Lie G, Eleti S, Chan D, Roshen M, Cross S, Qureshi M
Department of Radiology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR, UK.
Department of Radiology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR, UK.
Clin Radiol. 2022 Sep;77(9):639-649. doi: 10.1016/j.crad.2022.05.021. Epub 2022 Jun 24.
Acute abdominal pain in pregnancy poses a significant diagnostic challenge. The differential diagnosis is wide, clinical assessment is difficult, and the use of conventional imaging methods is restricted due to risks to the fetus. This can lead to delay in diagnosis, which increases the risk of maternal and fetal harm. Imaging techniques not involving ionising radiation are preferred. Sonography remains first line, but anatomical visualisation can be limited due to displacement of adjacent structures by the gravid uterus. MRI provides excellent cross-sectional soft-tissue assessment of the abdomen and pelvis, and no study to date has demonstrated significant deleterious effects to the fetus at any gestation; however, there remains a theoretical risk of tissue heating by radiofrequency pulses, and there must be consideration of benefit versus potential risk for any use of magnetic resonance imaging (MRI) in pregnancy. With a limited protocol of sequences, a broad spectrum of pathologies can be evaluated. Computed tomography carries the highest exposure of ionising radiation to the fetus, but may be necessary, particularly in cases of trauma. The patient must be kept informed and any potential risks to the patient and fetus should be clearly explained. We present a radiological decision-making tool to guide choice of imaging and best establish the underlying diagnosis in the acute pregnant abdomen. In addition, using illustrative examples from our practice at a large tertiary centre, we review the advantages and disadvantages of each imaging method, with particular focus on the utility of MRI.
孕期急性腹痛带来了重大的诊断挑战。鉴别诊断范围广泛，临床评估困难，并且由于对胎儿存在风险，传统成像方法的使用受到限制。这可能导致诊断延迟，增加母婴伤害的风险。首选不涉及电离辐射的成像技术。超声检查仍是一线方法，但由于妊娠子宫使相邻结构移位，解剖结构的可视化可能受限。磁共振成像（MRI）能对腹部和盆腔进行出色的横断面软组织评估，且迄今为止尚无研究表明在任何孕周对胎儿有显著有害影响；然而，射频脉冲仍存在使组织发热的理论风险，对于孕期使用磁共振成像（MRI）的任何情况，都必须权衡其益处与潜在风险。通过有限的序列方案，可以评估多种病理情况。计算机断层扫描对胎儿的电离辐射暴露最高，但在某些情况下可能是必要的，尤其是在创伤病例中。必须让患者了解情况，并清楚地向其解释对患者和胎儿的任何潜在风险。我们提出一种放射学决策工具，以指导成像选择并最好地确定孕期急性腹痛的潜在诊断。此外，我们以一家大型三级医疗中心的实际病例为例，回顾每种成像方法的优缺点，特别关注MRI的实用性。
