MRI in Pregnancy and Precision Medicine: A Review from Literature

Abstract

Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.

Gadolinium in Medical Imaging—Usefulness, Toxic Reactions and Possible Countermeasures—A Review

“…There was no significant increase in NSF, and no increased risk of congenital anomalies (although the power of the study to show such effects was low). A more recent review [ 45 ] came to similar conclusions.…”

Contrast Agents during Pregnancy: Pros and Cons When Really Needed

“…NSF is a rare and severe disease characterized by fibrosing skin lesions and organ failure, observed in patients with impaired renal function. To date, no cases of NSF have been reported in a pregnant patient or newborn after intrauterine exposure [ 32 ]. The retained intracranial gadolinium, first described as observed T1 shortening predominantly in the globus pallidus and dentate nucleus, and also observed in patients with normal renal function, has been mainly related to multiple administrations of GBCA during life [ 21 , 32 ].…”

Nanotechnologies in Obstetrics and Cancer during Pregnancy: A Narrative Review

“…In order to overcome this issue, the use of superparamagnetic iron oxide nanoparticle ferumoxytol has been tested, with encouraging results and no impact at the maternal–fetal interface in pregnant rhesus macaques [ 86 ]. Moreover, liposomal gadolinium has also been proposed as a promising tool in the obstetrics field [ 87 ]. In particular, Shetty and coworkers found, in a mouse model, that liposomal gadolinium nanoparticles were confined to the maternal compartment without passing to the fetal compartment [ 88 ].…”