MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites
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PICTORIAL ESSAY
MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites Mert Ko¨rog˘lu • Arda Kayhan • Fatma Nur Soylu • Bekir Erol • Christine Schmid-Tannwald • Cemil Gu¨rses • I˙brahim Karademir Randy Ernst • Ambereen Yousuf • Aytekin Oto
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Received: 27 July 2012 / Accepted: 1 October 2012 / Published online: 7 November 2012 Ó Japan Radiological Society 2012
Abstract Ectopic pregnancy (EP) is a life-threatening condition and remains the leading cause of death in the first trimester of pregnancy, although the mortality rate has significantly decreased over the past few decades because of earlier diagnoses and great improvements in treatment. EP is most commonly located in the ampullary portion of the fallopian tube and rarely in unusual sites such as the interstitium, cervix, cesarean scar, anomalous rudimentary horn of the uterus and peritoneal abdominal cavity. MRI may confirm or give additional information to ultrasonography, which is the most user-dependent imaging modality. Magnetic resonance imaging can accurately localize the site of abnormal implantation. It could be helpful for EP patient treatment by distinguishing the ruptured and unruptured cases before methotrexate treatment. MRI is quite sensitive to blood and can identify the hemorrhage phase. Keywords Diagnosis
symptoms are abdominal pain, vaginal bleeding, and abdominal or adnexal tenderness. The classic clinical triad of pain, abnormal bleeding and a palpable adnexal mass occurs in less than half of patients. The most common period of presentation is 5–6 weeks of gestational age [2]. Patients with a prior EP have a 12.6 % chance of having a second EP. Other risk factors include pelvic inflammatory disease, endometriosis, late primiparity, an intrauterine contraceptive device (IUD), previous tubal surgery and any other tubal disease [3, 4]. Specifically for IUDs, the pregnancy rate is low if IUDs have been placed, but once pregnancy occurs, the probability of ectopic pregnancy is high. The rates of ectopic pregnancies have increased with recent developments in assisted reproductive technologies (ART) such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation and intrauterine insemination (IUI) [5].
Pregnancy Ectopic Magnetic resonance
Introduction Ectopic pregnancy (EP) occurs in approximately 2 % of all pregnancies in the US and is the leading cause of first trimester pregnancy death [1]. The most common clinical M. Ko¨rog˘lu (&) B. Erol C. Gu¨rses Department of Radiology, Antalya Education and Research Hospital, Antalya 07100, Turkey e-mail: [email protected] A. Kayhan F. N. Soylu C. Schmid-Tannwald I˙. Karademir R. Ernst A. Yousuf A. Oto Department of Radiology, University of Chicago, Chicago, IL, USA
Ultrasound diagnosis of ectopic pregnancy Ultrasound along with b-HCG levels remains the most important imaging modality for the evaluation of possible EP. The most common location for an EP is the fallopian tube, which occurs in up to 97 % of cases (Fig.
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