MR features of ectopic pregnancy

Abstract

Ectopic pregnancy (EP), in which a fertilized ovum implants outside the uterine cavity, is the leading cause of pregnancy-related death in the first trimester. EP is usually suspected by a positive pregnancy test and an empty uterus on transvaginal sonography (TVS). Although TVS is the initial modality of choice, it may occasionally fail to demonstrate the implantation site. When TVS findings are indeterminate, magnetic resonance imaging (MRI) may provide better delineation of the focus of EP owing to its excellent tissue contrast. The key MRI features of EP include gestational sac (GS)-like structures that typically appear as a cystic sac-like structure, frequently associated with surrounding acute hematoma of distinct low intensity on T2-weighted images. In tubal pregnancy, an enhanced tubal wall on postcontrast images may be another diagnostic finding. Ruptured EP is inevitably associated with acute hematoma outside these structures. In intrauterine EP, recognition of the relationship between GS-like structure and the myometrium can aid in differentiating from normal pregnancy. Diagnostic pitfalls include heterotopic pregnancy, decidual changes in endometrial cyst and theca lutein cysts mimicking GS-like structures. Knowledge of a spectrum of clinical and MRI features of EP is essential for establishing an accurate diagnosis and determining appropriate management.

Recurrent Interstitial pregnancy: a new approach in diagnosis with MRI and management with systemic methotrexate along with intra foetal cardiac 10% potassium chloride

“…7 Key MRI features of interstitial pregnancy include an eccentric cystic structure which represents a gestational sac with foetal pole "a classically hypointense cystic appearance T1, T2 hyperintensity surrounded a ring" in the interstitial portion of fallopian tube is away from the sagittal axis of the uterus as we saw in our case (Figure 1). There is a myometrial coat around the gestational sac and thin hypointense line separates the gestation sac from the endometrium on T2 W images this represents the "interstitial line" sign seen on ultrasound images (Figure 2).…”

Mesenteric cystic lymphangioma presenting as acute peritonitis

“…If an abdominal mass is found in a young female patient with peritoneal irritation, gynaecological complications such as ovarian cyst or tumour with torsion, perforated ovarian cyst, ruptured tubo-ovarian abscess or ectopic pregnancy are considered in the differential diagnosis. However, radiological studies excluded the genital organs as the source of the lesion in the presented patient [12].…”

Endosonography of benign myometrium cysts and cyst-like lesions

“…As well, the marginal vascularity at the wall of the cyst will be higher in cases with pregnancy. MRI features of interstitial pregnancy include the heterogeneous mass of predominant hyperintense signal in the T2W image situated lateral to the uterine cornu with clear junctional zone with the uterine cavity [25,26].…”