Serviço de Imagiologia Neurológica, CHULN - Hospital Santa Maria, Lisbon, Portugal.
Neuroradiology. 2021 Jun;63(6):837-845. doi: 10.1007/s00234-021-02675-1. Epub 2021 Mar 11.
Imaging studies are crucial adjuncts when studying acute and chronic diseases, so pregnant and lactating women are as likely to be evaluated with one of the available imaging modalities. Due to the specific condition of the mother and child in this time period it is crucial to make an appropriate selection of imaging studies.
We review the existing literature and analyse the latest evidence and guidelines regarding neuroimaging safety during pregnancy and lactation, proposing an algorithm of action based on risk/benefits assessment.
Choosing the most appropriate neuroimaging modality implicates assessing the pretest pertinence of the study-the possibility of a serious treatable neurologic disease, pondering what is the most useful imaging modality for the diagnosis and evaluating the associated risks. Among physicians (and patients), however, the risk component is perhaps the least well understood, with misperceptions regarding safety and potential hazards. Computed tomography (CT) risks are principally related to ionizing radiation and intravenous (IV) administration of iodinated contrast. However, as very low risks for the mother and foetus have been reported and CT remains the most available tool for initial rapid diagnosis of acute neurological conditions, it should not be withheld in urgent situations. Magnetic resonance imaging (MRI), unlike CT, does not use ionizing radiation or iodinated contrast mediums, having the best anatomical detail possible. However, there are some usage safety concerns regarding the magnetic field strength and gadolinium-based contrast use.
There are lacking longitudinal and prospective studies to sustain evidence based choices of imaging studies during pregnancy and lactation. Ultimately the decision should be based on the risk/benefit, taking into account the patient's safety, care and outcomes. However, using a specific algorithm can guide decisions in daily clinical practice.
影像学研究对于研究急慢性疾病至关重要，因此孕妇和哺乳期妇女也可能需要使用现有的影像学方法之一进行评估。由于母亲和孩子在这个时期的特殊情况，因此选择适当的影像学检查方法至关重要。
我们回顾了现有的文献，并分析了关于妊娠和哺乳期神经影像学安全性的最新证据和指南，根据风险/获益评估提出了行动方案。
选择最合适的神经影像学方式需要评估研究的预测试相关性-是否存在严重的可治疗性神经系统疾病，考虑最有助于诊断的影像学方式，并评估相关风险。然而，在医生（和患者）中，风险因素可能是最不被理解的，对安全性和潜在危害存在误解。计算机断层扫描（CT）的风险主要与电离辐射和静脉内（IV）给予碘造影剂有关。然而，由于已报告母亲和胎儿的风险极低，并且 CT 仍然是急性神经状况快速初始诊断的最可用工具，因此在紧急情况下不应拒绝使用 CT。与 CT 不同，磁共振成像（MRI）不使用电离辐射或碘造影剂，具有可能的最佳解剖细节。但是，关于磁场强度和钆基造影剂的使用存在一些使用安全性问题。
缺乏关于妊娠和哺乳期影像学检查选择的纵向和前瞻性研究来支持基于证据的选择。最终决策应基于风险/获益，考虑患者的安全性、护理和结果。然而，使用特定的算法可以指导日常临床实践中的决策。
