How Can Pelvic MRI with Diffusion-Weighted Imaging Help My Pregnant Patient?

Abstract

The purpose of this review is to explain how diffusion-weighted imaging (DWI) is used during magnetic resonance imaging (MRI) exams in pregnant patients for specific maternal indications, including evaluation of acute pelvic pain, adnexal masses, cancer diagnosis and staging, and morbidly adherent placenta. While ultrasound is often the appropriate initial imaging for evaluating a pregnant patient, MRI can be helpful when a pelvic ultrasound is indeterminate. MRI has advantages in that it does not use ionizing radiation and has shown no known deleterious effects to the fetus. The use of gadolinium-based contrast is controversial during pregnancy. DWI is a functional sequence performed during an MRI exam, which is valuable in the absence of gadolinium contrast, and can increase the visibility of inflammation, abscesses, and tumors. Case examples will be presented to demonstrate the utility and added value of DWI over conventional anatomic T1- and T2-weighted imaging in diagnosis of maternal disease in the pregnant patient's pelvis.

How Could Nanomedicine Improve the Safety of Contrast Agents for MRI during Pregnancy?

“…Pregnancy-associated anatomical changes, organ displacement (taking place e cially during the second and third trimesters), physiological leukocytosis (elevated w blood cell count), and non-specificity of symptoms such as abdominal pain nausea vomiting, render the diagnosis of various pathologies on pregnant patients harder [14 Appendicitis is one of the most common non-obstetric causes of abdominal pa pregnancy [13]. An early diagnosis is paramount to avoid unnecessary or negative s cal interventions and reduce the risk of fetal loss associated with the eventuality of ap diceal rupture or abscess [13,14,16]. MRI has been indicated by many as a powerful d nostic tool for appendicitis, especially after inconclusive ultrasound examina [13,14,16,17].…”

“…In pathological ditions, according to how deeply placental tissues invade the myometrium, three can be distinguished: Appendicitis is one of the most common non-obstetric causes of abdominal pain in pregnancy [13]. An early diagnosis is paramount to avoid unnecessary or negative surgical interventions and reduce the risk of fetal loss associated with the eventuality of appendiceal rupture or abscess [13,14,16]. MRI has been indicated by many as a powerful diagnostic tool for appendicitis, especially after inconclusive ultrasound examinations [13,14,16,17].…”

MRI of Acute Gynecologic Conditions

“…Diffusion‐weighted imaging (DWI) may be utilized to improve the accuracy of evaluating acute processes in the absence of intravenous contrast . DWI can be helpful in the assessment of tuboovarian abscess: restricted diffusion will be demonstrable due to the presence of purulent contents . Additionally, DWI can help in the diagnosis of ovarian infarction in the absence of intravenous contrast …”

“…TOA can demonstrate areas of restricted diffusion due to the presence of purulent contents (Fig. ) . TOA can be difficult to differentiate from an ovarian neoplasm on all imaging modalities, including MRI, and requires clinical history to make the appropriate diagnosis.…”

Role of Ultrasound in the Assessment and Differential Diagnosis of Pelvic Pain in Pregnancy

“…No reports document the detrimental effects of MRI on the foetus development. In recent years, there has been a growing interest in the use of MRI in abdominal emergencies during pregnancy, particularly in the diagnosis of appendicitis, the most common cause of acute abdomen in pregnancy [17,18]. The American College of Radiology does not recommend the use of gadolinium during pregnancy due to its passage through the placenta to the foetal circulation with excretion by the foetal kidneys into the amniotic fluid and indefinite persistence in this compartment [19].…”