CME Article
MRI of Acute Gynecologic Conditions
Molly Somberg Gunther MD,
Deveraju Kanmaniraja MD,
Mariya Kobi MD,
Victoria Chernyak MD, MS,
Molly Somberg Gunther MD
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Search for more papers by this authorDeveraju Kanmaniraja MD
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Search for more papers by this authorMariya Kobi MD
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Search for more papers by this authorCorresponding Author
Victoria Chernyak MD, MS
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Address reprint requests to: V.C., Department of Radiology, Montefiore Medical Center, Bronx, NY 10467. E-mail: [email protected]Search for more papers by this authorMolly Somberg Gunther MD,
Deveraju Kanmaniraja MD,
Mariya Kobi MD,
Victoria Chernyak MD, MS,
Molly Somberg Gunther MD
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Search for more papers by this authorDeveraju Kanmaniraja MD
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Search for more papers by this authorMariya Kobi MD
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Search for more papers by this authorCorresponding Author
Victoria Chernyak MD, MS
Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
Address reprint requests to: V.C., Department of Radiology, Montefiore Medical Center, Bronx, NY 10467. E-mail: [email protected]Search for more papers by this authorAbstract
Although usually not a first-line imaging modality in the setting of acute pelvic pain, magnetic resonance imaging (MRI) is able to depict and characterize a wide range gynecologic diagnoses with high accuracy. Lack of ionizing radiation renders MRI particularly useful for assessment of pregnant women and children. Furthermore, inherent high soft-tissue resolution of MRI allows accurate diagnosis without intravenous contrast use, which is advantageous for patients with renal insufficiency and pregnant patients. Familiarity with the typical MRI appearance of various acute gynecologic conditions helps establish the correct diagnosis. This article reviews the common MRI findings of acute gynecologic processes, in both pregnant and nonpregnant patients.
Level of Evidence: 3
Technical Efficacy Stage: 3
J. Magn. Reson. Imaging 2020;51:1291–1309.
References
- 1Curtis KM, Hillis SD, Kieke BA Jr, Brett KM, Marchbanks PA, Peterson HB. Visits to emergency departments for gynecologic disorders in the United States, 1992-1994. Obstet Gynecol 1998; 91: 1007–1012.
- 2Bhosale PR, Javitt MC, Atri M, et al. ACR Appropriateness Criteria(R) acute pelvic pain in the reproductive age group. Ultrasound Q 2016; 32: 108–115.
- 3Masselli G, Derchi L, McHugo J, et al. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 2013; 23: 3485–3500.
- 4Long SS, Long C, Lai H, Macura KJ. Imaging strategies for right lower quadrant pain in pregnancy. AJR Am J Roentgenol 2011; 196: 4–12.
- 5Muthusami P, Bhuvaneswari V, Elangovan S, Dorairajan LN, Ramesh A. The role of static magnetic resonance urography in the evaluation of obstructive uropathy. Urology 2013; 81: 623–627.
- 6Torkzad MR, Bremme K, Hellgren M, et al. Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy. Thromb Res 2010; 126: 107–112.
- 7Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E. MR imaging evaluation of abdominal pain during pregnancy: Appendicitis and other nonobstetric causes. Radiographics 2012; 32: 317–334.
- 8Knoepp US, Mazza MB, Chong ST, Wasnik AP. MR imaging of pelvic emergencies in women. Magn Reson Imaging Clin N Am 2017; 25: 503–519.
- 9Chartier AL, Bouvier MJ, McPherson DR, Stepenosky JE, Taysom DA, Marks RM. The safety of maternal and fetal MRI at 3T. AJR Am J Roentgenol 2019: 1–4.
- 10Singh A, Danrad R, Hahn PF, Blake MA, Mueller PR, Novelline RA. MR imaging of the acute abdomen and pelvis: Acute appendicitis and beyond. Radiographics 2007; 27: 1419–1431.
- 11Kinner S, Repplinger MD, Pickhardt PJ, Reeder SB. Contrast-enhanced abdominal MRI for suspected appendicitis: How we do it. AJR Am J Roentgenol 2016; 207: 49–57.
- 12Heverhagen JT, Klose KJ. MR imaging for acute lower abdominal and pelvic pain. Radiographics 2009; 29: 1781–1796.
- 13Martin DR, Danrad R, Herrmann K, Semelka RC, Hussain SM. Magnetic resonance imaging of the gastrointestinal tract. Top Magn Reson Imaging 2005; 16: 77–98.
- 14Leyendecker 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: 1301–1316.
- 15Lubarsky M, Kalb B, Sharma P, Keim SM, Martin DR. MR imaging for acute nontraumatic abdominopelvic pain: Rationale and practical considerations. Radiographics 2013; 33: 313–337.
- 16Horowitz JM, Hotalen IM, Miller ES, Barber EL, Shahabi S, Miller FH. How can pelvic MRI with diffusion-weighted imaging help my pregnant patient? Am J Perinatol 2019 [Epub ahead of print].
- 17Inci E, Kilickesmez O, Hocaoglu E, Aydin S, Bayramoglu S, Cimilli T. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol 2011; 21: 768–775.
- 18Durur-Karakaya A, Seker M, Durur-Subasi I. Diffusion-weighted imaging in ectopic pregnancy: Ring of restriction sign. Br J Radiol 2018; 91: 20170528.
- 19Ozdemir O, Metin Y, Metin NO, Kupeli A. Contribution of diffusion-weighted imaging to conventional MRI for detection of haemorrhagic infarction in ovary torsion. BMC Med Imaging 2017; 17: 56.
- 20Moribata Y, Kido A, Yamaoka T, et al. MR imaging findings of ovarian torsion correlate with pathological hemorrhagic infarction. J Obstet Gynaecol Res 2015; 41: 1433–1439.
- 21Kato 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: 39–44.
- 22De Santis M, Straface G, Cavaliere AF, Carducci B, Caruso A. Gadolinium periconceptional exposure: Pregnancy and neonatal outcome. Acta Obstet Gynecol Scand 2007; 86: 99–101.
- 23Rubin JI, Gomori JM, Grossman RI, Gefter WB, Kressel HY. High-field MR imaging of extracranial hematomas. AJR Am J Roentgenol 1987; 148: 813–817.
- 24Hahn PF, Saini S, Stark DD, Papanicolaou N, Ferrucci JT Jr. Intraabdominal hematoma: The concentric-ring sign in MR imaging. AJR Am J Roentgenol 1987; 148: 115–119.
- 25Lane MJ, Katz DS, Shah RA, Rubin GD, Jeffrey RB Jr. Active arterial contrast extravasation on helical CT of the abdomen, pelvis, and chest. AJR Am J Roentgenol 1998; 171: 679–685.
- 26Lee NK, Kim S, Kim DU, Seo HI, Kim HS, Jo HJ, et al. Diffusion-weighted magnetic resonance imaging for non-neoplastic conditions in the hepatobiliary and pancreatic regions: Pearls and potential pitfalls in imaging interpretation. Abdom Imaging 2015; 40: 643–662.
- 27Czeyda-Pommersheim F, Kalb B, Costello J, et al. MRI in pelvic inflammatory disease: A pictorial review. Abdom Radiol 2017; 42: 935–950.
- 28Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011; 37: 231–240.
- 29Srisajjakul S, Prapaisilp P, Bangchokdee S. Magnetic resonance imaging in tubal and non-tubal ectopic pregnancy. Eur J Radiol 2017; 93: 76–89.
- 30Shalev 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: 62–65.
- 31Ramanathan S, Raghu V, Ladumor SB, et al. Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy. Abdom Radiol 2018; 43: 3425–3435.
- 32Masselli G, Derme M, Piccioni MG, et al. To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: A retrospective cohort study. Eur Radiol 2018; 28: 2444–2454.
- 33Parker RA 3rd, Yano M, Tai AW, Friedman M, Narra VR, Menias CO. MR imaging findings of ectopic pregnancy: A pictorial review. Radiographics 2012; 32: 1445–1460; discussion 60–62.
- 34Viets ZJ, Raptis CA, Fowler KJ, Hildebolt CF, Yano M. Magnetic resonance imaging of first trimester pregnancy: Expected intrauterine contents in relation to gestational age. Abdom Radiol (NY). 2017; 42: 2334–2339.
- 35Shin DS, Poder L, Courtier J, Naeger DM, Westphalen AC, Coakley FV. CT and MRI of early intrauterine pregnancy. AJR Am J Roentgenol 2011; 196: 325–330.
- 36Si MJ, Gui S, Fan Q, et al. Role of MRI in the early diagnosis of tubal ectopic pregnancy. Eur Radiol 2016; 26: 1971–1980.
- 37Raziel A, Schachter M, Mordechai E, Friedler S, Panski M, Ron-El R. Ovarian pregnancy—A 12-year experience of 19 cases in one institution. Eur J Obstet Gynecol Reprod Biol 2004; 114: 92–96.
- 38Kung FT, Lin H, Hsu TY, et al. Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril 2004; 81: 1642–1649.
- 39Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST. Characteristic MR findings of cervical pregnancy. J Magn Reson Imaging 2001; 13: 918–922.
- 40Kao LY, Scheinfeld MH, Chernyak V, Rozenblit AM, Oh S, Dym RJ. Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol 2014; 202: 904–911.
- 41Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound Obstet Gynecol 2003; 21: 220–227.
- 42Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: Issues in management. Ultrasound Obstet Gynecol 2004; 23: 247–253.
- 43Rheinboldt M, Osborn D, Delproposto Z. Cesarean section scar ectopic pregnancy: A clinical case series. J Ultrasound 2015; 18: 191–195.
- 44Peng KW, Lei Z, Xiao TH, et al. First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol 2014; 69: 123–129.
- 45Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007; 114: 253–263.
- 46Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a caesarean scar: Review of the medical approach to an iatrogenic complication. Hum Reprod Update 2004; 10: 515–523.
- 47 Prevention. CfDCa. Assisted reproductive technology, Centers for Disease Control and Prevention. 2017. https://www.cdc.gov/art/artdata/index.html?CDC_AA_refVal=www.cdc.gov/art/reports/index.html. Accessed November 27, 2019.
- 48Soares SR, Gomez R, Simon C, Garcia-Velasco JA, Pellicer A. Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome. Hum Reprod Update 2008; 14: 321–333.
- 49Jung BG, Kim H. Severe spontaneous ovarian hyperstimulation syndrome with MR findings. J Comput Assist Tomogr 2001; 25: 215–217.
- 50Baron KT, Babagbemi KT, Arleo EK, Asrani AV, Troiano RN. Emergent complications of assisted reproduction: Expecting the unexpected. Radiographics 2013; 33: 229–244.
- 51Noonan JB, Coakley FV, Qayyum A, Yeh BM, Wu L, Chen LM. MR imaging of retained products of conception. AJR Am J Roentgenol 2003; 181: 435–439.
- 52Zuckerman J, Levine D, McNicholas MM, et al. Imaging of pelvic postpartum complications. AJR Am J Roentgenol 1997; 168: 663–668.
- 53Brandt KR, Coakley KJ. MR appearance of placental site trophoblastic tumor: A report of three cases. AJR Am J Roentgenol 1998; 170: 485–487.
- 54Dresang LT, Leeman L. Cesarean delivery. Prim Care 2012; 39: 145–165.
- 55van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74: 1–6.
- 56Sawada M, Matsuzaki S, Nakae R, et al. Treatment and repair of uterine scar dehiscence during cesarean section. Clin Case Rep 2017; 5: 145–149.
- 57Alamo L, Vial Y, Denys A, Andreisek G, Meuwly JY, Schmidt S. MRI findings of complications related to previous uterine scars. Eur J Radiol Open 2018; 5: 6–15.
- 58Twickler DM, Setiawan AT, Harrell RS, Brown CE. CT appearance of the pelvis after cesarean section. AJR Am J Roentgenol 1991; 156: 523–526.
- 59Moshiri M, Osman S, Bhargava P, Maximin S, Robinson TJ, Katz DS. Imaging evaluation of maternal complications associated with repeat cesarean deliveries. Radiol Clin North Am 2014; 52: 1117–1135.
- 60Rodgers SK, Kirby CL, Smith RJ, Horrow MM. Imaging after cesarean delivery: Acute and chronic complications. Radiographics 2012; 32: 1693–1712.
- 61Green J. Placenta previa and abruptio placentae. Maternal fetal medicine: Principles and practice. Philadelphia: WB Saunders; 1989.
- 62Podrasky AE, Javitt MC, Glanc P, et al. ACR appropriateness Criteria(R) second and third trimester bleeding. Ultrasound Q 2013; 29: 293–301.
- 63Masselli G, Brunelli R, Di Tola M, Anceschi M, Gualdi G. MR imaging in the evaluation of placental abruption: Correlation with sonographic findings. Radiology 2011; 259: 222–230.
- 64Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 2008; 28: 1355–1368.
- 65Pedrosa I, Zeikus EA, Levine D, Rofsky NM. MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics 2007; 27: 721–743; discussion 43–53.
- 66Duigenan S, Oliva E, Lee SI. Ovarian torsion: Diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol 2012; 198: W122–131.
- 67Rha SE, Byun JY, Jung SE, et al. CT and MR imaging features of adnexal torsion. Radiographics 2002; 22: 283–294.
- 68Jain KA. Sonographic spectrum of hemorrhagic ovarian cysts. J Ultrasound Med 2002; 21: 879–886.
- 69McDermott S, Oei TN, Iyer VR, Lee SI. MR imaging of malignancies arising in endometriomas and extraovarian endometriosis. Radiographics 2012; 32: 845–863.
- 70Iraha Y, Okada M, Iraha R, et al. CT and MR imaging of gynecologic emergencies. Radiographics 2017; 37: 1569–1586.
- 71Roche O, Chavan N, Aquilina J, Rockall A. Radiological appearances of gynaecological emergencies. Insights Imaging 2012; 3: 265–275.
- 72Kobi M, Flusberg M, Chernyak V. MR imaging of acute abdomen and pelvis. Curr Radiol Rep 2016; 4(6).
10.1007/s40134-016-0160-1 Google Scholar
- 73Kawakami S, Togashi K, Konishi I, et al. Red degeneration of uterine leiomyoma: MR appearance. J Comput Assist Tomogr 1994; 18: 925–928.
- 74Takeuchi M, Matsuzaki K, Bando Y, Harada M. Evaluation of red degeneration of uterine leiomyoma with susceptibility-weighted MR Imaging. Magn Reson Med Sci 2019; 18: 158–162.
- 75Tukeva 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: 209–216.
- 76Dohke M, Watanabe Y, Okumura A, et al. Comprehensive MR imaging of acute gynecologic diseases. Radiographics 2000; 20: 1551–1566.
- 77Chaudhari VV, Patel MK, Douek M, Raman SS. MR imaging and US of female urethral and periurethral disease. Radiographics 2010; 30: 1857–1874.
