MR Imaging Findings of Ectopic Pregnancy: A Pictorial Review

Abstract

Because of its lack of ionizing radiation and excellent soft-tissue contrast, magnetic resonance (MR) imaging is being increasingly used in the evaluation of acute abdominal pain in the pregnant patient. Roughly 2% of all pregnancies are ectopic. Although ectopic pregnancy is usually diagnosed on the basis of a combination of clinical, laboratory, and ultrasonographic findings, it occasionally is initially identified at MR imaging. Thus, it is imperative that the radiologist should be familiar with the variable appearance of ectopic pregnancy at MR imaging and should evaluate for ectopic pregnancy at any time when (a) a patient has positive results of a pregnancy test and (b) an intrauterine pregnancy is not definitively seen. Because of potential issues of fetal safety, a conservative approach should be used for MR imaging in pregnancy. An MR imaging protocol for the evaluation of possible appendicitis in pregnant women is detailed. Specific findings that can aid in the diagnosis of ectopic pregnancy are the lack of an intrauterine pregnancy, isolated hemoperitoneum, tubal masses, hematosalpinx, and interstitial masses. In the differential diagnosis of acute abdominal pain in pregnancy, consideration should be given to the more unusual forms of ectopic pregnancy, such as angular pregnancy, cornual pregnancy, and abdominal pregnancy. Potential mimics of ectopic pregnancy include placental abnormalities, ovarian neoplasms, and corpus luteum cysts.

Ectopic Mural Pregnancy

“…Это ведет к повышению риска смерти до 2,5%, что в 7 раз выше в срав-нении с ВБ других локализаций, ввиду массивной кровопотери [16,24,27]. МРТ рассматривается как дополнительная опция в сложных случаях [28,29].…”

Acute pelvic pain in female with ruptured ectopic pregnancy: Magnetic Resonance Imaging as problem solving tool

“…3 The classic findings of ectopic pregnancy on MRI are lack of intrauterine pregnancy, hemoperitoneum, tubal mass, hematosalpinx and wall enhancement of the dilated fallopian tube. 4,5 The presence of hematosalpinx in a woman with a positive pregnancy test and with no intrauterine gestational sac is highly concerning for ectopic pregnancy, even in the absence of a clearly identifiable extra-uterine gestational sac. 5 The inclusion of a T1-weighted pulse sequence is helpful in identifying blood products and is recommended as part of imaging protocol for pregnant patients.…”

“…4,5 The presence of hematosalpinx in a woman with a positive pregnancy test and with no intrauterine gestational sac is highly concerning for ectopic pregnancy, even in the absence of a clearly identifiable extra-uterine gestational sac. 5 The inclusion of a T1-weighted pulse sequence is helpful in identifying blood products and is recommended as part of imaging protocol for pregnant patients. 5 Mimics of ectopic pregnancy include corpus luteal cyst and ovarian masses.…”

“…5 The inclusion of a T1-weighted pulse sequence is helpful in identifying blood products and is recommended as part of imaging protocol for pregnant patients. 5 Mimics of ectopic pregnancy include corpus luteal cyst and ovarian masses. Differentials for hemoperitoneum include placentation abnormalities like placenta accreta and percreta.…”

“…Differentials for hemoperitoneum include placentation abnormalities like placenta accreta and percreta. 5 It is imperative that the radiologists, obstetricians and emergency physicians be familiar with these features and always consider the possibility of ectopic pregnancy in the setting of hemoperitoneum or a pelvic mass in a woman of child-bearing age. Fig.…”