2016 Volume 32 Issue 1 Pages 201-207
Objectives: We retrospectively studied asymptomatic fallopian tubal ectopic pregnancies by pelvic magnetic resonance imaging (MRI).
Material and Methods: The study included 31 women with suspected asymptomatic ectopic pregnancies who underwent transvaginal ultrasound scanning, determination of human chorionic gonadotrophin level, and MRI at the Otsu Municipal Hospital. All women underwent laparoscopic or abdominal surgery, and histological examination revealed tubal pregnancy. We evaluated the following 4 key MRI features: presence of a gestational sac-like structure (GS), a surrounding acute hematoma with low-intensity attenuation on T2-weighted images (AH), an enhanced tubal wall on post-contrast images (ET), and/or high signal intensity on both T2- and diffusion-weighted images (DWI) outside the uterus.
Results: The 4 key MRI features had 100% sensitivity and 87.1% predictive accuracy for ectopic pregnancies. Among the 4 key MRI features, the presence of a GS had the highest level of sensitivity and predictive accuracy for asymptomatic tubal pregnancies. DWI also had a high degree of sensitivity. However, the presence of many patients without a final diagnosis of ectopic pregnancy showed the limitation of reliance on DWI.
Conclusions: Our results indicate that in patients with an asymptomatic fallopian tubal ectopic pregnancy, 4 key MRI features are an optimal diagnostic tool because of their 100% sensitivity and 87.1% predictive accuracy. MRI should be considered the gold standard for early diagnosis of tubal pregnancy. We conclude that MRI is more useful in laparoscopic conservative surgery for tubal pregnancy.
