Magnetic Resonance Imaging of Pelvis During Pregnancy
Number:28ESURABS0009
Type:Educational Electronic Presentation
Authors: Kyeong Ah Kim
Keywords:pregnancy, MRI
SECTIONS
Educational objective

Although ultrasonography(US) is the most commonly and primarily used diagnostic imaging modality for pregnant women, further evaluation is needed when the diagnosis is indeterminate. In such cases, magnetic resonance imaging (MRI) is helpful in that it provides excellent contrast resolution without radiation. The use of gadolinium based contrast media (GBCM) is not recommended in pregnant women, as there are safety issues. Limited sequences other than T1-weighted image with contrast enhancement (T1CE) are available, including T1-weighted image (T1WI), T1-weighted image with fat suppression (T1FS), T2-weighted image (T2WI), diffusion restricted image (DWI) and apparent diffusion coefficient (ADC) maps. DWI and ADC maps are especially helpful in distinguishing malignancies and inflammatory conditions.The aim of this poster is to review the safety of MRI and GBCM during pregnancy,...

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Topic Review

MRI safety in pregnant women

The theoretical harms have been proposed due to the heat produced by the radiofrequency pulse and the loud noise during the examination. The use of MRI has been particularly controversial in the first trimester when the cells rapidly divide and undergo organogenesis.  However, several retrospective studies showed no significant difference of the risk of harm to the fetus or in early childhood between the exposure and non-exposure to 1.5T (Tesla) MRI during first trimester.  As 3T  MRI produces more powerful radiofrequency pulse, the chances of harm are higher theoretically. A recent single center retrospective study showed that exposure to 3T MRI at any trimester has no adverse effect to neonatal hearing or fetal growth. Further studies with 3T MRI is required to assure the safety.

 

GBCM...

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Fig. 1. 32-year-old female with left ovarian torsion and bilateral ovarian teratomas, at 13 weeks + 6 days gestational age. Coronal T2-weighted MR image shows whirling pattern of thickened and twisted left vascular pedicle (arrows).
Fig. 2. 33-year-old female with right ovarian mucinous carcinoma, at 34 weeks + 6 days gestational age. Coronal T2-weighted image shows a 16cm sized heterogenous multilocular cystic mass (arrows) with solid portion (dashed arrows).
Conclusions

Although ultrasonography is the primary modality of diagnosis in pregnant women, it has limitation in evaluation of deep structures, relatively low tissue resolution, and user dependent modality. In pregnant patients, MRI is useful modality in that it provides excellent tissue resolution without harm of radiation. Instead of contrast enhanced image which is not proved to be safe in pregnancy, DWI and ADC map can give information about the probability of malignancy.

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