Role of MRI in the diagnosis of tubal and non-tubal ectopic pregnancy
Number:28ESURABS0008
Type:Educational Electronic Presentation
Authors: Lorenzo Vassallo, Mirella Fasciano
Keywords:Pregnancy, ectopic pregnancy, MRI, tubal and non-tubal.
SECTIONS
Educational objective

The aim of this poster is to review the role of magnetic resonance imaging (MRI) in ectopic pregnancy (EP), to describe the imaging findings that can be used to accurately diagnose tubal and non-tubal EP and to discuss the differential diagnosis.

Topic Review

Ectopic pregnancy (EP) occurs when the developing blastocyst becomes implanted at a site other than the endometrium of the uterine cavity. Approximately 2% of all pregnancies are ectopic, and despite improvements in treatment, EP remains the leading cause of maternal mortality during the first trimester of pregnancy. The commonest site for EP is ampulla of the fallopian tube. Other sites include ovaries, peritoneal cavity, omentum, and intra-uterine sites like uterine interstitial, cervix, cesarean scar, and anomalous uterine horn.

The diagnosis of EP is typically based on a combination of quantitative assay for β-HCG and findings on pelvic sonography. Major risk factors for EP include a history of pelvic inflammatory disease, gynecologic surgery...

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Figure 1. Isolated hemoperitoneum in a 28-year-old woman who presented with right lower quadrant pain. The results of a pregnancy test performed in the emergency department were positive. Sagittal T2-weighted HASTE MR image show an intermediate-signal-intensity clot (arrow) in the pelvic cul-de-sac. Note the lack of an intrauterine pregnancy.
Figure 2. Tubal pregnancy in a 32-year-old pregnant woman with abdominal pain. US had shown absence of a normal intrauterine pregnancy. Coronal T2-weighted HASTE MR images show a heterogeneous mass with predominantly intermediate to high T2 signal intensity in the right fallopian tube. The mass had no associated saclike cystic component. The findings at surgery helped confirm a right tubal ectopic pregnancy.
Conclusions

Ectopic pregnancy is relatively common, complicating 2% of all pregnancies and, as such, is increasingly encountered at MR imaging examinations performed to determine the cause of abdominal pain. The radiologist, therefore, should be familiar with the appearance of EP at MR imaging. Specific findings such as the lack of an intrauterine pregnancy, hematosalpinx, and a tubal or interstitial mass should be sought at every MR imaging examination performed in a pregnant patient. Unusual EP, such as abdominal pregnancy or cornual pregnancy, should also be considered in the differential diagnosis for pregnant patients with acute abdominal pain.