SK, Kumar N, Chandra R, Misra RN, Malik A, Thukral BB. Magnetic resonance imaging - A troubleshooter in obstetric emergencies: A pictorial review. Indian J Radiol Imaging 2016; 26:44-51. [PMID: 27081223 PMCID: PMC4813073 DOI: 10.4103/0971-3026.178292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The application of magnetic resonance imaging (MRI) in pregnancy faced initial skepticism of physicians because of fetal safety concerns. The perceived fetal risk has been found to be unwarranted and of late, the modality has attained acceptability. Its role in diagnosing fetal anomalies is well recognized and following its safety certification in pregnancy, it is finding increasing utilization during pregnancy and puerperium. However, the use of MRI in maternal emergency obstetric conditions is relatively limited as it is still evolving. In early gestation, ectopic implantation is one of the major life-threatening conditions that are frequently encountered. Although ultrasound (USG) is the accepted mainstay modality, the diagnostic predicament persists in many cases. MRI has a role where USG is indeterminate, particularly in the extratubal ectopic pregnancy. Later in gestation, MRI can be a useful adjunct in placental disorders like previa, abruption, and adhesion. It is a good problem-solving tool in adnexal masses such as ovarian torsion and degenerated fibroid, which have a higher incidence during pregnancy. Catastrophic conditions like uterine rupture can also be preoperatively and timely diagnosed. MRI has a definite role to play in postpartum and post-abortion life-threatening conditions, e.g., retained products of conception, and gestational trophoblastic disease, especially when USG is inconclusive or inadequate.
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Affiliation(s)
- Rohini Gupta
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunil Kumar Bajaj
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nishith Kumar
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ranjan Chandra
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ritu Nair Misra
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amita Malik
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Brij Bhushan Thukral
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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19
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A Case of Ovarian Pregnancy Diagnosed by MRI. Case Rep Obstet Gynecol 2015; 2015:143031. [PMID: 26491583 PMCID: PMC4600503 DOI: 10.1155/2015/143031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/13/2015] [Indexed: 12/26/2022] Open
Abstract
Ovarian pregnancy is a rare form of ectopic pregnancy, causing a great diagnostic challenge. We report a case of ovarian pregnancy in a 42-year-old woman, in whom MRI successfully demonstrated the implantation in the ovary. Transvaginal ultrasonography showed an echogenic mass in the right ovary but failed to demonstrate tubal pregnancy. T2-weighted MR images disclosed a gestational sac structure in the right ovary, which exhibited heterogeneous high intensity intermingled with punctate foci of distinct low intensity. MRI may be a useful tool for diagnosing ovarian pregnancy, by demonstrating a gestational sac in the ovary.
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Si MJ, Gui S, Fan Q, Han HX, Zhao QQ, Li ZX, Zhao JM. Role of MRI in the early diagnosis of tubal ectopic pregnancy. Eur Radiol 2015; 26:1971-80. [DOI: 10.1007/s00330-015-3987-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/28/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
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Revisiting the role of MRI in gynecological emergencies – An institutional experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Fukuda T, Inoue H, Toyama Y, Ichida T, Uzawa Y, Monma M, Kusaka T, Kohata Y. Bilateral tubal and intrauterine pregnancies diagnosed at laparoscopy. J Obstet Gynaecol Res 2014; 40:2114-7. [PMID: 25228435 DOI: 10.1111/jog.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 03/21/2014] [Indexed: 12/17/2022]
Abstract
A 32-year-old woman had bilateral tubal and intrauterine pregnancies after hyperovulation with clomiphene citrate and subsequent artificial insemination with husband's semen. Laparoscopic surgery revealed bilateral tubal pregnancies. Salpingectomy was performed on the left tube and linear salpingotomy was performed on the right tube. The postoperative course was uneventful. The patient delivered a healthy girl vaginally at 39 weeks' gestation. Only eight cases with bilateral and intrauterine pregnancy have been reported. The live birth rate of bilateral tubal pregnancy and intrauterine pregnancy is 60% (6/10), which is similar to that of heterotopic pregnancy. Laparoscopic surgery is effective for confirming the diagnosis and treating heterotopic pregnancy.
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Affiliation(s)
- Takanori Fukuda
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kamakura City, Japan
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Contrast-enhanced multiphasic CT and MRI of primary hepatic pregnancy: a case report and literature review. ACTA ACUST UNITED AC 2014; 39:731-5. [DOI: 10.1007/s00261-014-0101-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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