MRI in pregnant patients with suspected abdominal and pelvic cancer: a practical guide for radiologists

Gui, Benedetta; Cambi, Francesco; Miccò, Maura; Sbarra, Martina; Petta, Filomena; Autorino, R.; Vincenzo, Rosa De; Valentini, Vincenzo; Scambia, Giovanni; Manfredi, Riccardo

doi:10.5152/dir.2019.19343

Cited by 18 publications

(17 citation statements)

References 48 publications

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“…Additionally, MRI is a reproducible modality to assess response to neo-adjuvant chemotherapy. 3 For response evaluation after neoadjuvant chemotherapy for stage IB1 to IIB cervical cancers, MRI and transrectal ultrasound show similar accuracy of 77% for the detection of residual tumor but with highest sensitivity for MRI (96%). 42 To achieve the highest possible accuracy, the MRI protocol for locoregional staging of cervical cancer during pregnancy and response assessment should combine T2/DWI MRI and cover the entire abdomen in order to inform on local tumor extension, pelvicaortic lymph nodes, liver, bone, and peritoneum.…”

Section: Reviewmentioning

confidence: 92%

Section: Diagnosis and Staging By Tumor Typementioning

confidence: 92%

“…By combining high contrast anatomical sequences with the clinically available non-contrast dependent diffusion-weighted imaging (DWI) sequence, which allows functional characterization of tissue, this can nearly always be achieved. 3 …”

Section: Safety Considerationsmentioning

confidence: 99%

“…Importantly, DWI does not need gadolinium to generate image contrast enhancing the safety profile of MRI for use in pregnant patients while reaching a reported accuracy for detecting primary tumors, nodal and distant metastases at least similar to gadolinium-enhanced MRI. 3 24 …”

Section: General Considerations In Diagnostic Imaging In Pregnancymentioning

confidence: 99%

“…As an advantage, MRI does not depend on gadolinium-contrast to assess locoregional disease extent and allows accurate and reproducible assessment of prognostic tumor properties including tumor size, parametrial and pelvic wall invasion, adjacent organ invasion, lymph nodes, and metastases. 3 4 27 …”

Section: Diagnosis and Staging By Tumor Typementioning

confidence: 99%

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Imaging modalities in pregnant cancer patients

Vandecaveye¹,

Amant

Lecouvet

et al. 2021

Int J Gynecol Cancer

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Cancer during pregnancy is increasingly diagnosed due to the trend of delaying pregnancy to a later age and probably also because of increased use of non-invasive prenatal testing for fetal aneuploidy screening with incidental finding of maternal cancer. Pregnant women pose higher challenges in imaging, diagnosis, and staging of cancer. Physiological tissue changes related to pregnancy makes image interpretation more difficult. Moreover, uncertainty about the safety of imaging modalities, fear of (unnecessary) fetal radiation, and lack of standardized imaging protocols may result in underutilization of the necessary imaging tests resulting in suboptimal staging. Due to the absence of radiation exposure, ultrasound and MRI are obvious first-line imaging modalities for detailed locoregional disease assessment. MRI has the added advantage of a more reproducible comprehensive organ or body region assessment, the ability of distant staging through whole-body evaluation, and the combination of anatomical and functional information by diffusion-weighted imaging which obviates the need for a gadolinium-based contrast-agent. Imaging modalities with inherent radiation exposure such as CT and nuclear imaging should only be performed when the maternal benefit outweighs fetal risk. The cumulative radiation exposure should not exceed the fetal radiation threshold of 100 mGy. Imaging should only be performed when necessary for diagnosis and likely to guide or change management. Radiologists play an important role in the multidisciplinary team in order to select the most optimal imaging strategies that balance maternal benefit with fetal risk and that are most likely to guide treatment decisions. Our aim is to provide an overview of possibilities and concerns in current clinical applications and developments in the imaging of patients with cancer during pregnancy.

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Section: Reviewmentioning

confidence: 92%

Section: Diagnosis and Staging By Tumor Typementioning

confidence: 92%

Section: Safety Considerationsmentioning

confidence: 99%

Section: General Considerations In Diagnostic Imaging In Pregnancymentioning

confidence: 99%

Section: Diagnosis and Staging By Tumor Typementioning

confidence: 99%

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Imaging modalities in pregnant cancer patients

Vandecaveye¹,

Amant

Lecouvet

et al. 2021

Int J Gynecol Cancer

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Malignancy in pregnancy: Multimodality imaging and treatment

Nguyen

Bhosale

Cassia³

et al. 2023

Cancer

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The diagnosis of cancer is increasingly made in the pregnant population, thought to be from the increasing average age of pregnancy and the use of prenatal fetal noninvasive screening techniques, leading to incidental detection of cancer in the mother. Complex challenges are associated with imaging, diagnosis, staging, and treatment of cancers in this patient population, which require highly specialized interdisciplinary management. This report discusses the use of multimodality imaging and safety considerations in pregnant patients, reviews the current guidelines for ionizing radiation imaging techniques, and presents a series of commonly and uncommonly encountered cancers in pregnancy with current diagnostic imaging guidelines. The authors also discuss the role of multidisciplinary management and treatment options and provide an overview of therapy‐related considerations in the age of novel anticancer therapies. Plain Language Summary The diagnosis and management of pregnant patients who have cancer are actively evolving as novel imaging techniques and anticancer therapies are being developed. Radiologically, there are inherent difficulties in balancing the minimization of fetal ionization while acquiring diagnostic quality imaging necessary for the diagnosis, staging, and treatment of maternal disease. Standardized imaging protocols are still being developed, with evolving imaging guidelines coupled with rapidly expanding research and development of novel anticancer therapies, which come with their side effects and complications. Caring for this patient population is especially challenging and requires specialized multidisciplinary attention.

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Investigation of Effects of Gadolinium‐Based Contrast Agents on Uterine Contractility Using Isolated Rat Myometrium

Dinç

Salihoğlu

Ozgoren

et al. 2021

Magnetic Resonance Imaging

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Background Despite concerns about safety, gadolinium‐based contrast agents (GBCAs) are still used for abdominal and pelvic imaging during pregnancy. Researchers have mainly focused on teratogenicity, while very little is known about their possible direct effects on uterine contractility, yet free gadolinium potentially impacts contractility through interaction with calcium channels. Purpose To investigate possible effects of selected GBCAs (namely gadoteridol, gadoversetamide, gadobutrol, gadoterate meglumine, and gadoxetic acid) on the contractility of rat myometrium. Study Type In vitro organ bath study. Animal Model Myometria were isolated from adult (10–12 weeks old) Sprague Dawley rats, both pregnant (N = 8) and nonpregnant (N = 36). Field Strength/Sequence NA. Assessment Myometrial strips were suspended in tissue bath containing physiological saline and isometric contractions were recorded. GBCAs were added to the tissue bath cumulatively, and their effects on contractility parameters (quantified by amplitude, frequency, and area under contractility curve [AUC]) were evaluated by 10‐minute intervals. Statistical Tests Normality data, checked by Shapiro–Wilk test, were transformed by arcsine when needed. One‐ or two‐way analysis of variance was performed, where appropriate, followed by Student–Newman–Keuls test. A P value of <0.05 was considered statistically significant. Results All of the assayed GBCAs elicited some alterations in the myometrial contractility in a concentration‐dependent manner. Gadoterate meglumine, gadoxetic acid, and gadoversetamide caused a concentration‐dependent significant attenuation in AUC (oxytocin‐induced, from 100% during control period to 45.1 ± 9.0% (nonpregnant) and 59.9 ± 8.5% (pregnant), for 90 μM gadoterate meglumine; respectively), and frequency of the spontaneous and oxytocin‐induced contractions. Gadobutrol and gadoteridol at highest dose significantly attenuated mean AUC and frequency of oxytocin‐induced contractions of nonpregnant myometrium. Data Conclusion Results from this in vitro study indicate that GBCAs elicit modulation of myometrial contractions at clinically relevant concentrations. These effects may account, at least partially, for the known potential side effects (rare cases of miscarriages and elective abortion) of these agents. Level of Evidence 1 Technical Efficacy Stage 5

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MRI in pregnant patients with suspected abdominal and pelvic cancer: a practical guide for radiologists

Cited by 18 publications

References 48 publications

Imaging modalities in pregnant cancer patients

Imaging modalities in pregnant cancer patients

Malignancy in pregnancy: Multimodality imaging and treatment

Investigation of Effects of Gadolinium‐Based Contrast Agents on Uterine Contractility Using Isolated Rat Myometrium

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