MR-Diagnostik des Abdomens in der Schwangerschaft

Zusammenfassung

In der radiologischen Diagnostik akuter Erkrankungen der Schwangeren ist die Sonografie die Methode der ersten Wahl. Die veränderte Physiognomie der Frauen verstärkt die bekannten Limitationen des Ultraschalls, während die Stärken der MRT (großes FOV, hoher Weichteilkontrast, sensitive Ödemdarstellung) durch die Schwangerschaft nicht beeinträchtigt werden. Vielmehr ermöglichen die zur Verfügung stehenden Sequenzen die sichere Differenzierung verschiedener Pathologien. Bei vielen Fragestellungen kann auf die KM-Gabe verzichtet werden, was den nicht invasiven Charakter der MRT noch einmal unterstreicht. Der genaue Stellenwert von DWI oder ASL ist noch nicht systematisch untersucht, erste Beschreibungen sind jedoch vielversprechend, sodass der Stellenwert der MRT bei Schwangeren in der Zukunft noch zunehmen wird. Kenntnisse über die häufigsten Erkrankungen während der Schwangerschaft und deren MR-Morphologie sind daher auch für den Radiologen von Bedeutung. Die Vorteile der MRT gegenüber der Sonografie und der hieraus abzuleitende Stellenwert in der Schwangerschaft werden in diesem Artikel unter Berücksichtigung moderner Sequenztechniken diskutiert.

Abstract

Sonography is still the method of choice for imaging diseases in pregnant women. The changed physiognomy of the women increases the known limitations of sonography while the advantages of MRI (large field of view, excellent soft-tissue contrast, sensitive diagnosis of edema) are not affected. The available sequences allow the differentiation of various pathologies. Most of these can frequently be visualized without intravenous administration of contrast material. Although the significance of techniques like DWI and ASL has not yet been explored, initial descriptions are promising and MR imaging in pregnancy will be increasingly important in the future. Therefore, knowledge of the most frequent diseases in pregnancy and their image appearance is relevant to radiologists. The advantages of MRI in comparison to sonography and its important role in imaging pathologies of the acute abdomen in pregnancy are illustrated and discussed.

abdomen - pregnancy - MR diffusion/perfusion - MR imaging - safety

Literatur

• 1 Blondin D, Turowski B, Schaper J. Fetales MRT.  Fortschr Röntgenstr. 2007;  179 111-118
• 2 Blondin D, Schaper J, Klee D et al. Das fetale MRT in der pränatalen Beurteilung von ZNS-Störungen.  Fortschr Röntgenstr. 2008;  180 715-721
• 3 Leyendecker J R, Gorengaut V, Brown J J. MR Imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period.  Radiographics. 2004;  24 1301-1316
• 4 Martirosian P, Klose U, Mader I et al. FAIR True-FISP perfusion imaging of the kidneys.  Magn Reson Med. 2004;  51 353-361
• 5 Lanzman R S, Voiculescu A, Walther C et al. ECG-gated Nonenhanced 3D Steady-State Free Precession MR Angiography in Assessment of Transplant Renal Arteries: Comparison with DSA.  Radiology. 2009;  252 914-921
• 6 De Wilde J P, Rivers A W, Price D L et al. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus.  Progress in Biophysics and Molecular Biology. 2005;  87 335-353
• 7 Kanal E, Barkovich A J, Bell C et al. ACR Guidance Document for Safe MR Practices: 2007.  AJR. 2007;  188 1447-1474
• 8 Webb J AW, Thomsen H S, Morcos S K et al. The use of iodinated and gadolinium contrast media during pregnancy and lactation.  Eur Radiol. 2005;  15 1234-1240
• 9 Shellock F G, Kanal E. Safety of Magnetic Resonance Imaging Contrast Agents.  Journal of Magnetic resonance Imaging. 1999;  10 477-484
• 10 Cappell M S, Friedel D. Abdominal pain during pregnancy.  Gastroenterol Clin North Am. 2003;  32 1-58
• 11 Oto A, Ernst R, Ghulmiyyah L et al. Rightlower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging – initial experience.  Radiology. 2005;  234 445-451
• 12 Oto A, Ernst R, Ghulmiyyah L et al. MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain.  Abdom Imaging. 2009;  34 243-250
• 13 Pedrosa I, Zeikus E A, Levine D. MR Imaging of Acute Right Lower Quadrant Pain in Pregnant and Nonpregnant Patients.  RadioGraphics. 2007;  27 721-753
• 14 Woodfield C A, Lazarus E, Chen K C et al. Abdominal Pain in Pregnancy: Diagnoses and Imaging Unique to Pregnancy – Review.  AJR. 2010;  194 WS14-WS30
• 15 Dabir D, Fürst G, Blondin D. MRT bei akuter Appendizitis in der Schwangerschaft.  Fortschr Röntgenstr. 2010;  182 1010-1011
• 16 Firstenberg M S, Malangoni M A. Gastrointestinal surgery during pregnancy.  Gastroenterol Clin North Am. 1998;  27 73-88
• 17 Parangi S, Levine D, Henry A et al. Surgical gastrointestinal disorders during pregnancy.  Am J Surg. 2007;  193 223-232
• 18 Oto A, Ernst R, Ghulmiyyah L et al. The role of MR cholangiopancreatography in the evaluation of pregnant patients with acute pancreaticobiliary disease.  The British Journal of Radiology. 2009;  82 279-285
• 19 McKay A J, O’Neill J, Imrie C W. Pancreatitis, pregnancy and gallstones.  Br J Obstet Gynaecol. 1980;  87 47-50
• 20 Ramin K D, Ramin S M, Richey S D et al. Acute pancreatitis in pregnancy.  Am J Obstet Gynecol. 1995;  173 187-191
• 21 Stampfer M J, Maclure K M, Colditz G A et al. Risk of symptomatic gallstones in women with severe obesity.  Am J Clin Nutr. 1992;  55 652-658
• 22 Pandey M, Shukla V K. Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer.  Eur J Cancer Prev. 2003;  12 269-272
• 23 Arvanitakis M, Koustiani G, Gantzarou A et al. Staging of severity and prognosis of acute pancreatitis by computed tomography and magnetic resonance imaging – A comparative study.  Digestive and Liver Disease. 2007;  39 473-482
• 24 Satoh S, Okuma A, Fujita Y et al. Spontaneous rupture of the renal pelvis during pregnancy: a case report and review of the literature.  Am J Perinatol. 2002;  14 189-195
• 25 Regan F, Kuszyk B, Bohlman M E et al. Acute ureteric calculus obstruction: unenhanced spiral CT versus haste MR urography and abdominal radiograph.  Br J Radiol. 2005;  78 506-511
• 26 Ries I, Baumann M, Tauber R et al. Diagnostik und Therapie der symptomatischen Harnstauungsniere in der Schwangerschaft – Einsatz der Kernspintomographie bei Urolithiasis.  Geburtsh Frauenheilkd. 2004;  64 405-410
• 27 Klasen J, Rabenalt R, Heinen W et al. Harnleitersteinbedingte Fornixruptur in der Schwangerschaft: Kontrastmittelfreie MR-Urographie.  Der Urologe. 2010;  49 1172-1175
• 28 Kalish G M, Patel M D, Gunn M L et al. Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain.  Ultrasound Q. 2007;  23 167-175
• 29 Hasiakos D et al. Adnexal torsion during pregnancy: Report of four cases and review of the literature.  J Obstet Gynaecol Res. 2008;  34 683-687
• 30 Ghossain M A, Hachem K, Buy J N et al. Adnexal torsion: magnetic resonance findings in the viable adnexa with emphasis on stromal ovarian appearance.  J Magn Reson Imaging. 2004;  20 451-462
• 31 Kawakami K, Murata K, Kawaguchi N et al. Hemorrhagic infarction of the diseased ovary: acommon MR finding in two cases.  Magn Reson Imaging. 1993;  11 595-597
• 32 Kilickesmez O, Tasdelen, Yetimoglu B et al. Diffusion-weighted imaging of adnexal torsion.  Emerg Radiol. 2009;  16 399-401
• 33 Schraml C, Müssig K, Martirosian P et al. Autoimmune thyroid disease: arterial-spin-labeling perfusion MR imaging.  Radiology. 2009;  253 435-442
• 34 Marik P E, Plante L A. Venous thromboembolic disease and pregnancy.  N Engl J Med. 2008;  359 2025-2033
• 35 Nordstrom M, Lindblad B, Bergqvist D et al. A prospective study of the incidence of deep-vein thrombosis within a defined urban population.  J Intern Med. 1992;  232 155-160
• 36 Chunila S D, Bates S M. Venous thromboembolism in pregnancy: diagnosis, management and prevention.  Thromb Haemost. 2009;  101 428-438
• 37 Douketis J D, Ginsberg J S. Diagnostic problems with venous thromboembolic disease in pregnancy.  Haemostasis. 1995;  25 58-71
• 38 Torkzad M R, Bremme K, Hellgren M et al. Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy.  Thrombosis Research. 2010;  126 107-112
• 39 Forstner R, Kalbhen C L, Filly R A et al. Abdominopelvic MR imaging in the nonobstetric evaluation of pregnant patients.  Am J Roentgenol. 1996;  166 1139-1144
• 40 Kier R, McCarthy S M, Scoutt L M et al. Pelvic masses in pregnancy: MR imaging.  Radiology. 1990;  176 709-713
• 41 Pentheroudakis G, Pavlidis N. Cancer and pregnancy: poena magna, not anymore.  Eur J Cancer. 2006;  42 126-140
• 42 Oto A, Ernst R, Jesse M K et al. Magnetic Resonance Imaging of the Chest, cAbdomen, and Pelvis in the Evaluation of Pregnant Patients with Neoplasms.  Am J Perinatol. 2007;  24 243-250
• 43 Nicolet V, Carignan L, Bourdon F et al. MR imaging of cervical carcinoma: a practical staging approach.  Radiographics. 2000;  20 1539-1549
• 44 El-Shawarby S A, Hendeson A F, Mossa M A. Ovarian cysts during pregnancy: dilemmas in diagnosis and management.  J Obstet Gynaecol. 2005;  25 669-675
• 45 Reichelt D C, Scherer A, Blondin D. Erstdiagnose eines Krukenberg-Tumors in der Schwangerschaft.  Fortschr Röntgenstr. 2009;  181 483-485
• 46 Leslie K K, Lange C A. Breast cancer and pregnancy.  Obstet Gynecol Clin North Am. 2005;  32 547-558
• 47 Ohno Y, Sugimura K, Hatabu H. MR imaging of lung cancer.  Eur J Radiol. 2002;  44 172-181
• 48 Ward J. New MR techniques for the detection of liver metastases.  Cancer Imaging. 2006;  6 33-42
• 49 Baughman W C, Corteville J E, Shah R R. Placenta accreta: spectrum of US and MR findings.  Radio-Graphics. 2008;  28 1905-1916
• 50 Dighe M, Cuevas C, Moshiri M et al. Sonography in first trimester bleeding.  J ClinUltrasound. 2008;  36 352-366
• 51 Green C L, Angtuaco T L, Shah H R et al. Gestational trophoblastic disease: a spectrum ofradiologic diagnosis.  RadioGraphics. 1996;  16 1371-1384
• 52 Elsayes K M, Trout A T, Friedkin A M et al. Imaging of the Placenta: A Multimodality Pictorial Review.  RadioGraphics. 2009;  29 1371-1391
• 53 Baughman W C, Corteville J E, Shah R R. Placenta Accreta: Spectrum of US and MR Imaging Findings.  RadioGraphics. 2008;  28 1905-1916
• 54 ACOG Committee on Obstetric Practice . ACOG Committee opinion no. 266, January 2002: placenta accreta.  Obstet Gynecol. 2002;  99 169-170
• 55 Warshak C R, Eskander R, Hull A D et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta.  Obstet Gynecol. 2006;  108 573-581
• 56 Usta I M, Hobeika E M, Musa A A et al. Placenta previa-accreta: risk factors and complications.  Am J Obstet Gynecol. 2005;  193 1045-1049
• 57 McGahan J P, Phillips H E, Reid M H. The anechoic retroplacental area: a pitfall in diagnosis of placental-endometrial abnormalities during pregnancy.  Radiology. 1980;  134 475-478
• 58 Levine D, Hulka C A, Ludmir J et al. Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging.  Radiology. 1997;  205 773-776
• 59 Dwyer B K, Belogolovkin V, Tran L et al. Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging?.  J Ultrasound Med. 2008;  27 1275-1281
• 60 Mitsuru Takeuchi M, Sasaki S, Ito M et al. UrinaryBladder Cancer: Diffusionweighted MR Imaging – Accuracy for Diagnosing T Stage and Estimating Histologic Grade.  Radiology. 2009;  251 Number 1