Top

European Radiology

Published in:

Open Access 20-04-2022 | Magnetic Resonance Imaging | Urogenital

Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester

Authors: Wenjuan Liu, Weili Xie, Hang Zhao, Xufeng Jiao, Enzhao Sun, Shan Jiang, Ning Zheng, Zhenchang Wang

Published in: European Radiology | Issue 10/2022

Abstract

Objectives

To retrospectively evaluate the diagnostic value of MRI for the uterotubal junctional pregnancies during the first trimester.

Methods

This retrospective study involved 59 patients (January 2016 to July 2021) with a preoperative imaging diagnosis of uterotubal junctional pregnancy. Using operative and pathological reports as the reference standard, we identified 22 patients with upper-lateral intracavitary (angular) pregnancy and 37 patients with interstitial pregnancy. Two senior radiologists, blinded to the patients’ information, reviewed the MRI images and determined each MRI feature based on the original interpretation criteria. Any disagreement was resolved by discussion to achieve a consensus. The sensitivity and specificity of each MRI feature were calculated according to the reference standard.

Results

The endometrial thickness in the upper-lateral intracavitary pregnancy group was larger than in the interstitial group (p = 0.001). The cutoff value of the endometrial thickness was 11.5 mm with a sensitivity, specificity, and area under the curve that were 77.3%, 64.9%, and 0.743, respectively. Two key features to diagnose upper-lateral intracavitary pregnancy were “medial free edge” and “medial free edge plus above-cutoff endometrial thickness.” The sensitivity and specificity of the medial free edge were 100% and 94.9%, respectively. The sensitivity and specificity of the medial free edge plus above-cutoff endometrial thickness were 77.3% and 100%, respectively. The key feature to diagnose interstitial pregnancy was an “intact lateral junctional zone,” of which the sensitivity and specificity were 94.6% and 100%, respectively.

Conclusions

MRI can be used to differentiate the upper-lateral intracavitary pregnancy and interstitial pregnancy during the first trimester.

Key Points

• We demonstrated MRI diagnostic criteria for the interstitial pregnancy and upper-lateral intracavitary pregnancy.

• MRI might be used to identify the complex interstitial pregnancies, those with a gestational sac protruding into the uterine cavity.

Pregnancy EwgoE, Kirk E, Ankum P et al (2020) Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum Reprod Open 2020:hoaa055CrossRef

Jansen RP, Elliott PM (1981) Angular intrauterine pregnancy. Obstet Gynecol 58:167–175PubMed

Rankin MB, Dunning A, Arleo EK (2014) Angular pregnancy: a review of cases reported in the past 80 years. Obstet Gynecol Cases Rev 1:015

Bollig KJ, Schust DJ (2020) Refining angular pregnancy diagnosis in the first trimester: a case series of expectant management. Obstet Gynecol 135:175–184CrossRef

Arleo EK, DeFilippis EM (2014) Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging 38:763–770CrossRef

Finlinson AR, Bollig KJ, Schust DJ (2020) Differentiating pregnancies near the uterotubal junction (angular, cornual, and interstitial): a review and recommendations. Fertil Res Pract 6:8CrossRef

Grant A, Murji A, Atri M (2017) Can the presence of a surrounding endometrium differentiate eccentrically located intrauterine pregnancy from interstitial ectopic pregnancy? J Obstet Gynaecol Can 39:627–634CrossRef

Panelli DM, Phillips CH, Brady PC (2015) Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract 1:15CrossRef

Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N (2002) Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 17:3224–3230CrossRef

10.

Marfori CQ, Kotzen M (2018) Angular vs. interstitial pregnancy: a case report highlighting diagnostic nuances with stark management differences. Case Rep. Womens Health 19:e00068

11.

Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW (2010) Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol 202:15–29CrossRef

12.

Alalade AO, Smith FJE, Kendall CE, Odejinmi F (2017) Evidence-based management of non-tubal ectopic pregnancies. J Obstet Gynaecol 37:982–991CrossRef

13.

Koroglu M, Kayhan A, Soylu FN et al (2013) MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites. Jpn J Radiol 31:75–80CrossRef

14.

Kao LY, Scheinfeld MH, Chernyak V, Rozenblit AM, Oh S, Dym RJ (2014) Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol 202:904–911CrossRef

15.

Rana P, Kazmi I, Singh R et al (2013) Ectopic pregnancy: a review. Arch Gynecol Obstet 288:747–757CrossRef

16.

Masselli G, Derme M, Piccioni MG et al (2018) To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study. Eur Radiol 28:2444–2454CrossRef

17.

Masselli G, Derchi L, McHugo J et al (2013) Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 23:3485–3500CrossRef

18.

Tamai K, Koyama T, Togashi K (2007) MR features of ectopic pregnancy. Eur Radiol 17:3236–3246CrossRef

19.

Filhastre M, Dechaud H, Lesnik A, Taourel P (2005) Interstitial pregnancy: role of MRI. Eur Radiol 15:93–95CrossRef

20.

Takeda A, Koike W, Hayashi S, Imoto S, Nakamura H (2015) Magnetic resonance imaging for diagnosis and management of unruptured interstitial pregnancy. J Obstet Gynaecol Res 41:1384–1393CrossRef

21.

Srisajjakul S, Prapaisilp P, Bangchokdee S (2017) Magnetic resonance imaging in tubal and non-tubal ectopic pregnancy. Eur J Radiol 93:76–89CrossRef

22.

Choi JS, Ahn HK, Han JY et al (2015) A case series of 15 women inadvertently exposed to magnetic resonance imaging in the first trimester of pregnancy. J Obstet Gynaecol 35:871–872CrossRef

23.

Weisstanner C, Gruber GM, Brugger PC et al (2017) Fetal MRI at 3T-ready for routine use? Br J Radiol 90:20160362CrossRef

24.

Choi JA, Lee KH, Jun WS, Yi MG, Lee S, Kang HS (2003) Osseous metastasis from renal cell carcinoma: “flow-void” sign at MR imaging. Radiology 228:629–634CrossRef

25.

Bradley WG, Fiske CE, Filly RA (1982) The double sac sign of early intrauterine pregnancy: use in exclusion of ectopic pregnancy. Radiology 143:223–226CrossRef

26.

Spandorfer SD, Barnhart KT (1996) Endometrial stripe thickness as a predictor of ectopic pregnancy. Fertil Steril 66:474–477CrossRef

27.

Liu H, Zhang J, Wang B, Kuang Y (2020) Effect of endometrial thickness on ectopic pregnancy in frozen embryo transfer cycles: an analysis including 17,244 pregnancy cycles. Fertil Steril 113:131–139CrossRef

28.

Levgur M, Tsai T, Kang K, Feldman J, Kory LA (2000) Endometrial stripe thickness in tubal and intrauterine pregnancies. Fertil Steril 74:889–891CrossRef

29.

Dart RG, Dart L, Mitchell P, Berty C (1999) The predictive value of endometrial stripe thickness in patients with suspected ectopic pregnancy who have an empty uterus at ultrasonography. Acad Emerg Med 6:602–608CrossRef

30.

Seeber B, Sammel M, Zhou L, Hummel A, Barnhart KT (2007) Endometrial stripe thickness and pregnancy outcome in first-trimester pregnancies with bleeding, pain or both. J Reprod Med 52:757–761PubMed

31.

Babayev E, Robins JC (2020) Endometrial thickness as an independent risk factor for ectopic pregnancy in in vitro fertilization: should we change our counseling and practice? Fertil Steril 113:78–79CrossRef

32.

Murphy J, Patel A, James SL, Botchu R, Davies AM (2019) “Flow-void” sign in osseous metastatic renal cell carcinoma. Clin Radiol 74:111–115CrossRef

33.

Osol G, Moore LG (2014) Maternal uterine vascular remodeling during pregnancy. Microcirculation 21:38–47CrossRef

Title: Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester
Authors: Wenjuan Liu
Weili Xie
Hang Zhao
Xufeng Jiao
Enzhao Sun
Shan Jiang
Ning Zheng
Zhenchang Wang
Publication date: 20-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Ectopic Pregnancy
Published in: European Radiology / Issue 10/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08786-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 10/2022

Influence of angioplasty and stenting on intracranial artery stenosis: preliminary results of high-resolution vessel wall imaging evaluation

Thermal ablation versus hepatic resection for colorectal cancer with synchronous liver metastases: a propensity score matching study

Standardized measurement of abdominal muscle by computed tomography: association with cardiometabolic risk in the Framingham Heart Study

Machine learning for the automatic assessment of aortic rotational flow and wall shear stress from 4D flow cardiac magnetic resonance imaging

Diagnostic performance of hippocampal volumetry in Alzheimer’s disease or mild cognitive impairment: a meta-analysis

Deep learning–based atherosclerotic coronary plaque segmentation on coronary CT angiography