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Magnetic Resonance Imaging of Acute Adnexal Pathology. Magn Reson Imaging Clin N Am 2023; 31:109-120. [DOI: 10.1016/j.mric.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sheng S, Zhang H, Pan Z, Li T, Wang X, Shi M, Wang F. Treatment of heterotopic cervical pregnancy by ultrasound-guided hysteroscopy: A case report and literature review. Medicine (Baltimore) 2022; 101:e32177. [PMID: 36482618 PMCID: PMC9726398 DOI: 10.1097/md.0000000000032177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heterotopic cervical pregnancy is a rare event of ectopic pregnancy with an incidence rate of < 1%. Herein, we report a rare case of successful treatment of heterotopic pregnancy following an in vitro fertilization-embryo transfer using ultrasound-guided hysteroscopy. In order to choose the best treatment option, we reviewed the clinical treatments and discussion of heterotopic cervical pregnancy over the last 15 years. METHODS The heterotopic pregnancy was terminated using ultrasound-guided hysteroscopy; however, the intrauterine pregnancy was maintained. We searched for the keywords "cervical pregnancy combined with intrauterine pregnancy," "compound pregnancy," "assisted reproductive technology," "cervical pregnancy," and "ectopic pregnancy" on PubMed to include articles published in the last 15 years. RESULTS The patient underwent an emergency cervical cerclage at 22 weeks' gestation for cervical insufficiency and delivered a healthy newborn at 38 weeks' gestation by transvaginal compliance. Twenty-one relevant case reports were selected. After analysis and discussion, we found that assisted reproductive technology is more likely to lead to heterotopic pregnancy than unassisted reproduction. Most women requesting the preservation of intrauterine embryos opted for surgical termination of cervical pregnancy and achieved the ideal outcomes. CONCLUSION More attention should be paid to the diagnosis and treatment of heterotopic pregnancies to obtain the most optimal pregnancy outcome and long-term prognosis. Hysteroscopic surgery is a completely feasible cervical pregnancy treatment option with less postoperative impact on the mother and the intrauterine fetus.
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Affiliation(s)
- Shuman Sheng
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Haomeng Zhang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Zhengwu Pan
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Tao Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Xin Wang
- Department of Ultrasound Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Min Shi
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Fei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People’s Republic of China
- * Correspondence: Fei Wang, Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, Shandong 250021, People’s Republic of China (e-mail: )
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Sheng S, Zhang H, Li T, Wang X, Shi M, Wang F. WITHDRAWN: Treatment of heterotopic pregnancy after in vitro fertilization-embryo transfer by ultrasound-guided hysteroscopy: A case report. Int J Surg Case Rep 2022. [DOI: 10.1016/j.ijscr.2022.107472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Abstract
OBJECTIVE. The purpose of this case-based article is to discuss the pathophysiologic findings, common pathways of spread, and imaging features associated with Krukenberg tumors. CONCLUSION. Not all ovarian metastases are Krukenberg tumors. Krukenberg tumors are the most common subtype of ovarian metastases, and they are histologically characterized by signet ring cell mucinous features. Common primary tumor sites include the stomach or colon. Although often difficult, distinguishing between Krukenberg tumors and primary ovarian malignancy on imaging is important because of management and prognostic implications.
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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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Somberg Gunther M, Kanmaniraja D, Kobi M, Chernyak V. MRI of Acute Gynecologic Conditions. J Magn Reson Imaging 2019; 51:1291-1309. [PMID: 31833165 DOI: 10.1002/jmri.27002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/08/2022] Open
Abstract
Although usually not a first-line imaging modality in the setting of acute pelvic pain, magnetic resonance imaging (MRI) is able to depict and characterize a wide range gynecologic diagnoses with high accuracy. Lack of ionizing radiation renders MRI particularly useful for assessment of pregnant women and children. Furthermore, inherent high soft-tissue resolution of MRI allows accurate diagnosis without intravenous contrast use, which is advantageous for patients with renal insufficiency and pregnant patients. Familiarity with the typical MRI appearance of various acute gynecologic conditions helps establish the correct diagnosis. This article reviews the common MRI findings of acute gynecologic processes, in both pregnant and nonpregnant patients. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1291-1309.
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Affiliation(s)
| | | | - Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
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7
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A. Lea R, K. Niakan K. Human germline genome editing. Nat Cell Biol 2019; 21:1479-1489. [DOI: 10.1038/s41556-019-0424-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022]
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Kurzbard-Roach N, Jha P, Poder L, Menias C. Abdominal and pelvic imaging findings associated with sex hormone abnormalities. Abdom Radiol (NY) 2019; 44:1103-1119. [PMID: 30483844 DOI: 10.1007/s00261-018-1844-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hormones are substances that serve as chemical communication between cells. They are unique biological molecules that affect multiple organ systems and play a key role in maintaining homoeostasis. In this role, they are usually produced from a single organ and have defined target organs. However, hormones can affect non-target organs as well. As such, biochemical and hormonal abnormalities can be associated with anatomic changes in multiple target as well as non-target organs. Hormone-related changes may take the form of an organ parenchymal abnormality, benign neoplasm, or even malignancy. Given the multifocal action of hormones, the observed imaging findings may be remote from the site of production, and may actually be multi-organ in nature. Anatomic findings related to hormone level abnormalities and/or laboratory biomarker changes may be identified with imaging. The purpose of this image-rich review is to sensitize radiologists to imaging findings in the abdomen and pelvis that may occur in the context of hormone abnormalities, focusing primarily on sex hormones and their influence on these organs.
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Affiliation(s)
- Nicole Kurzbard-Roach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Santos-Ribeiro S, Mackens S, Racca A, Blockeel C. Towards complication-free assisted reproduction technology. Best Pract Res Clin Endocrinol Metab 2019; 33:9-19. [PMID: 30473208 DOI: 10.1016/j.beem.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assisted reproductive technology (ART) has vastly improved over the last 40 years, from a frequently unsuccessful and complicated procedure requiring hospital admission and routine laparoscopy to a fairly simple outpatient technique with relatively high success rates. However, it is important to stress that ART is not without risk and medical complications may still occur. The incidence of most of these ART-related complications is associated with how women undergo ovarian stimulation. For this reason, physicians should be aware that a carefully thought-out ovarian stimulation protocol and cycle monitoring are of paramount importance to maximise the success of the treatment while avoiding potentially life-threating complications to occur in this frequently otherwise healthy patient population. This review discusses the rationale and evolution of ovarian stimulation strategies over the years and the current developments towards finding a balance between the retrieval of a sufficient number of oocytes and ART-related complication prevention.
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Affiliation(s)
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
| | - Annalisa Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, Genova 16132, Italy.
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium; Department of Obstetrics and Gynaecology, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia.
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Hirshberg B, Rheinboldt M. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. Emerg Radiol 2019; 26:205-219. [PMID: 30631995 DOI: 10.1007/s10140-018-01665-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023]
Abstract
Over the past 40 years since the first in vitro fertilization was performed, both the role of assisted reproductive technology (ART) in establishing viable pregnancy as well as the available treatment options have expanded enormously. Annually in the USA, nearly 2% of pregnancies now employ some form of ART assistance, with in vitro fertilization (IVF) being the most commonly utilized methodology. Both maternal and fetal risks are elevated in ART pregnancies, the latter including adverse outcome due to both increased gestational number as well as advanced maternal age. Maternal risks may be divided into locoregional and systemic complications. Adverse pelvic complications include those relating to gamete harvesting and transfer, ovarian hyperstimulation, the sequela of ectopic and heterotopic pregnancies, as well as ovarian torsion, all of which are elevated in the ART cohort. Ovarian hyperstimulation syndrome is the most commonly encountered complication, with both systemic and pelvic features relating to increased vascular permeability, hemoconcentration, and ascites. While life-threatening cases are relatively rare, moderate and severe manifestations may occur in up to 10% of ART cycles and, as such, are a not infrequent cause for ER visitation. Familiarity with the clinical and imaging manifestations of ART complications as well as their prognostic implications will facilitate a timely diagnosis and assist the interpreting radiologist in best expediting appropriate clinical care. In this article, we will briefly discuss the current methodology of ART then present an imaging-based multimodality review of the potentially encountered adverse maternal sequela, highlighting key diagnostic features and differential considerations as well as potential prognostic implications.
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Warzecha D, Szymusik I, Grzechocińska B, Cyganek A, Kociszewska-Najman B, Mazanowska N, Madej A, Pazik J, Wielgoś M, Pietrzak B. In Vitro Fertilization and Pregnancy Outcomes Among Patients After Kidney Transplantation: Case Series and Single-Center Experience. Transplant Proc 2018; 50:1892-1895. [DOI: 10.1016/j.transproceed.2018.02.144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 11/15/2022]
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Chu K, Zhang Q, Sun N, Ding H, Li W. Conservative laparoscopic management of adnexal torsion based on a 17-year follow-up experience. J Int Med Res 2018; 46:1685-1689. [PMID: 29486636 PMCID: PMC6091833 DOI: 10.1177/0300060517754025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Laparoscopic unwinding of adnexal torsion has been proposed for decades. However, this technique is still controversial regarding the concern of thromboembolic events. We present two cases of conservative laparoscopic management of adnexal torsion. In the first case, a 16-year-old adolescent with serous cystadenoma was successfully managed by untwisting and cystectomy. We followed up this patient for 17 years with regular re-examinations in our hospital. To the best of our knowledge, this is the longest follow-up reported of this condition. In the second case, a 32-year-old infertile woman who received oocyte retrieval 3 days before being admitted to hospital was referred to hospital with right ovarian torsion. We treated her successfully based on our long-term follow-up experience, and she is now asymptomatic and in her 7th month of pregnancy.
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Affiliation(s)
- Kun Chu
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qing Zhang
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ningxia Sun
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haixia Ding
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Li
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Bilateral Tubal Pregnancy without Known Risk Factor. Case Rep Obstet Gynecol 2017; 2017:4356036. [PMID: 29181210 PMCID: PMC5664235 DOI: 10.1155/2017/4356036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022] Open
Abstract
Spontaneous bilateral ectopic gestation is very rare. The authors report a case diagnosed and taken care of at Yalgado Ouedraogo Teaching Hospital, Ouagadougou. It was a 30-year-old patient with no known pathological history. She had presented at the obstetric emergencies with a state of hypovolemic shock by haemoperitoneum with digestive disorders, pelvic pain, vaginal bleeding, and a mention of delayed menstruation. The ultrasound coupled with the urinary immunological pregnancy test confirmed the diagnosis of ruptured ectopic pregnancy and a bilateral form was suspected. A laparotomy in emergency confirmed the diagnosis of bilateral ectopic gestation with a right ampullary unruptured pregnancy and a left isthmic ruptured gestation. A bilateral salpingectomy was performed and counseling was made for the use of medical help of procreation in case of future need of pregnancy.
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Rao A. Potential imaging findings following assisted reproduction: complications and clinical implications. Emerg Radiol 2017; 25:73-86. [PMID: 28988371 DOI: 10.1007/s10140-017-1561-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 11/24/2022]
Abstract
Recent rapid advances in assisted reproduction (ART) have led to global increase in usage of in vitro fertilization. This in turn has resulted in clinicians and imaging specialists encountering increase in complications associated with ART. The specialists dealing with infertility should be aware of potential complications associated with ART. Early diagnosis of these problems is based on clinician's suspicion and radiologist's awareness of these complications. Many of these conditions may be life threatening. Hence, early diagnosis and treatment of these complications can safeguard the fetal and maternal health.
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Affiliation(s)
- Anuradha Rao
- Associate Consultant, Apollo Hospitals, Bangalore, Karnataka, 560078, India.
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Phillips CH, Wortman JR, Ginsburg ES, Sodickson AD, Doubilet PM, Khurana B. First-trimester emergencies: a radiologist's perspective. Emerg Radiol 2017; 25:61-72. [PMID: 28948411 DOI: 10.1007/s10140-017-1556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this article is to help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. First-trimester fetal development is a stepwise process that can be challenging to evaluate in the emergency department (ED) setting. This is due, in part, to the complex anatomy of early pregnancy, subtlety of the sonographic findings, and the fact that fewer than half of patients with ectopic pregnancy present with the classic clinical findings of a positive pregnancy test, vaginal bleeding, pelvic pain, and tender adnexa. Ultrasound (US) has been the primary approach to diagnostic imaging of first-trimester emergencies, with magnetic resonance imaging (MRI) and computed tomography (CT) playing a supportive role in a small minority of cases. Familiarity with the sonographic findings diagnostic of and suspicious for early pregnancy failure, ectopic pregnancy, retained products of conception, gestational trophoblastic disease, failed intrauterine devices, and complications associated with assisted reproductive technology (ART) is critical for any emergency radiologist. Evaluation of first-trimester emergencies is challenging, and knowledge of key imaging findings and familiarity with management pathways are needed to ensure early diagnosis and response.
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Affiliation(s)
- Catherine H Phillips
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jeremy R Wortman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Elizabeth S Ginsburg
- Department of Infertility and Reproductive Surgery, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Asch E, Wei J, Mortele KJ, Humm K, Thornton K, Levine D. Magnetic resonance imaging performance for diagnosis of ovarian torsion in pregnant women with stimulated ovaries. FERTILITY RESEARCH AND PRACTICE 2017; 3:13. [PMID: 28904809 PMCID: PMC5585973 DOI: 10.1186/s40738-017-0040-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022]
Abstract
Background To determine if asymmetric ovarian edema on non-contrast MRI can be used to distinguish torsed from non-torsed stimulated ovaries in pregnant women. Methods In this retrospective study, our radiology database was searched for women who were pregnant and who had undergone ovarian stimulation and underwent MRI abdomen/pelvis from 1/2000–12/2012. At our institution, ultrasound is typically performed as a first line study for pregnant women with pelvic pain, with MR for those patients with indeterminate findings. 64 pregnant women (gestational age range 3–37 weeks) were included. MRI indication, prospective interpretation, operative diagnosis, and follow-up were recorded. Two blinded radiologists (with a third radiologist tie-breaker) independently measured and described the ovaries, including the likelihood of torsion. If one or both ovaries/adnexa had an underlying lesion such as a dermoid, cystadenoma, or abscess, the patient was excluded from size and signal intensity comparison (N = 14). For the remaining 50 women, comparison was made of the ovaries in women with normal ovaries (N = 27), stimulated ovaries without torsion (N = 11), non-stimulated ovaries with torsion (N = 3), and stimulated ovaries with torsion (N = 3). Patients with asymmetric ovarian edema without stimulation or torsion (N = 3) and with polycystic ovary syndrome (N = 3) were analyzed separately. Results Average normal ovarian length was 3.2 cm, compared to 4.5 cm for asymmetric edema and 5.6–8.8 cm for the other four groups. Average difference in greatest right and left ovarian diameter was 19% for normal ovaries compared to 24–37% for the other 5 groups. Asymmetric signal on T2-weighted imaging (T2WI) was seen in 12% (3/27) of normal ovaries compared to 9% (1/11) of stimulated patients without torsion, 33% (1/3) of patients with PCOS and 67% (2/3) of patients with torsion both without and with stimulation. The correct diagnosis of torsion was made prospectively in 5/6 cases but retrospectively in only 3/6 cases. In patients with stimulation, correct diagnosis of torsion was made in 2/3 cases prospectively (both with asymmetric T2 signal) and retrospectively in only 1/3 cases. In 13/64 patients, other acute gynecologic and non-gynecologic findings were diagnosed on MRI. Conclusions Enlarged edematous ovary can be seen with ovarian stimulation, ovarian torsion, or both. Although asymmetric ovarian edema occurred more frequently in patients with torsion than without, in pregnant patients with stimulated ovaries referred for MRI (typically after non-diagnostic ultrasound), ovarian torsion could not be confidently diagnosed or excluded retrospectively with non-contrast MRI.
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Affiliation(s)
- Elizabeth Asch
- Department of Radiology, Division of Ultrasound, Brigham and Women's Hospital, 75 Francis Street, L1, Boston, MA 02115 USA
| | - Jesse Wei
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA USA
| | - Koenraad J Mortele
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA USA
| | - Kathryn Humm
- George Washington University Hospital, 22nd and I Street, NW, 6th Floor, Washington, DC USA
| | - Kim Thornton
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA USA
| | - Deborah Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA USA
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Li JB, Kong LZ, Yang JB, Niu G, Fan L, Huang JZ, Chen SQ. Management of Heterotopic Pregnancy: Experience From 1 Tertiary Medical Center. Medicine (Baltimore) 2016; 95:e2570. [PMID: 26844463 PMCID: PMC4748880 DOI: 10.1097/md.0000000000002570] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The objective of this study is to summarize the experiences of our department in the management of heterotopic pregnancy (HP) and to analyze the influence of different treatment modality on the viable intrauterine pregnancy.There were 64 patients diagnosed as HP in the Department of Gynecology and Obstetrics in our hospital between January 2003 and June 2014, 52 HP patients with viable intrauterine pregnancy were included and analyzed in our study. Interventions included expectant management, surgical management and transabdominal sonographic guided transvaginal aspiration of ectopic gestational embryo (embryo aspiration) management.Main outcome measures are maternal outcome and pregnancy outcome.In expectant management group, 4 patients suffered rupture of ectopic pregnancy, 6 patients transferred to surgical management, 1 patient suffered a fever of 40.4°C, the abortion rate was 5% (1/20). In surgical management group, emergency surgery was performed in 9 patients with unstable hemodynamics and 3 patients with stable hemodynamics, 1 patient suffered uterine rupture 5 weeks later and dead fetus was demonstrated, 1 patient suffered urinary retention postoperative, the abortion rate was 14.8% (4/27). In embryo aspiration management group, 1 patient needed another embryo aspiration, all patients were eventful and no abortion was observed.In our retrospective study, transabdominal sonographic guided aspiration of ectopic gestational embryo has the best maternal outcome and the lowest abortion rate, surgical management group shows the highest abortion rate, and expectant management presents the worst maternal outcome.
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Affiliation(s)
- Jin-Bo Li
- From the Department of Gynecology and Obstetrics, The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, Guangzhou, P.R. China
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Gynecologic Emergencies: Findings Beyond US and Advances in Management. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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de Ravello L, Folkema A, Tulloch S, Taylor M, Reilley B, Hoover K, Holman R, Creanga A. Ectopic pregnancy among American Indian and Alaska Native women, 2002-2009. Matern Child Health J 2015; 19:733-8. [PMID: 25023759 PMCID: PMC4303537 DOI: 10.1007/s10995-014-1558-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15-44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002-2009. We used 2002-2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15-44 years receiving care at IHS-affiliated facilities during 2002-2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15-19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35-39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1-2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002-2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women.
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Affiliation(s)
- Lori de Ravello
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS F-74, Atlanta, GA 30341, USA
| | - Arianne Folkema
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS A-30, Atlanta, GA 30333, USA
| | - Scott Tulloch
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS E-45, Atlanta, GA 30333, USA
| | - Melanie Taylor
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, c/o ADHS, 1845 E. Roosevelt St., Phoenix, AZ 85006, USA
| | - Brigg Reilley
- HIV/AIDS Prevention Program, Division of Epidemiology and Disease Prevention, Indian Health Service, 5300 Homestead Rd NE, Albuquerque, NM 87110, USA
| | - Karen Hoover
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS E-45, Atlanta, GA 30333, USA
| | - Robert Holman
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS A-30, Atlanta, GA 30333, USA
| | - Andreea Creanga
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS F-74, Atlanta, GA 30341, USA
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Wang LL, Chen X, Ye DS, Liu YD, He YX, Guo W, Chen SL. Misdiagnosis and delayed diagnosis for ectopic and heterotopic pregnancies after in vitro fertilization and embryo transfer. ACTA ACUST UNITED AC 2014; 34:103-107. [PMID: 24496687 DOI: 10.1007/s11596-014-1239-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/18/2013] [Indexed: 10/25/2022]
Abstract
This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy (EP) and heterotopic pregnancy (HP) after in vitro fertilization and embryo transfer (IVF-ET) in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP: early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8% (125/3286) and 0.8% (27/3286) respectively for IVF/ICSI-ET cycle, and 3.8% (55/1431) and 0.7% (10/1431) respectively for frozen- thawed embryo transfer (FET) cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories: (1) clinician factors: misunderstanding of patients' medical history, insufficient training in ultrasonography and unawareness of EP and HP; (2) patient factors: noncompliance with medical orders and lack of communication with clinicians; (3) complicated conditions of EP: atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.
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Affiliation(s)
- Lin-Lin Wang
- Centre for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xin Chen
- Centre for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - De-Sheng Ye
- Centre for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yu-Dong Liu
- Centre for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yu-Xia He
- Centre for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Wei Guo
- Centre for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Shi-Ling Chen
- Centre for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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