Dr. Gabriele Masselli's presentation
RSNA 2012: Studies find new imaging solutions for problem pregnancies
November 27, 2012
by Nancy Ryerson, Staff Writer
A slew of complications can arise during a pregnancy, many of which are difficult to spot even with advanced imaging technologies. At RSNA 2012, six researchers showed the signs and signals, possibly overlooked in the past, that improved sonogram and MRI technology can now reveal. Some of the papers also suggested the value of using MRI over sonogram when trying to detect particular complications.
Findings in sonography
The first paper presented sonographic predictors of Pregnancy Induced Hypertension, or PIH, which happens in 6 to 8 percent of all pregnancies and can contribute to low birth weight and other complications. The paper set out to measure the value of color Doppler sonography in detecting signs of the problem, namely uterine artery flow velocity.
"Prior studies done on uterine artery Doppler have revealed considerably varied results," said study author Dr. Amit Jain, during the presentation.
His findings suggested that screenings done weeks 28 to 30 were the most useful in identifying signs of PIH, and confirmed that color Doppler sonography was useful in identifying blood pressure speed.
The second paper explored the value of sonography in detecting partial molar pregnancy, in which an incomplete embryo starts to develop, a condition that has traditionally been more challenging to detect than complete molar pregnancy. The study found that dicidual thickening and/or masses can be found in 50 percent of ultrasounds performed on women with early partial molar pregnancies.
"Sonographic diagnosis of partial molar pregnancy in the first trimester is clinically relevant as it results in management with surgical evacuation and histological confirmation, which can lead to improved patient outcome from early diagnosis," said Dr. Elizabeth Lazarus, in her conclusion.
At the end of the presentation, a sixth paper also explored the value of improved ultrasound image technology, this time in detecting the signs of ectopic pregnancy, a pregnancy that occurs outside the womb. Transvaginal sonography demonstrated an adnexal abnormality in over 95 percent of patients with ectopic pregnancy, a result that matches prior studies.
New uses of MR for pregnancy
MRI is growing in popularity as a means of identifying certain birth defects and problems in pregnancy. The third paper presented showed the value of MR in pregnant patients who are experiencing pelvic pain, which can result from appendicitis or ovarian torsion. The study revealed the value of MR in detecting those causes and the need for surgery.
"Patients can be appropriately triaged for surgery, treatment, medical treatment or expectant management with a high degree of accuracy," study author Dr. Sherelle Laifer-Narin said.
The following paper covered obstetric hemorrhage, one of the leading causes of maternal mortality.
"Ultrasound is the mainstay of fetal and placental imaging, and despite improvements in technology, the diagnostic sensitivity for revealing bleeding is low," said study author Dr. Gabriele Masselli.
The study revealed that MR detects the source of hemorrhage more accurately than a sonogram can, making it a useful second modality when an ultrasound comes up negative.
Imaging can't solve it all — yet
The fifth paper tackled respiratory distress syndrome, a complication that impacts 80,000 pregnancies in the U.S. each year. Amniocentesis has traditionally been used to detect lung immaturity, associated with the syndrome, but the procedure is invasive and can lead to infection, the study author noted.
"As far-reaching as technological advances have been, there are many diseases that remain untouched by technology," said study author Dr. Megan Mills, of the fourth paper. "Respiratory distress syndrome is one of them."
Her team set out to determine the value of MR as a replacement screening for lung immaturity. The hypothesis was that a correlation exists between MR lung signal intensity and gestational age, but unfortunately, while numbers were promising, the team did not feel a conclusion could be drawn from them.
Quoting Mark Twain, Mills noted, "Facts are stubborn but statistics are more pliable."
Findings in sonography
The first paper presented sonographic predictors of Pregnancy Induced Hypertension, or PIH, which happens in 6 to 8 percent of all pregnancies and can contribute to low birth weight and other complications. The paper set out to measure the value of color Doppler sonography in detecting signs of the problem, namely uterine artery flow velocity.
"Prior studies done on uterine artery Doppler have revealed considerably varied results," said study author Dr. Amit Jain, during the presentation.
His findings suggested that screenings done weeks 28 to 30 were the most useful in identifying signs of PIH, and confirmed that color Doppler sonography was useful in identifying blood pressure speed.
The second paper explored the value of sonography in detecting partial molar pregnancy, in which an incomplete embryo starts to develop, a condition that has traditionally been more challenging to detect than complete molar pregnancy. The study found that dicidual thickening and/or masses can be found in 50 percent of ultrasounds performed on women with early partial molar pregnancies.
"Sonographic diagnosis of partial molar pregnancy in the first trimester is clinically relevant as it results in management with surgical evacuation and histological confirmation, which can lead to improved patient outcome from early diagnosis," said Dr. Elizabeth Lazarus, in her conclusion.
At the end of the presentation, a sixth paper also explored the value of improved ultrasound image technology, this time in detecting the signs of ectopic pregnancy, a pregnancy that occurs outside the womb. Transvaginal sonography demonstrated an adnexal abnormality in over 95 percent of patients with ectopic pregnancy, a result that matches prior studies.
New uses of MR for pregnancy
MRI is growing in popularity as a means of identifying certain birth defects and problems in pregnancy. The third paper presented showed the value of MR in pregnant patients who are experiencing pelvic pain, which can result from appendicitis or ovarian torsion. The study revealed the value of MR in detecting those causes and the need for surgery.
"Patients can be appropriately triaged for surgery, treatment, medical treatment or expectant management with a high degree of accuracy," study author Dr. Sherelle Laifer-Narin said.
The following paper covered obstetric hemorrhage, one of the leading causes of maternal mortality.
"Ultrasound is the mainstay of fetal and placental imaging, and despite improvements in technology, the diagnostic sensitivity for revealing bleeding is low," said study author Dr. Gabriele Masselli.
The study revealed that MR detects the source of hemorrhage more accurately than a sonogram can, making it a useful second modality when an ultrasound comes up negative.
Imaging can't solve it all — yet
The fifth paper tackled respiratory distress syndrome, a complication that impacts 80,000 pregnancies in the U.S. each year. Amniocentesis has traditionally been used to detect lung immaturity, associated with the syndrome, but the procedure is invasive and can lead to infection, the study author noted.
"As far-reaching as technological advances have been, there are many diseases that remain untouched by technology," said study author Dr. Megan Mills, of the fourth paper. "Respiratory distress syndrome is one of them."
Her team set out to determine the value of MR as a replacement screening for lung immaturity. The hypothesis was that a correlation exists between MR lung signal intensity and gestational age, but unfortunately, while numbers were promising, the team did not feel a conclusion could be drawn from them.
Quoting Mark Twain, Mills noted, "Facts are stubborn but statistics are more pliable."