MRI of the Acute Female Pelvis

  • Joseph W. Owen
  • Christine O. MeniasEmail author


Magnetic resonance (MR) imaging can be used as a primary or secondary modality in the evaluation of acute pelvic pain in women. MR avoids the ionizing radiation exposure of computed tomography (CT) and provides a larger field of view with greater detail than ultrasound. This chapter first addresses practical considerations including scanner strength, intravenous gadolinium contrast use, and essential MR sequences. Then pelvic inflammatory disease, ectopic pregnancy, and ovarian torsion are reviewed with an emphasis on the MR imaging findings. At the end of this chapter, the reader should be able to structure an MR protocol, implement it in an emergency department setting, and recognize the common causes of acute pelvic pain on MR.


  1. 1.
    Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK. CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology. 2007;244(3):784–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Nagayama M, Watanabe Y, Okumura A, Amoh Y, Nakashita S, Dodo Y, Fast MR. Imaging in obstetrics. Radiographics. 2002;22(3):563–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Leyendecker JR, Gorengaut V, Brown JJ. MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. Radiographics. 2004;24(5):1301–16.PubMedCrossRefGoogle Scholar
  4. 4.
    Singh A, Danrad R, Hahn PF, Blake MA, Mueller PR, Novelline R. MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics. 2007;27(5):1419–31.CrossRefPubMedGoogle Scholar
  5. 5.
    Heverhagen JT, Klose KJ. MR imaging for acute lower abdominal and pelvic pain. Radiographics. 2009;29(6):1781–96.CrossRefPubMedGoogle Scholar
  6. 6.
    Qayyum A. Diffusion-weighted imaging in the abdomen and pelvis: concepts and applications. Radiographics. 2009;29(6):1797–810.PubMedCrossRefGoogle Scholar
  7. 7.
    Lubarsky M, Kalb B, Sharma P, Keim SM, Martin DR. MR imaging for acute nontraumatic abdominopelvic pain: rationale and practical considerations. Radiographics. 2013;33(2):313–37.PubMedCrossRefGoogle Scholar
  8. 8.
    Kataoka M, Kido A, Koyama T, Isoda H, Umeoka S, Tamai K, et al. MRI of the female pelvis at 3T compared to 1.5T: evaluation on high-resolution T2-weighted and HASTE images. J Magn Reson Imaging. 2007;25(3):527–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Choi SH, Kim SH, Choi HJ, Park BK, Lee HJ. Preoperative magnetic resonance imaging staging of uterine cervical carcinoma: results of prospective study. J Comput Assist Tomogr. 2004;28(5):620–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson AK, Filippi CG, Andrews T, Higgins T, Tam J, Keating D, et al. Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. Am J Roentgenol. 2012;198(6):1424–30.CrossRefGoogle Scholar
  11. 11.
    Expert Panel on MR Safety, Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG, et al. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 2013;37(3):501–30.CrossRefGoogle Scholar
  12. 12.
    ACR Manual on Contrast Media v10.2. American College of Radiology; 2016Google Scholar
  13. 13.
    Thomsen HS, Morcos SK, Almén T, Bellin M, Bertolotto M, Bongartz G, et al. Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol. 2013;23(2):307–18.PubMedCrossRefGoogle Scholar
  14. 14.
    Li W, Zhang Y, Cui Y, Zhang P, Wu X. Pelvic inflammatory disease: evaluation of diagnostic accuracy with conventional MR with added diffusion-weighted imaging. Abdom Imaging. 2013;38(1):193–200.PubMedCrossRefGoogle Scholar
  15. 15.
    Kato H, Kanematsu M, Uchiyama M, Yano R, Furui T, Morishige K. Diffusion-weighted imaging of ovarian torsion: usefulness of apparent diffusion coefficient (ADC) values for the detection of hemorrhagic infarction. Magn Reson Med Sci. 2014;13(1):39–44.PubMedCrossRefGoogle Scholar
  16. 16.
    Fujii S. Diffusion-weighted imaging findings of adnexal torsion: initial results. Eur J Radiol. 2011;77:330–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Eschenbach DA, Wölner-Hanssen P, Hawes SE, Pavletic A, Paavonen J, Holmes KK. Acute pelvic inflammatory disease: associations of clinical and laboratory findings with laparoscopic findings. Obstet Gynecol. 1997;89(2):184–92.PubMedCrossRefGoogle Scholar
  18. 18.
    Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372(21):2039–48.PubMedCrossRefGoogle Scholar
  19. 19.
    Monif GR. Clinical staging of acute bacterial salpingitis and its therapeutic ramifications. Am J Obstet Gynecol. 1982;143(5):489–95.PubMedCrossRefGoogle Scholar
  20. 20.
    Soper DE. Pelvic inflammatory disease. Obstet Gynecol. 2010;116(2 Part 1):419–28.PubMedCrossRefGoogle Scholar
  21. 21.
    Fitz-Hugh T. Acute gonococcic perihepatitis, a new syndrome of right upper quadrant abdominal pain in young women. Rev Gastroenterol. 1936;3:125–31.Google Scholar
  22. 22.
    Pickhardt PJ, Fleishman MJ, Fisher AJ. Fitz-Hugh–Curtis syndrome: multidetector CT Findings of transient hepatic attenuation difference and gallbladder wall thickening. Am J Roentgenol. 2003;180(6):1605–6.CrossRefGoogle Scholar
  23. 23.
    Lee MH, Moon MH, Sung CK, Woo H, Oh S. CT findings of acute pelvic inflammatory disease. Abdom Imaging. 2014;39(6):1350–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Kreisel K. Prevalence of pelvic inflammatory disease in sexually experienced women of reproductive age—United States, 2013–2014. MMWR Morb Mortal Wkly Rep [Internet]. 2017 [cited 2017 May 16];66.
  25. 25.
    Sutton MY, Sternberg M, Zaidi A, St Louis ME, Markowitz LE. Trends in pelvic inflammatory disease hospital discharges and ambulatory visits, United States, 1985–2001. Sex Transm Dis. 2005;32(12):778–84.PubMedCrossRefGoogle Scholar
  26. 26.
    Bohm MK, Newman L, Satterwhite CL, Tao G, Weinstock HS. Pelvic inflammatory disease among privately insured women, United States, 2001–2005. Sex Transm Dis. 2010;37(3):131–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334(21):1362–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Brunham RC, Paavonen J, Stevens CE, Kiviat N, Kuo C-C, Critchlow CW, et al. Mucopurulent cervicitis—the ignored counterpart in women of urethritis in men. N Engl J Med. 1984;311(1):1–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Taylor SN, Lensing S, Schwebke J, Lillis R, Mena LA, Nelson AL, et al. Prevalence and treatment outcome of cervicitis of unknown etiology. Sex Transm Dis. 2013;40(5):379–85.PubMedCrossRefGoogle Scholar
  30. 30.
    Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K. MR imaging of disorders associated with female infertility: use in diagnosis, treatment, and management. Radiographics. 2003;23(6):1401–21.PubMedCrossRefGoogle Scholar
  31. 31.
    Okamoto Y, Tanaka YO, Nishida M, Tsunoda H, Yoshikawa H, Itai YMR. Imaging of the uterine cervix: imaging-pathologic correlation. Radiographics. 2003;23(2):425–45.PubMedCrossRefGoogle Scholar
  32. 32.
    Yitta S, Hecht EM, Mausner EV, Bennett GL. Normal or abnormal? Demystifying uterine and cervical contrast enhancement at multidetector CT. Radiographics. 2011;31(3):647–61.PubMedCrossRefGoogle Scholar
  33. 33.
    Dohke M, Watanabe Y, Okumura A, Amoh Y, Hayashi T, Yoshizako T, et al. Comprehensive MR imaging of acute gynecologic diseases. Radiographics. 2000;20(6):1551–66.PubMedCrossRefGoogle Scholar
  34. 34.
    Siddall KA, Rubens DJ. Multidetector CT of the female pelvis. Radiol Clin North Am. 2005;43(6):1097–118.PubMedCrossRefGoogle Scholar
  35. 35.
    Paavonen J, Critchlow CW, DeRouen T, Stevens CE, Kiviat N, Brunham RC, et al. Etiology of cervical inflammation. Am J Obstet Gynecol. 1986;154(3):556–64.PubMedCrossRefGoogle Scholar
  36. 36.
    Saini S, Kanetkar SR. Histopathol study lesions uterine cervix [Internet]. 2016 Dec 26 [cited 2017 May 17];(95463).
  37. 37.
    Wager GP, Martin DH, Koutsky L, Eschenbach DA, Daling JR, Chiang WT, et al. Puerperal infectious morbidity: relationship to route of delivery and to antepartum Chlamydia trachomatis infection. Am J Obstet Gynecol. 1980;138(7):1028–33.PubMedCrossRefGoogle Scholar
  38. 38.
    Watts DH, Eschenbach DA, Kenny GE. Early postpartum endometritis: the role of bacteria, genital mycoplasmas, and chlamydia trachomatis. Obstet Gynecol. 1989;73(1):52–60.Google Scholar
  39. 39.
    Cicinelli E, Matteo M, Tinelli R, Lepera A, Alfonso R, Indraccolo U, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 2015;30(2):323–30.PubMedCrossRefGoogle Scholar
  40. 40.
    Nalaboff KM, Pellerito JS, Ben-Levi E. Imaging the endometrium: disease and normal variants. Radiographics. 2001;21(6):1409–24.PubMedCrossRefGoogle Scholar
  41. 41.
    Sudderuddin S, Helbren E, Telesca M, Williamson R, Rockall A. MRI appearances of benign uterine disease. Clin Radiol. 2014;69(11):1095–104.PubMedCrossRefGoogle Scholar
  42. 42.
    Jung SI, Kim YJ, Park HS, Jeon HJ, Jeong KA. Acute pelvic inflammatory disease: diagnostic performance of CT. J Obstet Gynaecol Res. 2011;37(3):228–35.PubMedCrossRefGoogle Scholar
  43. 43.
    Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M. Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics. 2016;36(5):1579–96.PubMedCrossRefGoogle Scholar
  44. 44.
    Patton DL, Moore DE, Spadoni LR, Soules MR, Halbert SA, Wang SP. A comparison of the fallopian tube’s response to overt and silent salpingitis. Obstet Gynecol. 1989;73(4):622–30.PubMedGoogle Scholar
  45. 45.
    Kim MY, Rha SE, Soon Nam O, Jung SE, Lee YJ, Kim YS, et al. MR imaging findings of hydrosalpinx: a comprehensive review. Radiographics. 2009;29(2):495–507.PubMedCrossRefGoogle Scholar
  46. 46.
    Propeck PA, Scanlan KA. Isolated fallopian tube torsion. Am J Roentgenol. 1998;170(4):1112–3.CrossRefGoogle Scholar
  47. 47.
    Gross M, Blumstein SL, Chow LC. Isolated fallopian tube torsion: a rare twist on a common theme. Am J Roentgenol. 2005;185(6):1590–2.CrossRefGoogle Scholar
  48. 48.
    Landers DV, Sweet RL. Current trends in the diagnosis and treatment of tuboovarian abscess. Am J Obstet Gynecol. 1985;151(8):1098–110.PubMedCrossRefGoogle Scholar
  49. 49.
    Ueda H, Togashi K, Kataoka ML, Koyama T, Fujiwara T, Fujii S, et al. Adnexal masses caused by pelvic inflammatory disease: MR appearance. Magn Reson Med Sci. 2002;1(4):207–15.PubMedCrossRefGoogle Scholar
  50. 50.
    Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology. 1999;210(1):209–16.PubMedCrossRefGoogle Scholar
  51. 51.
    Rezvani M, Shaaban AM. Fallopian tube disease in the nonpregnant patient. Radiographics. 2011;31(2):527–48.PubMedCrossRefGoogle Scholar
  52. 52.
    Ha HK, Lim GY, Cha ES, Lee HG, Ro HJ, Kim HS, et al. MR imaging of tubo-ovarian abscess. Acta Radiol 1987. 1995;36(5):510–4.PubMedCrossRefGoogle Scholar
  53. 53.
    Twickler DM, Setiawan AT, Evans RS, Erdman WA, Stettler RW, Brown CE, et al. Imaging of puerperal septic thrombophlebitis: prospective comparison of MR imaging, CT, and sonography. Am J Roentgenol. 1997;169(4):1039–43.CrossRefGoogle Scholar
  54. 54.
    Kubik-Huch RA, Hebisch G, Huch R, Hilfiker P, Debatin JF, Krestin GP. Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis. Abdom Imaging. 1999;24(1):85–91.PubMedCrossRefGoogle Scholar
  55. 55.
    Sharma P, Abdi S. Ovarian vein thrombosis. Clin Radiol. 2012;67(9):893–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Cuyper K, Eyselbergs M, Bernard P, Clabout L, Vanhoenacker FM. Added value of diffusion weighted MRI in the diagnosis of postpartum ovarian vein thrombosis. J Belg Soc Radiol [Internet]. 2014 [cited 2017 May 23];97(4). CrossRefGoogle Scholar
  57. 57.
    Valicenti JF, Pappas AA, Graber CD, Williamson HO, Willis NF. Detection and prevalence of IUD-associated Actinomyces colonization and related morbidity. A prospective study of 69,925 cervical smears. JAMA. 1982;247(8):1149–52.PubMedCrossRefGoogle Scholar
  58. 58.
    Chatwani A, Amin-Hanjani S. Incidence of actinomycosis associated with intrauterine devices. J Reprod Med. 1994;39(8):585–7.PubMedGoogle Scholar
  59. 59.
    Perlow JH, Wigton T, Yordan EL, Graham J, Wool N, Wilbanks GD. Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device. Rev Infect Dis. 1991;13(6):1115–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Hawnaur JM, Reynolds K, McGettigan C. Magnetic resonance imaging of actinomycosis presenting as pelvic malignancy. Br J Radiol. 1999;72(862):1006–11.PubMedCrossRefGoogle Scholar
  61. 61.
    Bae JH, Song R, Lee A, Park JS, Kim MR. Computed tomography for the preoperative diagnosis of pelvic actinomycosis. J Obstet Gynaecol Res. 2011;37(4):300–4.PubMedCrossRefGoogle Scholar
  62. 62.
    O’Connor KF, Bagg MN, Croley MR, Schabel SI. Pelvic actinomycosis associated with intrauterine devices. Radiology. 1989;170(2):559–60.PubMedCrossRefGoogle Scholar
  63. 63.
    Kim SH, Kim SH, Yang DM, Kim KA. Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics. 2004;24(6):1575–89.PubMedCrossRefGoogle Scholar
  64. 64.
    Dejanović D, Ahnlide JA, Nilsson C, Berthelsen AK, Loft A. Pelvic actinomycosis associated with an intrauterine contraceptive device demonstrated on F-18 FDG PET/CT. Diagnostics. 2015;5(3):369–71.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the pelvic inflammatory disease evaluation and clinical health (peach) randomized trial. Am J Obstet Gynecol. 2002;186(5):929–37.PubMedCrossRefGoogle Scholar
  66. 66.
    Pelvic Inflammatory Disease (PID)—2015 STD Treatment Guidelines [Internet]. [cited 2017 May 23].
  67. 67.
    Farid H, Lau TC, Karmon AE, Styer AK. Clinical characteristics associated with antibiotic treatment failure for tuboovarian abscesses. Infect Dis Obstet Gynecol. 2016;2016:e5120293.CrossRefGoogle Scholar
  68. 68.
    Perez-Medina T, Huertas MA, Bajo JM. Early ultrasound-guided transvaginal drainage of tuba-ovarian abscesses: a randomized study. Ultrasound Obstet Gynecol. 1996;7(6):435–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Goharkhay N, Verma U, Maggiorotto F.Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo-ovarian abscesses. Ultrasound Obstet Gynecol. 2007;29(1):65–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Gjelland K, Ekerhovd E, Granberg S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynecol. 2005;193(4):1323–30.PubMedCrossRefGoogle Scholar
  71. 71.
    Labropoulos N, Malgor RD, Comito M, Gasparis AP, Pappas PJ, Tassiopoulos AK. The natural history and treatment outcomes of symptomatic ovarian vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2015;3(1):42–7.PubMedCrossRefGoogle Scholar
  72. 72.
    Taga S. Diagnosis and therapy of pelvic actinomycosis. J Obstet Gynaecol Res. 2007;33(6):882–5.PubMedCrossRefGoogle Scholar
  73. 73.
    Smego RA, Foglia G. Actinomycosis. Clin Infect Dis. 1998;26(6):1255–61.PubMedCrossRefGoogle Scholar
  74. 74.
    Lippes J. Pelvic actinomycosis: a review and preliminary look at prevalence. Am J Obstet Gynecol. 1999;180(2):265–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Garner JP, Macdonald M, Kumar PK. Abdominal actinomycosis. Int J Surg. 2007;5(6):441–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152(4):456–61.PubMedCrossRefGoogle Scholar
  77. 77.
    Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med. 2001;38(2):156–9.PubMedCrossRefGoogle Scholar
  78. 78.
    Hiller N, Appelbaum L, Simanovsky N, Lev-Sagi A, Aharoni D, Sella TCT. Features of adnexal torsion. Am J Roentgenol. 2007;189(1):124–9.CrossRefGoogle Scholar
  79. 79.
    Béranger-Gibert S, Sakly H, Ballester M, Rockall A, Bornes M, Bazot M, et al. Diagnostic value of MR imaging in the diagnosis of adnexal torsion. Radiology. 2015;279(2):461–70.PubMedCrossRefGoogle Scholar
  80. 80.
    Chiou S-Y, Lev-Toaff AS, Masuda E, Feld RI, Bergin D. Adnexal torsion. J Ultrasound Med. 2007;26(10):1289–301.PubMedCrossRefGoogle Scholar
  81. 81.
    Duigenan S, Oliva E, Lee SI. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. Am J Roentgenol. 2012;198(2):W122–31.CrossRefGoogle Scholar
  82. 82.
    Fahmy HS, Swamy N, Elshahat HM. Revisiting the role of MRI in gynecological emergencies: an institutional experience. Egypt J Radiol Nucl Med. 2015;46(3):769–79.CrossRefGoogle Scholar
  83. 83.
    Petkovska I, Duke E, Martin DR, Irani Z, Geffre CP, Cragun JM, et al. MRI of ovarian torsion: correlation of imaging features with the presence of perifollicular hemorrhage and ovarian viability. Eur J Radiol. 2016;85(11):2064–71.PubMedCrossRefGoogle Scholar
  84. 84.
    Yuk J-S, Kim LY, Shin J-Y, Choi DY, Kim TY, Lee JHA. national population-based study of the incidence of adnexal torsion in the Republic of Korea. Int J Gynecol Obstet. 2015;129(2):169–70.CrossRefGoogle Scholar
  85. 85.
    Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990;53(1):76–80.PubMedCrossRefGoogle Scholar
  86. 86.
    Ginath S, Shalev A, Keidar R, Kerner R, Condrea A, Golan A, et al. Differences between adnexal torsion in pregnant and nonpregnant women. J Minim Invasive Gynecol. 2012;19(6):708–14.PubMedCrossRefGoogle Scholar
  87. 87.
    Moribata Y, Kido A, Yamaoka T, Mikami Y, Himoto Y, Kataoka M, et al. MR imaging findings of ovarian torsion correlate with pathological hemorrhagic infarction. J Obstet Gynaecol Res. 2015;41(9):1433–9.PubMedCrossRefGoogle Scholar
  88. 88.
    Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med. 1998;17(2):83–9.PubMedCrossRefGoogle Scholar
  89. 89.
    Ghossain MA, Hachem K, Buy J-N, Hourany-Rizk RG, Aoun NJ, Haddad-Zebouni S, et al. Adnexal torsion: magnetic resonance findings in the viable adnexa with emphasis on stromal ovarian appearance. J Magn Reson Imaging. 2004;20(3):451–62.PubMedCrossRefGoogle Scholar
  90. 90.
    Fujii S, Kaneda S, Kakite S, Kanasaki Y, Matsusue E, Harada T, et al. Diffusion-weighted imaging findings of adnexal torsion: initial results. Eur J Radiol. 2011;77(2):330–4.PubMedCrossRefGoogle Scholar
  91. 91.
    Rha SE, Byun JY, Jung SE, Jung JI, Choi BG, Kim BS, et al. CT and MR imaging features of adnexal torsion. Radiographics. 2002;22(2):283–94.PubMedCrossRefGoogle Scholar
  92. 92.
    Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J. Ovarian torsion: CT and MR imaging appearances. Radiology. 1994;190(2):337–41.PubMedCrossRefGoogle Scholar
  93. 93.
    Haque TL, Togashi K, Kobayashi H, Fujii S, Konishi J. Adnexal torsion: MR imaging findings of viable ovary. Eur Radiol. 2000;10(12):1954–7.PubMedCrossRefGoogle Scholar
  94. 94.
    Zweizig S, Perron J, Grubb D, Mishell DR. Conservative management of adnexal torsion. Am J Obstet Gynecol. 1993;168(6):1791–5.PubMedCrossRefGoogle Scholar
  95. 95.
    McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv. 1999;54(9):601–8.PubMedCrossRefGoogle Scholar
  96. 96.
    Oelsner G, Bider D, Goldenberg M, Admon D, Mashiach S. Long-term follow-up of the twisted ischemic adnexa managed by detorsion. Fertil Steril. 1993;60(6):976–9.PubMedCrossRefGoogle Scholar
  97. 97.
    Galinier P, Carfagna L, Delsol M, Ballouhey Q, Lemasson F, Le Mandat A, et al. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg. 2009;44(9):1759–65.PubMedCrossRefGoogle Scholar
  98. 98.
    Germain M, Rarick T, Robins E. Management of intermittent ovarian torsion by laparoscopic oophoropexy. Obstet Gynecol. 1996;88(4):715–7.PubMedCrossRefGoogle Scholar
  99. 99.
    Grunewald B, Keating J, Brown S. Asynchronous ovarian torsion: the case for prophylactic oophoropexy. Postgrad Med J. 1993;69(810):318–9.PubMedPubMedCentralCrossRefGoogle Scholar
  100. 100.
    Breen JL. A 21 year survey of 654 ectopic pregnancies. Am J Obstet Gynecol. 1970;106(7):1004–19.PubMedCrossRefGoogle Scholar
  101. 101.
    Körolu M, Kayhan A, Soylu FN, Erol B, Schmid-tannwald C, Gürses C, et al. MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites. Jpn J Radiol. 2013;31(2):75–80.Google Scholar
  102. 102.
    Cacciatore B, Stenman U-H, Ylostalo P. Early screening for ectopic pregnancy in high-risk symptom-free women. Lancet. 1994;343(8896):517–8.CrossRefGoogle Scholar
  103. 103.
    Barnhart KT. Ectopic pregnancy. N Engl J Med. 2009;361(4):379–87.PubMedCrossRefGoogle Scholar
  104. 104.
    Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250–61.PubMedCrossRefGoogle Scholar
  105. 105.
    Barnhart K, Mennuti MT, Benjamin I, Jacobson S, Goodman D, Coutifaris C. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol. 1994;84(6):1010–5.PubMedGoogle Scholar
  106. 106.
    Condous G, Lu C, Van Huffel SV, Timmerman D, Bourne T. Human chorionic gonadotrophin and progesterone levels in pregnancies of unknown location. Int J Gynecol Obstet. 2004;86(3):351–7.CrossRefGoogle Scholar
  107. 107.
    Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I. Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril. 1998;69(1):62–5.PubMedCrossRefGoogle Scholar
  108. 108.
    Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy—United States, 1970–1989. MMWR CDC Surveill Summ Morb Mortal Wkly Rep CDC Surveill Summ. 1993;42(6):73–85.Google Scholar
  109. 109.
    Centers for Disease Control. Current trends ectopic pregnancy: United States, 1990–1992. MMWR Wkly. 1995;44(3):46–8.Google Scholar
  110. 110.
    Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, et al. Pregnancy-related mortality surveillance—United States, 1991–1999. MMWR Surveill Summ. 2003;52(2):1–8.PubMedGoogle Scholar
  111. 111.
    Grimes DA. Estimation of pregnancy-related mortality risk by pregnancy outcome, United States, 1991 to 1999. Am J Obstet Gynecol. 2006;194(1):92–4.PubMedCrossRefGoogle Scholar
  112. 112.
    Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM. Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol. 2011;117(4):837–43.PubMedCrossRefGoogle Scholar
  113. 113.
    Tamai K, Koyama T, Saga T, Kido A, Kataoka M, Umeoka S, et al. MR features of physiologic and benign conditions of the ovary. Eur Radiol. 2006;16(12):2700–11.PubMedCrossRefGoogle Scholar
  114. 114.
    Tamai K, Koyama T, Togashi K. MR features of ectopic pregnancy. Eur Radiol. 2007;17(12):3236–46.PubMedCrossRefGoogle Scholar
  115. 115.
    Si M-J, Gui S, Fan Q, Han H-X, Zhao Q-Q, Li Z-X, et al. Role of MRI in the early diagnosis of tubal ectopic pregnancy. Eur Radiol. 2016;26(7):1971–80.PubMedCrossRefGoogle Scholar
  116. 116.
    Takahashi A, Takahama J, Marugami N, Takewa M, Itoh T, Kitano S, et al. Ectopic pregnancy: MRI findings and clinical utility. Abdom Imaging. 2013;38(4):844–50.PubMedCrossRefGoogle Scholar
  117. 117.
    Yoshigi J, Yashiro N, Kinoshita T, O’uchi T, Kitagaki H. Diagnosis of ectopic pregnancy with MRI: efficacy of T2-weighted imaging. Magn Reson Med Sci. 2006;5(1):25–32.PubMedCrossRefGoogle Scholar
  118. 118.
    Gamzu R, Almog B, Levin Y, Pauzner D, Lessing JB, Jaffa A, et al. The ultrasonographic appearance of tubal pregnancy in patients treated with methotrexate. Hum Reprod. 2002;17(10):2585–7.PubMedCrossRefGoogle Scholar
  119. 119.
    Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224–30.PubMedCrossRefGoogle Scholar
  120. 120.
    Filhastre M, Dechaud H, Lesnik A, Taourel P. Interstitial pregnancy: role of MRI. Eur Radiol. 2005;15(1):93–5.PubMedCrossRefGoogle Scholar
  121. 121.
    Bourdel N, Roman H, Gallot D, Lenglet Y, Dieu V, Juillard D, et al. Interstitial pregnancy. Ultrasonographic diagnosis and contribution of MRI. A case report. Gynécologie Obstétrique Fertil. 2007;35(2):121.CrossRefGoogle Scholar
  122. 122.
    Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol. 2010;202(1):15–29.PubMedCrossRefGoogle Scholar
  123. 123.
    Cohen J, Weinreb J, Lowe T, Brown CMR. imaging of a viable full-term abdominal pregnancy. Am J Roentgenol. 1985;145(2):407–8.CrossRefGoogle Scholar
  124. 124.
    Wagner A, Burchardt A-JMR. Imaging in advanced abdominal pregnancy a case report of fetal death. Acta Radiol. 1995;36(2):193–5.PubMedCrossRefGoogle Scholar
  125. 125.
    Malian V, Lee JE. MR imaging and MR angiography of an abdominal pregnancy with placental infarction. Am J Roentgenol. 2001;177(6):1305–6.CrossRefGoogle Scholar
  126. 126.
    Ozdemir I, Demirci F, Yucel O, Alper M. Primary omental pregnancy presenting with hemorrhagic shock. Gynecol Obstet Invest. 2003;55(2):116–8.PubMedCrossRefGoogle Scholar
  127. 127.
    Wong WC, Wong BPY, Kun KY, Ng TK, Kwok SY, Lee CK. Primary omental ectopic pregnancy. J Obstet Gynaecol Res. 2004;30(3):226–9.PubMedCrossRefGoogle Scholar
  128. 128.
    Børlum K-G, Blom R. Primary hepatic pregnancy. Int J Gynecol Obstet. 1988;27(3):427–9.CrossRefGoogle Scholar
  129. 129.
    Cormio G, Santamato S, Vimercati A, Selvaggi L. Primary splenic pregnancy. A case report. J Reprod Med. 2003;48(6):479–81.PubMedGoogle Scholar
  130. 130.
    Werber J, Prasadarao PR, Harris VJ. Cervical pregnancy diagnosed by ultrasound. Radiology. 1983;149(1):279–80.PubMedCrossRefGoogle Scholar
  131. 131.
    Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST, Characteristic MR findings of cervical pregnancy. J Magn Reson Imaging. 2001;13(6):918–22.PubMedCrossRefGoogle Scholar
  132. 132.
    Gun M, Mavrogiorgis M. Cervical ectopic pregnancy: a case report and literature review. Ultrasound Obstet Gynecol. 2002;19(3):297–301.PubMedCrossRefGoogle Scholar
  133. 133.
    Sherer DM, Gorelick C, Dalloul M, Sokolovski M, Kheyman M, Kakamanu S, et al. Three-dimensional sonographic findings of a cervical pregnancy. J Ultrasound Med. 2008;27(1):155–8.PubMedCrossRefGoogle Scholar
  134. 134.
    Herbertsson G, Magnusson SS, Benediktsdottir K. Ovarian pregnancy and IUCD use in a defined complete population. Acta Obstet Gynecol Scand. 1987;66(7):607–10.PubMedCrossRefGoogle Scholar
  135. 135.
    Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114(3):253–63.PubMedCrossRefGoogle Scholar
  136. 136.
    Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107(6):1373–81.PubMedCrossRefGoogle Scholar
  137. 137.
    Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012;207(1):14–29.PubMedCrossRefGoogle Scholar
  138. 138.
    Lipscomb GH, Bran D, McCord ML, Portera JC, Ling FW. Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate. Am J Obstet Gynecol. 1998;178(6):1354–8.PubMedCrossRefGoogle Scholar
  139. 139.
    Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ectopic pregnancy. N Engl J Med. 2000;343(18):1325–9.PubMedCrossRefGoogle Scholar
  140. 140.
    Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW. Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Engl J Med. 1999;341(26):1974–8.PubMedCrossRefGoogle Scholar
  141. 141.
    Tzafettas JM, Stephanatos A, Loufopoulos A, Anapliotis S, Mamopoulos M, Kalogeropoulos A. Single high dose of local methotrexate for the management of relatively advanced ectopic pregnancies. Fertil Steril. 1999;71(6):1010–3.PubMedCrossRefGoogle Scholar
  142. 142.
    Romero R, Copel JA, Kadar N, Jeanty P, Decherney A, Hobbins JC. Value of culdocentesis in the diagnosis of ectopic pregnancy. Obstet Gynecol. 1985;65(4):519–22.PubMedGoogle Scholar
  143. 143.
    Vermesh M, Graczykowski JW, Sauer MV. Reevaluation of the role of culdocentesis in the management of ectopic pregnancy. Am J Obstet Gynecol. 1990;162(2):411–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of KentuckyLexingtonUSA
  2. 2.Department of RadiologyMayo ClinicPhoenixUSA

Personalised recommendations