Investigation of clinical utility of contrast-enhanced MRI in the diagnosis of ectopic pregnancy

• Published in: Clinical radiology Vol. 75; no. 7; pp. 543 - 551
• Main Authors: Nishio, N., Kido, A., Kurata, Y., Minami, M., Tokunaga, K., Honda, M., Mandai, M., Togashi, K.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2020
• Subjects: Adult; Contrast Media; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Magnetic Resonance Imaging - methods; Pregnancy; Pregnancy, Ectopic - diagnosis; Pregnancy, Ectopic - diagnostic imaging; Retrospective Studies; Young Adult
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2020.02.013

To investigate whether contrast-enhanced (CE)-magnetic resonance imaging (MRI) improves identification of implantation site of ectopic pregnancy.
This retrospective study enrolled 63 patients in whom implantation sites had been confirmed at histopathology. Two expert radiologists for gynaecological imaging and two inexpert radiologists independently reviewed non-CE MRI and a combination of non-CE and CE-MRI (non-CE+CE-MRI), then determined implantation site with a confidence level. The following MRI features were also evaluated: extrauterine gestational sac (GS)-like structure (shape, signal intensities at T1-weighted imaging [WI], T2WI, and diffusion-weighted imaging [DWI], presence of the three rings appearance, and distinct low intensity areas at T2WI, presence of tree or dot-like components, degree of contrast enhancement), fallopian tube (dilatation, dilatation with haematoma, degree of contrast enhancement, enhanced components within the tube), and ascites. These findings were compared for non-CE and non-CE+CE-MRI data, and for expert and inexpert groups.
The expert group identified implantation sites correctly in 58/63 (92%) cases for non-CE and non-CE+CE-MRI. In the inexpert group, the correct identification was improved from 54/63 (86%) using non-CE MRI to 58/63 (92%) using non-CE+CE-MRI, but was not significant (p=0.29). In comparison between non-CE and non-CE+CE-MRI, dilation of the fallopian tubes was observed more frequently (p=0.004) and the confidence level was elevated significantly in the non-CE+CE-MRI (p<0.0001) in the inexpert group. Intergroup comparison revealed that confidence level was significantly higher in the expert group than in the inexpert group using non-CE MRI (p<0.0001), although the difference was not significant at non-CE+CE MRI (p=0.49).
CE-MRI did not significantly improve correct identification of ectopic pregnancy implantation sites, although the addition of contrast enhancement did enable inexpert radiologists to diagnose confidently.
•Contrast-enhanced MR images did not improve identification of implantation site.•Reading experience did not influence the identification of implantation site.•Inexpert readers might benefit from contrast-enhanced MR images.