Type:
Educational Exhibit
Keywords:
Obstetrics (Pregnancy / birth / postnatal period), Oncology, MR, Diagnostic procedure, Cancer, Foetus
Authors:
N. Kinger1, P. Mittal2; 1Atlanta, GA/US, 2Decatur, GA/US
DOI:
10.26044/ecr2019/C-1462
Background
Pregnancy results in myriad health changes for the female patient.
Hormonal changes can result in symptoms such as nausea/vomiting and abdominal pain and even depression.
Unfortunately,
the health changes of pregnancy can also involve tumors.
A tumor,
which can be benign or malignant,
is often defined as a solid,
cystic,
or mixed solid/cystic mass.
Tumors may present before,
during,
or even after a pregnancy.
In terms of health management,
pregnancy limits the imaging available to the patient.
Ultrasound and MRI often take a broader role in the imaging of pregnant patients in order to reduce the risks of radiation to the fetus from CT and fluoroscopy.
At an age of less than 2 weeks there is risk of death for the fetus secondary to radiation.
The possibility of birth defects,
childhood cancer,
and intellectual disability are present up to 18 weeks.
There also remains risk of intellectual disability up to 22 weeks.
As a result ultrasound is generally the first line test of choice for acute symptoms and concerns and MR is generally used in lieu of CT for symptoms or follow up requiring cross sectional imaging.
Pregnancy does not preclude CT if the symptoms and presentation suggest that the benefits outweigh the risks.
Tumors as defined include both benign and malignant neoplasms.
Often the chief concern for the clinician is a malignant lesion.
The presence of a malignancy during pregnancy is a rare occurrence.
The most common cancers detected during or before pregnancy are also the most common cancers in female patients of reproductive age.
These malignancies include breast cancer,
cervical cancer,
lymphoma/leukemia,
and malignant melanoma.
MR is a useful modality for the evaluation of these tumors in lieu of CT,
however,
imaging is limited by restrictions on the use of gadolinium during pregnancy due to the potential for gadolinium to cause effects within the fetus as gadolinium can cross into the fetal circulation from the mother.
Regardless of the possibile effects of gadolinium on the fetus,
noncontrast MR can provide great information to the medical team and radiologists.