Magnetic Resonance Imaging Evaluation of Ectopic Pregnancy: A Value-Added Review

Abstract Ectopic pregnancy (EP) is a known cause of maternal mortality and may be misdiagnosed in up to 50% of pregnant female individuals (Ann Emerg Med. 1996;28(1):10–17). Magnetic resonance imaging, with its superior soft tissue resolution, is a valuable alternative diagnostic modality to diagnose EP when transvaginal ultrasound results are inconclusive. Although an extrauterine gestational sac is the most specific finding, there are other key MRI findings that can aid in diagnosing EP. As availability of MRI access in the emergency department setting increases across the nation, its utility in women with a positive pregnancy test has also increased. Specific MRI findings that are diagnostic of EP include absence of intrauterine pregnancy, adnexal mass separate from the ovary, and hemoperitoneum. In addition, intrauterine ectopic locations, especially intramural, cornual, and cervical pregnancies, can be diagnosed with increased accuracy with the help of MRI. Magnetic resonance imaging is also useful in excluding potential mimics of EP, including adnexal cysts, ovarian neoplasms, and fibroids. In summary, providing an accurate diagnosis and determining the precise location of an EP, which is supported by the use of MRI, is imperative for guiding a patient's treatment to prevent a potentially fatal outcome.

[1]  K. Maturen,et al.  ACR Appropriateness Criteria® First Trimester Vaginal Bleeding. , 2018, Journal of the American College of Radiology : JACR.

[2]  N. Schieda,et al.  Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy , 2018, Abdominal Radiology.

[3]  A. Sodickson,et al.  First-trimester emergencies: a radiologist’s perspective , 2018, Emergency Radiology.

[4]  G. Masselli,et al.  To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study , 2018, European Radiology.

[5]  M. Şeker,et al.  Diffusion-weighted imaging in ectopic pregnancy: ring of restriction sign. , 2017, The British journal of radiology.

[6]  S. Srisajjakul,et al.  Magnetic resonance imaging in tubal and non-tubal ectopic pregnancy. , 2017, European journal of radiology.

[7]  M. Si,et al.  Role of MRI in the early diagnosis of tubal ectopic pregnancy , 2016, European Radiology.

[8]  Z. Delproposto,et al.  Cesarean section scar ectopic pregnancy: a clinical case series , 2015, Journal of Ultrasound.

[9]  E. Arleo,et al.  Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. , 2014, Clinical imaging.

[10]  V. Chernyak,et al.  Beyond ultrasound: CT and MRI of ectopic pregnancy. , 2014, AJR. American journal of roentgenology.

[11]  Sweta Singh Diagnosis and management of cervical ectopic pregnancy , 2013, Journal of human reproductive sciences.

[12]  A. Littooij,et al.  Ruptured interstitial ectopic pregnancy at 18 weeks gestation diagnosed by MRI: a case report. , 2013, Journal of radiology case reports.

[13]  A. Oto,et al.  MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites , 2013, Japanese Journal of Radiology.

[14]  T. Williams,et al.  Cesarean Scar Pregnancy , 2012, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[15]  M. Yano,et al.  MR imaging findings of ectopic pregnancy: a pictorial review. , 2012, Radiographics : a review publication of the Radiological Society of North America, Inc.

[16]  S. Takeda,et al.  Use of magnetic resonance analysis for clinical evaluation of the peripheral area of gestational sac in bleeding and non-bleeding ectopic pregnancy cases , 2012, Reproductive medicine and biology.

[17]  C. Buhimschi,et al.  Myometrial wound healing post-Cesarean delivery in the MRL/MpJ mouse model of uterine scarring. , 2010, The American journal of pathology.

[18]  S. Bhatt,et al.  Diagnostic clues to ectopic pregnancy. , 2008, Radiographics : a review publication of the Radiological Society of North America, Inc.

[19]  K. Togashi,et al.  MR features of ectopic pregnancy , 2007, European Radiology.

[20]  W. Mayo-Smith,et al.  CT in the evaluation of nontraumatic abdominal pain in pregnant women. , 2007, Radiology.

[21]  J. Moodley,et al.  The value of magnetic resonance imaging in the diagnosis and management of extra-uterine abdominal pregnancy. , 2006, Clinical radiology.

[22]  B. Siewert,et al.  MR imaging evaluation of acute appendicitis in pregnancy. , 2006, Radiology.

[23]  S. Jung,et al.  Characteristic MR findings of cervical pregnancy , 2001, Journal of magnetic resonance imaging : JMRI.

[24]  T. Helbich,et al.  Systemic methotrexate treatment of interstitial pregnancy--magnetic resonance imaging (MRI) as a valuable tool for monitoring treatment. , 2000, Wiener klinische Wochenschrift.

[25]  B. Kaplan,et al.  Ectopic pregnancy: prospective study with improved diagnostic accuracy. , 1996, Annals of emergency medicine.

[26]  H. Matsuo,et al.  Enhanced magnetic resonance imaging in monitoring of conservative treatment of cervical pregnancy. , 1995, Journal of obstetrics and gynaecology.

[27]  D. Nyberg,et al.  Extrauterine findings of ectopic pregnancy of transvaginal US: importance of echogenic fluid. , 1991, Radiology.

[28]  O. R. Grassiotto,et al.  Cesarean scar ectopic pregnancy: invasion of the bladder wall detected by magnetic resonance imaging , 2017, Radiologia brasileira.