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Neuroimaging safety during pregnancy and lactation: a review

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Abstract

Purpose

Imaging studies are crucial adjuncts when studying acute and chronic diseases, so pregnant and lactating women are as likely to be evaluated with one of the available imaging modalities. Due to the specific condition of the mother and child in this time period it is crucial to make an appropriate selection of imaging studies.

Methods

We review the existing literature and analyse the latest evidence and guidelines regarding neuroimaging safety during pregnancy and lactation, proposing an algorithm of action based on risk/benefits assessment.

Results

Choosing the most appropriate neuroimaging modality implicates assessing the pretest pertinence of the study—the possibility of a serious treatable neurologic disease, pondering what is the most useful imaging modality for the diagnosis and evaluating the associated risks. Among physicians (and patients), however, the risk component is perhaps the least well understood, with misperceptions regarding safety and potential hazards. Computed tomography (CT) risks are principally related to ionizing radiation and intravenous (IV) administration of iodinated contrast. However, as very low risks for the mother and foetus have been reported and CT remains the most available tool for initial rapid diagnosis of acute neurological conditions, it should not be withheld in urgent situations. Magnetic resonance imaging (MRI), unlike CT, does not use ionizing radiation or iodinated contrast mediums, having the best anatomical detail possible. However, there are some usage safety concerns regarding the magnetic field strength and gadolinium-based contrast use.

Conclusion

There are lacking longitudinal and prospective studies to sustain evidence based choices of imaging studies during pregnancy and lactation. Ultimately the decision should be based on the risk/benefit, taking into account the patient’s safety, care and outcomes. However, using a specific algorithm can guide decisions in daily clinical practice.

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Data availability

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Code availability

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Abbreviations

ACOG:

American College of Obstetricians and Gynecologists

ACR-SPR:

American College of Radiology/Society for Pediatric Radiology

CT:

Computed tomography

FDA:

US Food and Drug Administration

GBCAs :

Gadolinium-based contrast agents

mGy:

Miligray

MRI :

Magnetic resonance imaging

NSF:

Nephrogenic systemic fibrosis

PRES:

Posterior reversible encephalopathy syndrome.

RCVS:

Reversible vasoconstriction syndrome

SAR:

Specific absorption rate

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Author notes

  1. C. Guerreiro has equal contribution or is a joint first author.

Authors and Affiliations

  1. Serviço de Imagiologia Neurológica, CHULN – Hospital Santa Maria, Lisbon, Portugal

    F. Proença, C. Guerreiro, G. Sá & S. Reimão

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  1. F. Proença
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Contributions

F Proença reviewed the subject, performed the literature search and data analysis, wrote and reviewed the manuscript.

C Guerreiro reviewed the subject, performed the literature search and data analysis, wrote and reviewed the manuscript.

G Sá is the Director of the Neuroradiology Department who reviewed the manuscript.

S Reimão conceptualized the manuscript, helped writing and reviewed the manuscript.

Corresponding author

Correspondence to S. Reimão.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This report is a literature review and so not requiring approval by an ethical committee. This article does not contain any studies with human participants or animals performed by any of the authors.

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Key points

• Neuroradiologists need to be aware of pregnancy/lactating neuroimaging safety procedures.

• Definitive guidelines and longitudinal studies regarding imaging safety during the pregnancy and lactating period are lacking.

• Non-contrast MRI is the typical first choice in pregnancy.

• Although there are some concerns regarding CT scan imaging safety, CT remains the most available tool for initial rapid diagnosis of acute neurological conditions and it should not be withheld in urgent situations.

• Contrast agents should only be used if absolutely required and neuroimaging in the lactating period is usually safe.

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Proença, F., Guerreiro, C., Sá, G. et al. Neuroimaging safety during pregnancy and lactation: a review. Neuroradiology 63, 837–845 (2021). https://doi.org/10.1007/s00234-021-02675-1

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