Evaluation of ectopic pregnancy by magnetic resonance imaging

Abstract

Patients (n = 37) suspected of ectopic pregnancy were prospectively evaluated with magnetic resonance (MR) imaging to assess the capability of MR imaging in the diagnosis of ectopic pregnancy. Five levels of confidence were defined: diagnostic, suspicious, equivocal, questionable, and negative. Tubal wall enhancement and presence of tubal haematoma or gestational sac-like structure were considered diagnostic findings. There were 21 diagnostic, two suspicious, eight equivocal, and six negative findings. MR findings were compared with the surgical findings in 18 patients. Surgical confirmation was obtained in 12 diagnostic, two suspicious, and four equivocal studies. Using the MR diagnostic criteria for tubal pregnancy, MR had 12 true positive, three true negative, three false negative, and no false positive results for the diagnosis of tubal pregnancy. Retrospective analysis of the signal intensity of haematoma and ascites was performed for these 18 surgically confirmed cases. The predominant signal intensity of tubal haematoma was an intermediate signal on T1-weighted image (WI) and a low signal on T2WI. Ascites showed signal intensity higher than that of urine on T1WI in 100% of 13 cases. In conclusion, MR imaging with use of intravenous contrast material allows a specific diagnosis of tubal pregnancy, recognizing tubal wall enhancement and fresh tubal haematoma.

Interstitial pregnancy: role of MRI

“…Although sagittal T2-weighted sequence is the basic sequence in MRI performed in gynaecologic emergencies [5], axial and coronal views are helpful in suspicion of ectopic pregnancy to show the relationship between the gestational sac and the myometrium; additionally, T1-weighted sequence performed in one of these three planes is helpful to identify blood. It has been established that tubal wall enhancement and fresh tubal hematoma were specific for ectopic pregnancy, whereas a gestational sac-like structure without tubal structure was equivocal because of the differential diagnosis of cystic masses of the ovary [6]. By contrast, little has been reported about MRI findings in interstitial pregnancy [3,4].…”

MR features of ectopic pregnancy

“…When TVS findings are indeterminate, magnetic resonance imaging (MRI) can serve as a problemsolving tool owing to its excellent tissue contrast. The advantage of MRI for the diagnosis of EP has been reported to be its capability to identify fresh blood and to precisely localize the site of implantation [11,12]. The recognition of MRI findings in EP is essential for accurate interpretation of this condition.…”

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.…”