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To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the accuracy of pelvic MRI in the diagnosis of unusual ectopic pregnancy (EP), when ultrasound (US) examination is inconclusive.

Methods

We retrospectively reviewed the medical records of 150 patients with suspected EP. Clinical, US and MRI features of 15 unusual EPs were analysed. Two radiologists independently reviewed each case resolving by consensus any diagnostic discrepancy. Interobserver agreement was assessed using the Cohen κ test.

Results

MRI displayed a gestational sac-like structure surrounded by a thick wall in all cases. The thick wall displayed hyperintensity in 41 %, isointensity in 35 % and hypointensity in 24 % of cases on T1-weighted images. Diffusion- and fat saturation T1-weighted images were the most accurate sequences, as they enabled identification of 15/15 and 14/15 patients, respectively. Although US was false negative in detecting cervical and uterine infiltration underlying the caesarean scar, MRI was able to identify the invasion. Interobserver agreement was very good for all sequences (κ=0.892–1.0).

Conclusions

MRI plays an important role in the early diagnosis of unusual EP. It should be considered after negative US findings, providing accurate evaluation of the site and the possible infiltration of these lesions, which help in the management of these patients.

Key Points

• MRI is being increasingly used as a problem-solving modality in ectopic pregnancy.

• MRI plays an important role in early diagnosis of unusual ectopic pregnancy.

• Knowledge of MRI features in EP is essential to determinate appropriate management.

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Abbreviations

BMI:

Body mass index

EP:

Ectopic pregnancy

GE:

Gestational age

GS:

Gestational sac

hCG:

Human chorionic gonadotropin

ICSI:

Standard intracytoplasmic sperm injection

IUD:

Intrauterine device

MRI:

Magnetic resonance imaging

MTX:

Methotrexate

SD:

Standard deviation

SPSS:

Statistical Package for the Social Sciences

TV:

Transvaginal

US:

Ultrasound

WI:

Weighted image

References

  1. Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy. Available via https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg21/. Published: 4 Nov 2016

  2. Parker VL, Srinivas M (2016) Non-tubal ectopic pregnancy. Arch Gynecol Obstet 294:19–27

    Article  PubMed  Google Scholar 

  3. Levine D (2007) Ectopic pregnancy. Radiology 245:385–397

    Article  PubMed  Google Scholar 

  4. Köroğlu M, Kayhan A, Soylu FN et al (2013) MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites. Jpn J Radiol 31:75–80

    Article  PubMed  Google Scholar 

  5. Kao LY, Scheinfeld MH, Chernyak V, Rozenblit AM, Oh S, Dym RJ (2014) Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol 202:904–911

    Article  PubMed  Google Scholar 

  6. Si MJ, Gui S, Fan Q et al (2016) Role of MRI in the early diagnosis of tubal ectopic pregnancy. Eur Radiol 26:1971–1980

    Article  PubMed  Google Scholar 

  7. Takahashi A, Takahama J, Marugami N et al (2013) Ectopic pregnancy: MRI findings and clinical utility. Abdom Imaging 38:844–850

    Article  PubMed  Google Scholar 

  8. Tamai K, Koyama T, Togashi K (2007) MR features of ectopic pregnancy. Eur Radiol 17:3236–3246

    Article  PubMed  Google Scholar 

  9. 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 5:25–32

    Article  PubMed  Google Scholar 

  10. Kataoka ML, Togashi K, Kobayashi H, Inoue T, Fujii S, Konishi J (1999) Evaluation of ectopic pregnancy by magnetic resonance imaging. Hum Reprod 14:2644–2650

    Article  CAS  PubMed  Google Scholar 

  11. Io S, Hasegawa M, Koyama T (2015) A Case of Ovarian Pregnancy Diagnosed by MRI. Case Rep Obstet Gynecol 2015:143031

    PubMed  PubMed Central  Google Scholar 

  12. 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

    Article  PubMed  PubMed Central  Google Scholar 

  13. Renfroe S, Dajani NK, Pandey T, Magann EF (2013) Role of serial MRI assessment in the management of an abdominal pregnancy. BMJ Case Rep. https://doi.org/10.1136/bcr-2013-200495

  14. Tu J, Wang E, Shen J (2016) Primary Hepatic Ectopic Pregnancy: A Case Report. J Reprod Med 61:175–178

    PubMed  Google Scholar 

  15. Bourdel N, Roman H, Gallot D et al (2007) Interstitial Pregnancy. Ultrasonographic diagnosis and contribution of MRI. A case report. Gynecol Obstet Fertil 35:121–124

    Article  CAS  PubMed  Google Scholar 

  16. Forstner R, Thomassin-Naggara I, Cunha TM et al (2017) ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol 27:2248–2257

    Article  PubMed  Google Scholar 

  17. Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46

    Article  Google Scholar 

  18. Gupta R, Bajaj SK, Kumar N et al (2016) Magnetic resonance imaging - A troubleshooter in obstetric emergencies: A pictorial review. Indian J Radiol Imaging 26:44–51

    Article  PubMed  PubMed Central  Google Scholar 

  19. Masselli G, Brunelli R, Parasassi T, Perrone G, Gualdi G (2011) Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound. Eur Radiol 21:1841–1849

    Article  PubMed  Google Scholar 

  20. Singh AK, Desai H, Novelline RA (2009) Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol 16:133–141

    Article  PubMed  Google Scholar 

  21. Masselli G, Derchi L, McHugo J et al (2013) Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 23:3485–3500

    Article  PubMed  Google Scholar 

  22. Alalade AO, Smith FJE, Kendall CE, Odejinmi F (2017) Evidence-based management of non-tubal ectopic pregnancies. J Obstet Gynaecol 20:1–10

    Google Scholar 

  23. Parker RA, Yano M, Tai AW, Friedman M, Narra VR, Menias CO (2012) MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics 32:1445–1460

    Article  PubMed  Google Scholar 

  24. Arleo EK, DeFilippis EM (2014) Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging 38:763–770

    Article  PubMed  Google Scholar 

  25. Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381

    Article  PubMed  Google Scholar 

  26. Osborn DA, Williams TR, Craig BM (2012) Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med 31:1449–1456

    Article  PubMed  Google Scholar 

  27. Krusen W (1902) Triple ectopic gestation. Amer J Med 3:18

    Google Scholar 

  28. Diamant Z (1914) Ein Fall von Drillingsschwangerschaft in demselben Eileiter. Zbl Gynaek 3:128

    Google Scholar 

  29. Plyler CO, Freeman WH, Johnson JM (1956) Unilateral triplet tubal pregnancy. N Carolina Med J. 17:170

    PubMed  Google Scholar 

  30. Forbes DA, Natale A (1968) Unilateral tubal triplet pregnancy: Report of a case. Obstet Gynecol 31:360

    Article  CAS  PubMed  Google Scholar 

  31. Schmitt R, Heinen K (1972) Unilateral ectopic pregnancy of triplets. Geburtshilfe Frauenheilkd 32:136–137

    CAS  PubMed  Google Scholar 

  32. Am S, Chin VP (1992) Unilateral triplet ectopic pregnancy. A case report. J Reprod Med 37:187–188

    Google Scholar 

  33. Tsai HD, Chang CC, Hsieh YY, Chang CC, Yang TC, Chen CM (1998) Sonographic diagnosis of triplet tubal pregnancy after in vitro fertilization and embryo transfer. J Clin Ultrasound 26:159–162

    Article  CAS  PubMed  Google Scholar 

  34. Nwanodi O, Berry R (2006) Spontaneous Triplet, Tubal Ectopic Gestation. J Natl Med Assoc 98:963–964

    PubMed  PubMed Central  Google Scholar 

  35. Berkes E, Szendei G, Csabay L, Sipos Z, Joo JG, Rigo J (2008) Unilateral triplet ectopic pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 90:2003.e17–2003.e20

    Article  Google Scholar 

  36. Srisajjakul S, Prapaisilp P, Bangchokdee S (2017) Magnetic resonance imaging in tubal and non-tubal ectopic pregnancy. Eur J Radiol 93:76–89

    Article  PubMed  Google Scholar 

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Radiology Dea Department, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155-00161, Rome, Italy

    Gabriele Masselli, Francesca Laghi & Gianfranco Gualdi

  2. Department of Gynaecological, Obstetrical and Urological Sciences, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155-00161, Rome, Italy

    Martina Derme, Maria Grazia Piccioni & Marialuisa Framarino-dei-Malatesta

  3. Department of Obstetrics and Gynaecology, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389-00157, Rome, Italy

    Vincenzo Spina

Authors
  1. Gabriele Masselli
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  2. Martina Derme
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  3. Maria Grazia Piccioni
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  4. Vincenzo Spina
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  5. Francesca Laghi
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  6. Gianfranco Gualdi
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  7. Marialuisa Framarino-dei-Malatesta
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Corresponding author

Correspondence to Gabriele Masselli.

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Guarantor

The scientific guarantor of this publication is Dr. Masselli Gabriele.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Masselli, G., Derme, M., Piccioni, M.G. et al. To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study. Eur Radiol 28, 2444–2454 (2018). https://doi.org/10.1007/s00330-017-5237-6

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  • DOI: https://doi.org/10.1007/s00330-017-5237-6

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