Abdominal Radiology

, Volume 43, Issue 12, pp 3425–3435 | Cite as

Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy

  • Subramaniyan RamanathanEmail author
  • Vineetha Raghu
  • Sushila B. Ladumor
  • Anita N. Nagadi
  • Yegu Palaniappan
  • Vikram Dogra
  • Nicola Schieda
Pictorial essay



To review the MRI appearances of tubal and non-tubal implantation sites in ectopic pregnancy.


Transvaginal ultrasound is the primary imaging modality in ectopic pregnancy and MRI is used as a problem-solving tool in selected indications as detailed in the article. MRI features of tubal, interstitial, cervical, cesarean scar, cornual, ovarian, abdominal, and heterotopic pregnancies are provided to familiarize the radiologists with their appearances thereby assisting them in making early and accurate diagnosis.


MRI Ectopic pregnancy Trans vaginal ultrasound Uncommon implantation Cervical ectopic Abdominal pregnancy 


Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ectopic pregnancy–United States, 1990–1992 (1995). MMWR Morb Mortal Wkly Rep 44 (3):46–48Google Scholar
  2. 2.
    Jurkovic D, Wilkinson H (2011) Diagnosis and management of ectopic pregnancy. BMJ 342:d3397CrossRefGoogle Scholar
  3. 3.
    Creanga AA, Shapiro-Mendoza CK, Bish CL, et al. (2011) Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol 117(4):837–843. CrossRefPubMedGoogle Scholar
  4. 4.
    Condous G (2004) The management of early pregnancy complications. Best Pract Res Clin Obstet Gynaecol 18(1):37–57. CrossRefPubMedGoogle Scholar
  5. 5.
    Lin EP, Bhatt S, Dogra VS (2008) Diagnostic clues to ectopic pregnancy. Radiographics 28(6):1661–1671. CrossRefPubMedGoogle Scholar
  6. 6.
    Tenore JL (2000) Ectopic pregnancy. Am Fam Physician 61(4):1080–1088PubMedGoogle Scholar
  7. 7.
    Oto A, Ernst RD, Ghulmiyyah LM, et al. (2009) MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdom Imaging 34(2):243–250. CrossRefPubMedGoogle Scholar
  8. 8.
    Knoepp US, Mazza MB, Chong ST, Wasnik AP (2017) MR imaging of pelvic emergencies in women. Magn Reson Imaging Clin N Am 25(3):503–519. CrossRefPubMedGoogle Scholar
  9. 9.
    Lipscomb GH, Stovall TG, Ling FW (2000) Nonsurgical treatment of ectopic pregnancy. N Engl J Med 343(18):1325–1329. CrossRefPubMedGoogle Scholar
  10. 10.
    Seeber BE, Barnhart KT (2006) Suspected ectopic pregnancy. Obstet Gynecol 107(2 Pt 1):399–413. CrossRefPubMedGoogle Scholar
  11. 11.
    Braffman BH, Coleman BG, Ramchandani P, et al. (1994) Emergency department screening for ectopic pregnancy: a prospective US study. Radiology 190(3):797–802. CrossRefPubMedGoogle Scholar
  12. 12.
    Condous G, Okaro E, Khalid A, et al. (2005) The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod 20(5):1404–1409. CrossRefPubMedGoogle Scholar
  13. 13.
    Tamai K, Koyama T, Togashi K (2007) MR features of ectopic pregnancy. Eur Radiol 17(12):3236–3246. CrossRefPubMedGoogle Scholar
  14. 14.
    Chukus A, Tirada N, Restrepo R, Reddy NI (2015) Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics 35(3):946–959. CrossRefPubMedGoogle Scholar
  15. 15.
    Parker RA, Yano M, Tai AW, et al. (2012) MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics 32(5):1445–1460 (discussion 1460-1442). CrossRefPubMedGoogle Scholar
  16. 16.
    Yoshigi J, Yashiro N, Kinoshita T, O’Uchi T, Kitagaki H (2006) Diagnosis of ectopic pregnancy with MRI: efficacy of T2*-weighted imaging. Magn Reson Med Sci 5(1):25–32CrossRefGoogle Scholar
  17. 17.
    Schieda N, Isupov I, Chung A, Coffey N, Avruch L (2017) Practical applications of balanced steady-state free-precession (bSSFP) imaging in the abdomen and pelvis. J Magn Reson Imaging 45(1):11–20. CrossRefPubMedGoogle Scholar
  18. 18.
    Kao LY, Scheinfeld MH, Chernyak V, et al. (2014) Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol 202(4):904–911. CrossRefPubMedGoogle Scholar
  19. 19.
    Masselli G, Derme M, Piccioni MG, et al. (2018) To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study. Eur Radiol . CrossRefPubMedGoogle Scholar
  20. 20.
    Filhastre M, Dechaud H, Lesnik A, Taourel P (2005) Interstitial pregnancy: role of MRI. Eur Radiol 15(1):93–95. CrossRefPubMedGoogle Scholar
  21. 21.
    Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST (2001) Characteristic MR findings of cervical pregnancy. J Magn Reson Imaging 13(6):918–922CrossRefGoogle Scholar
  22. 22.
    Koroglu M, Kayhan A, Soylu FN, et al. (2013) MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites. Jpn J Radiol 31(2):75–80. CrossRefPubMedGoogle Scholar
  23. 23.
    Peng KW, Lei Z, Xiao TH, et al. (2014) First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol 69(2):123–129. CrossRefPubMedGoogle Scholar
  24. 24.
    Srisajjakul S, Prapaisilp P, Bangchokdee S (2017) Magnetic resonance imaging in tubal and non-tubal ectopic pregnancy. Eur J Radiol 93:76–89. CrossRefPubMedGoogle Scholar
  25. 25.
    Tsafrir A, Rojansky N, Sela HY, Gomori JM, Nadjari M (2005) Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging. J Ultrasound Med 24(2):219–223CrossRefGoogle Scholar
  26. 26.
    Tamai K, Koyama T, Saga T, et al. (2006) MR features of physiologic and benign conditions of the ovary. Eur Radiol 16(12):2700–2711. CrossRefPubMedGoogle Scholar
  27. 27.
    Jung SE, Byun JY, Lee JM, et al. (2001) MR imaging of maternal diseases in pregnancy. AJR Am J Roentgenol 177(6):1293–1300. CrossRefPubMedGoogle Scholar
  28. 28.
    Kereshi B, Lee KS, Siewert B, Mortele KJ (2017) Clinical utility of magnetic resonance imaging in the evaluation of pregnant females with suspected acute appendicitis. Abdom Radiol (NY). CrossRefGoogle Scholar
  29. 29.
    Si MJ, Gui S, Fan Q, et al. (2016) Role of MRI in the early diagnosis of tubal ectopic pregnancy. Eur Radiol 26(7):1971–1980. CrossRefPubMedGoogle Scholar
  30. 30.
    Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 316(9):952–961. CrossRefPubMedGoogle Scholar
  31. 31.
    Yip YP, Capriotti C, Talagala SL, Yip JW (1994) Effects of MR exposure at 1.5 T on early embryonic development of the chick. J Magn Reson Imaging 4(5):742–748CrossRefGoogle Scholar
  32. 32.
    Prola-Netto J, Woods M, Roberts VHJ, et al. (2018) Gadolinium chelate safety in pregnancy: barely detectable gadolinium levels in the juvenile nonhuman primate after in utero exposure. Radiology 286(1):122–128. CrossRefPubMedGoogle Scholar
  33. 33.
    Patenaude Y, Pugash D, Lim K, et al. (2014) The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can 36(4):349–363CrossRefGoogle Scholar
  34. 34.
    Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N (2002) Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 17(12):3224–3230CrossRefGoogle Scholar
  35. 35.
    Breen JL (1970) A 21 year survey of 654 ectopic pregnancies. Am J Obstet Gynecol 106(7):1004–1019CrossRefGoogle Scholar
  36. 36.
    Pellerito JS, Taylor KJ, Quedens-Case C, et al. (1992) Ectopic pregnancy: evaluation with endovaginal color flow imaging. Radiology 183(2):407–411. CrossRefPubMedGoogle Scholar
  37. 37.
    Russell SA, Filly RA, Damato N (1993) Sonographic diagnosis of ectopic pregnancy with endovaginal probes: what really has changed? J Ultrasound Med 12(3):145–151CrossRefGoogle Scholar
  38. 38.
    Kataoka ML, Togashi K, Kobayashi H, et al. (1999) Evaluation of ectopic pregnancy by magnetic resonance imaging. Hum Reprod 14(10):2644–2650CrossRefGoogle Scholar
  39. 39.
    Takahashi A, Takahama J, Marugami N, et al. (2013) Ectopic pregnancy: MRI findings and clinical utility. Abdom Imaging 38(4):844–850. CrossRefPubMedGoogle Scholar
  40. 40.
    Shan N, Dong D, Deng W, Fu Y (2014) Unusual ectopic pregnancies: a retrospective analysis of 65 cases. J Obstet Gynaecol Res 40(1):147–154. CrossRefPubMedGoogle Scholar
  41. 41.
    Lau S, Tulandi T (1999) Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 72(2):207–215CrossRefGoogle Scholar
  42. 42.
    Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ (1993) Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 189(1):83–87. CrossRefPubMedGoogle Scholar
  43. 43.
    Jafri SZ, Loginsky SJ, Bouffard JA, Selis JE (1987) Sonographic detection of interstitial pregnancy. J Clin Ultrasound 15(4):253–257CrossRefGoogle Scholar
  44. 44.
    Dibble EH, Lourenco AP (2016) Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and More. AJR Am J Roentgenol 207(6):1380–1392. CrossRefPubMedGoogle Scholar
  45. 45.
    Baldawa PS, Chaudhari HK (2008) Angular ectopic pregnancy presenting as rupture of lateral wall of the uterus. J Hum Reprod Sci 1(1):33–34CrossRefGoogle Scholar
  46. 46.
    Seow KM, Huang LW, Lin YH, et al. (2004) Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23(3):247–253. CrossRefPubMedGoogle Scholar
  47. 47.
    Timor-Tritsch IE, Monteagudo A, Cali G, et al. (2014) Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol 43(4):383–395. CrossRefPubMedGoogle Scholar
  48. 48.
    Wu R, Klein MA, Mahboob S, Gupta M, Katz DS (2013) Magnetic resonance imaging as an adjunct to ultrasound in evaluating cesarean scar ectopic pregnancy. J Clin Imaging Sci 3:16. CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Nonaka M, Toyoki H, Imai A (2006) Cesarean section scar pregnancy may be the cause of serious hemorrhage after first-trimester abortion by dilatation and curettage. Int J Gynaecol Obstet 95(1):50–51. CrossRefPubMedGoogle Scholar
  50. 50.
    Saleem SN (2003) MR imaging diagnosis of uterovaginal anomalies: current state of the art. Radiographics 23(5):e13. CrossRefPubMedGoogle Scholar
  51. 51.
    Smolders D, Deckers F, Pouillon M, et al. (2002) Ectopic pregnancy within a rudimentary horn in a case of unicornuate uterus. Eur Radiol 12(1):121–124. CrossRefPubMedGoogle Scholar
  52. 52.
    Jayasinghe Y, Rane A, Stalewski H, Grover S (2005) The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol 105(6):1456–1467. CrossRefPubMedGoogle Scholar
  53. 53.
    Malinowski A, Bates SK (2006) Semantics and pitfalls in the diagnosis of cornual/interstitial pregnancy. Fertil Steril 86(6):1764. CrossRefPubMedGoogle Scholar
  54. 54.
    Raziel A, Schachter M, Mordechai E, et al. (2004) Ovarian pregnancy-a 12-year experience of 19 cases in one institution. Eur J Obstet Gynecol Reprod Biol 114(1):92–96. CrossRefPubMedGoogle Scholar
  55. 55.
    Marcus SF, Brinsden PR (1993) Primary ovarian pregnancy after in vitro fertilization and embryo transfer: report of seven cases. Fertil Steril 60(1):167–169CrossRefGoogle Scholar
  56. 56.
    Oliver R, Malik M, Coker A, Morris J (2007) Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature. Arch Gynecol Obstet 276(2):125–131. CrossRefPubMedGoogle Scholar
  57. 57.
    Ozdemir I, Demirci F, Yucel O, Alper M (2003) Primary omental pregnancy presenting with hemorrhagic shock. A case report. Gynecol Obstet Invest 55(2):116–118. CrossRefPubMedGoogle Scholar
  58. 58.
    Poole A, Haas D, Magann EF (2012) Early abdominal ectopic pregnancies: a systematic review of the literature. Gynecol Obstet Invest 74(4):249–260. CrossRefPubMedGoogle Scholar
  59. 59.
    Atrash HK, Friede A, Hogue CJ (1987) Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol 69(3 Pt 1):333–337PubMedGoogle Scholar
  60. 60.
    Perkins KM, Boulet SL, Kissin DM, Jamieson DJ (2015) Risk of ectopic pregnancy associated with assisted reproductive technology in the United States, 2001–2011. Obstet Gynecol 125(1):70–78. CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Cohen JM, Weinreb JC, Lowe TW, Brown C (1985) MR imaging of a viable full-term abdominal pregnancy. AJR Am J Roentgenol 145(2):407–408. CrossRefPubMedGoogle Scholar
  62. 62.
    Wagner A, Burchardt AJ (1995) MR imaging in advanced abdominal pregnancy. A case report of fetal death. Acta Radiol 36(2):193–195CrossRefGoogle Scholar
  63. 63.
    Liu J, Khan A, Johnson S, Grigorian C, Li T (2014) The usefulness of gestational sac and placental sonographic morphology in differentiating between second-trimester tubal and abdominal pregnancy: case report and a review of literature. J Clin Ultrasound 42(3):162–168. CrossRefPubMedGoogle Scholar
  64. 64.
    Lockhat F, Corr P, Ramphal S, Moodley J (2006) The value of magnetic resonance imaging in the diagnosis and management of extra-uterine abdominal pregnancy. Clin Radiol 61(3):264–269. CrossRefPubMedGoogle Scholar
  65. 65.
    Malian V, Lee JH (2001) MR imaging and MR angiography of an abdominal pregnancy with placental infarction. AJR Am J Roentgenol 177(6):1305–1306. CrossRefPubMedGoogle Scholar
  66. 66.
    Soriano D, Shrim A, Seidman DS, et al. (2002) Diagnosis and treatment of heterotopic pregnancy compared with ectopic pregnancy. J Am Assoc Gynecol Laparosc 9(3):352–358CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology, Al-Wakra HospitalHamad Medical CorporationDohaQatar
  2. 2.Department of RadiologyWeil Cornell Medical CollegeDohaQatar
  3. 3.Department of RadiologyColumbia Asia Referral HospitalYeshwanthpurIndia
  4. 4.Department of Radiology, Hamad General HospitalHamad Medical CorporationDohaQatar
  5. 5.Department of Obstetrics and GynecologySRM Medical College and Research CenterChennaiIndia
  6. 6.Department of Imaging ScienceUniversity of Rochester Medical CenterRochesterUSA
  7. 7.Department of Medical ImagingThe Ottawa HospitalOttawaCanada

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