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What Student Need to Know about Diagnostic Imaging Of Obstetrics And Gynecology In Radio-Diagnosis.

 What Student Need to Know about Diagnostic Imaging Of Obstetrics And Gynecology In Radio-Diagnosis.

Ultrasonography (US) is the initial imaging modality of choice for evaluation of patients in obstetrics. However, the results of US are not always sufficient. Magnetic resonance (MR) imaging, which uses no ionizing radiation, may be an ideal method for further evaluation. Although MR imaging is not recommended during the first trimester and use of contrast material is not recommended in pregnant patients, fast MR imaging is useful in various obstetric settings and can provide more specific information with excellent tissue contrast and multiplanar views. In pregnant patients with acute conditions, various diseases (eg, red degeneration of a uterine leiomyoma) may be diagnosed.

MR imaging allows characterization of pelvic masses discovered during pregnancy and diagnosis of postpartum complications (eg, abscess, hematoma, ovarian vein thrombosis). In pregnant patients with hydronephrosis, MR urography can demonstrate the site of obstruction and the cause (eg, a ureteral stone). MR pelvimetry may be beneficial in cases of breech presentation. Contrast material–enhanced dynamic MR imaging allows one to evaluate the vascularity of a placental polyp, detect the viable component of a gestational trophoblastic tumor, and diagnose a uterine arteriovenous malformation. MR imaging enables diagnosis of rare forms of ectopic pregnancy and early diagnosis of ectopic pregnancy. Prolonged exposure to electromagnetic radiation has been linked with some deleterious effects on embryogenesis, chromosomal structure, or fetal development.

Safe use of doppler in the 11 to 13+6-week fetal ultrasound examination:

1) Pulsed Doppler (spectral, power and color flow imaging) ultrasound should not be used routinely.

2) Pulsed Doppler ultrasound may be used for clinical indications such as to refine risks for   trisomies.

3) When performing Doppler ultrasound, the displayed thermal index (TI) should be ≤1.0 and exposure time should be kept as short as possible (usually no longer than 5–10 min) and should not exceed 60 min.

4) When using Doppler ultrasound for research, teaching and training purposes, the displayed TI should be ≤1.0 and exposure time should be kept as short as possible (usually no longer than 5–10 min) and should not exceed 60 min. Informed consent should be obtained.

5) In educational settings, discussion of first-trimester pulsed or color Doppler should be accompanied by information on safety and bioeffects (e.g. TI, exposure times and how to reduce output power)

6) When scanning maternal uterine arteries in the first trimester, there are unlikely to be any fetal safety implications as long as the embryo/fetus lies outside the Doppler ultrasound beam.

Main Objectives of Ultrasound Examination in the First Trimester :

  • Confirmation of pregnancy
  • Intrauterine localization of gestational sac
  • Confirmation of viability (cardiac activity in embryo/fetus)
  • Detection of signs of early pregnancy failure
  • Single vs. Multiple pregnancy (define chorionicity in multiples)
  • Assessment of gestational age (pregnancy dating)
  • Assessment of normal embryo and gestational sac before 10 weeks
  • Assessment of basic anatomy after 11 week

Use of Contrast Material during Pregnancy

Gadolinium-based contrast material has been shown to cross the placenta after intravenous administration and appear within the fetal bladder. Then, it is excreted into the amniotic fluid, swallowed by the fetus, and reabsorbed from the gastrointestinal tract. The half-life of the drug in the fetal circulation and the effect of this drug on the developing human fetus are unknown.

Two methods of contrast-enhanced MR imaging are used. One is dynamic MR imaging with bolus injection of contrast material, which allows creation of MR angiograms by postprocessing. The other is contrast-enhanced fat-suppressed T1-weighted imaging. Usually, we perform both methods to evaluate lesion vascularity. When an inflammatory lesion is suspected, contrast-enhanced fat-suppressed T1-weighted images are obtained. The total examination time is about 30 minutes when both of these contrast-enhanced imaging methods are used.

Ectopic pregnancy is a well-known acute condition associated with pregnancy. Massive hemorrhage due to rupture leads to symptoms of shock. If the start of appropriate therapy is delayed, this condition may be fatal. The β–human chorionic gonadotropin (hCG) level is useful for detection of early ectopic pregnancies. Transvaginal US is the initial imaging modality of choice for establishing gestational location and allows one to make the diagnosis in combination with the β-hCG level.

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Common Indications for Ultrasound in the First Trimester of Pregnancy

  • Amenorrhea (patient does not know she is pregnant)
  • Pelvic pain
  • Vaginal bleeding
  • Unknown menstrual dates
  • Subjective feeling of pregnancy
  • Uterus greater or smaller than dates on clinical evaluation
  • Pregnancy test positive or increased Human Chorionic Gonadotropin (hCG) values
  • Nuchal translucency measurement

Radiographic pelvimetry may be beneficial in patients with a fetus in breech presentation who desire a trial of vaginal delivery. However, this technique involves the disadvantage of fetal exposure to ionizing radiation. MR imaging can provide information about maternal bony structures, soft tissue, and the fetal position in multiple planes without ionizing radiation.

Fast MR imaging is a valuable complement to US in various obstetric settings when results of US are inconclusive. It can provide important information that may influence a patient’s treatment.

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