This document discusses various imaging modalities used during pregnancy, including their risks and benefits. It covers ionizing radiation-based methods like radiography and CT scanning, as well as ultrasound, MRI, and nuclear medicine imaging. While ionizing radiation poses risks to the fetus, careful use of these modalities when clinically indicated can still provide diagnostic benefits. Newer techniques have also reduced radiation exposure. Ultrasound is generally safe but can cause thermal or mechanical effects if overused. MRI does not use radiation but subjects the fetus to strong magnetic fields, though studies have not found adverse outcomes from standard MRI use. The key is weighing risks versus benefits for each individual case.

1. IMAGING
IN
PREGNANCY
Prof.
Aboubakr
Elnashar
Benha
university
Hospital,
Egypt
ABOUBAKR
ELNASHAR
CONTENTS
A.
MODALITIES
I.
IONISING
RADIATION
1.
RADIOGRAPHY
2.
COMPUTED
TOMOGRAPHY
3.
MINIMIZING
RISKS
II.
ULTRASOUND
III.
MRI
IV.
NUCLEAR
MEDICINE
IMAGING
B.
RADIOLOGICAL
INVESTIGATION
OF
1.
DVT
2.
ABDOMINAL
PAIN
3.
HEADACHE
4.
BREAST
MASS
CONCLUSION
ABOUBAKR
ELNASHAR

2. INTRODUCTION
▪
Imaging
studies
are
important
adjuncts
for
the
diagnosis
of
acute
and
chronic
conditions.
▪
Reliance
on
imaging
is
not
substitute
for
thorough
history
taking,
cl
examination&
selective
use
of
appropriate
radiological
investigations.
▪
Debate
over
the
safety
of
imaging
modalities
for
pregnant
women
can
result
in
avoidance
of
useful
diagnostic
tests
in
pregnancy
&
the
potential
for
delayed
diagnosis.
ABOUBAKR
ELNASHAR
A.
IMAGING
MODALITIES
ABOUBAKR
ELNASHAR

3. I.
IONISING
RADIATION
▪
Including
▪
Radiography
▪
Computed
tomography
(CT)
▪
±required
during
pregnancy
to
aid
cl
diagnosis
and
decision
making.
▪
Alternatively,
a
fetus
may
be
unintentionally
exposed
to
ionising
radiation,
particularly
in
early
pregnancy.
▪
Fetus
is
exposed
to
background
radiation
in
the
order
of
1
mGy
during
pregnancy.
ABOUBAKR
ELNASHAR
Units
used
to
measure
ionising
radiation.
ABOUBAKR
ELNASHAR

4. ▪
Both
X-rays
and
gamma
rays
are
▪
short
wavelength
electromagnetic
waves
▪
can
ionise
tissues
and
alter
normal
cellular
structure
in
two
ways:
1.
Stochastic
2.
Deterministic
effects.
ABOUBAKR
ELNASHAR
1.
Stochastic
effects:
▪
For
example,
development
of
carcinogenesis
–
are
theorised
to
occur
at
any
radiation
dose
{cellular
damage
following
a
germline
mutation}
▪
No
known
threshold
value
at
which
these
effects
will
not
occur
▪
associated
with
an
increased
risk
of
childhood
malignancy
including
leukaemia
and
lymphoma
ABOUBAKR
ELNASHAR

5. 2.
Deterministic
effects
▪
Involve
the
loss
of
tissue
function
{cell
death}
▪
Result
from
radiation
doses
above
threshold
value
▪
Predictable
and
involve
multicellular
injury,
including
chromosomal
anomalies.
▪
Major
risks
include
▪
Fetal
malformation:
skeletal,
ophthalmic
and
genital
tract
anomalies
▪
Fetal
growth
restriction
▪
Neurological
effects:
microcephaly,
intellectual
or
developmental
disability
ABOUBAKR
ELNASHAR
▪
These
outcomes
are
dependent
on
1.
Gestational
age
2.
Dose
used
for
the
diagnostic
test
ABOUBAKR
ELNASHAR

6. Exact
fetal
exposure
does,
vary
with
1.
Gestational
age,
2.
Maternal
BMI
3.
Image
acquisition
parameters.
ABOUBAKR
ELNASHAR
1.
RADIOGRAPHY
▪
British
Thoracic
Society
recommends
chest
radiography
for
all
patients
–
including
pregnant
1.
Chronic
cough
(>8
ws)
2.
Atypical
symptoms
of
▪
Haemoptysis,
breathlessness,
chest
pain
▪
Fever
or
weight
loss.
▪
Clinicians
should
proceed
with
chest
radiography
for
the
same
indications
as
in
the
nonpregnant
patient.
▪
{minimal
risks
to
the
fetus
in
pregnancy
&
potential
for
delayed
diagnosis}
ABOUBAKR
ELNASHAR

7. 2.
COMPUTED
TOMOGRAPHY
▪
As
a
diagnostic
imaging
modality
in
pregnancy
has
increased
dramatically
▪
Indications
1.
Assessing
injuries
following
trauma
2.
Diagnosing
pulmonary
embolism
3.
Investigating
GIT
complications
(appendicitis,
small
bowel
obstruction)
4.
Malignancy.
5.
Defining
fetal
anomalies
before
delivery
–
for
example,
in
cases
of
skeletal
dysplasia.
ABOUBAKR
ELNASHAR
▪
The
fetal
radiation
dose
of
CT
is
dependent
on:
1.
Anatomical
region
of
interest
▪
Abdominopelvic
CT:
Fetal
radiation
dose
is
highest
{fetus
is
captured
directly
in
the
Xray
beam}
▪
Head
and
chest
CT:
fetus
is
exposed
to
scatter
radiation:
low-dose
radiation
exposure.
2.
Machine
set-up
3.
X-ray
tube
voltage
4.
Tube
current
&
number
of
image
acquisitions.
ABOUBAKR
ELNASHAR

8. ▪
Radiologists
should
aim
to
plan
scans
in
advance:
1.
Monitor
the
length
of
scanning
time
2.
Check
the
quality
of
images
collected
to
minimise
scanning
time.
3.
Increasing
the
voltage&
decreasing
the
pitch
will
increase
the
radiation
dose.
▪
In
a
single-slice
CT,
pitch
is
the
ratio
of
table
movement
per
gantry
rotation
(mm)
to
collimation
(mm).
▪
Higher
pitch
results
in
more
scan
artefact
and
lower-resolution
images,
but
it
may
be
required
to
image
women
with
a
higher
body
mass
index
and
those
with
cardiovascular
implanted
electronic
devices.
ABOUBAKR
ELNASHAR
▪
The
use
of
IV
contrast
agents
▪
Iodinated
contrast
medium:
adverse
effects
▪
Maternal:
nausea,
vomiting,
flushing
and
anaphylactoid
reactions.
▪
Fetal:
▪
cross
the
placenta
and
enter
the
fetal
circulation
or
pass
directly
into
the
am
fluid
▪
however,
animal
studies
have
not
revealed
any
teratogenic.
ABOUBAKR
ELNASHAR

9. 3.
Minimising
the
effects
of
ionising
radiation
1.
Follow
the
ALARA
(As
Low
As
Reasonably
Achievable)
principle.
▪
The
International
Commission
on
Radiological
Protection
recommends
that
‘imaging
radiation
must
be
applied
at
levels
as
low
as
reasonably
achievable,
while
the
degree
of
medical
benefit
must
counterbalance
the
well-managed
levels
of
risk’.
ABOUBAKR
ELNASHAR
2.
Use
of
modern
shielding
techniques
▪
significantly
reduced
the
dose
of
ionising
radiation
exposure
to
the
fetus
▪
for
example,
the
fetal
radiation
dose
received
during
mammography
is
in
the
order
of
0.001–
0.01
mGy.
3.
Use
of
lead
shielding
can
further
reduce
this
risk
by
an
additional
50%.
ABOUBAKR
ELNASHAR

10. II.
Ultrasound
▪
Initially,
US
imaging
was
assumed
to
be
safe
in
pregnancy.
▪
Early
US
machines
used
▪
Low
output
settings
▪
Did
not
rely
on
colour
flow,
power
Doppler
or
3D
or
4D
imaging
of
the
fetus
▪
Effects
▪
demonstrated
in
laboratory
studies
but
not
completely
borne
out
in
clinical
practice.
1.
Thermal
effects
on
tissue
temperature
2.
Mechanical:
tissue
cavitation.
ABOUBAKR
ELNASHAR
1.
Thermal
effects
▪
The
fetal
CNS
is
the
most
susceptible
tissue
▪
Animal
studies:
associations
with
NTD,
arthrogryposis,
disorders
of
muscle
tone,
miscarriage
and
FGR.
▪
The
risk
of
temperature
elevation
is
▪
lowest
in
B-mode
imaging
▪
higher
with
▪
colour
Doppler
▪
spectral
Doppler
applications.
ABOUBAKR
ELNASHAR

11. 2.
Mechanical:
Cavitation
▪
Development
of
gas
bubbles
in
tissues
exposed
to
US
vibration.
▪
These
bubbles:
▪
Inertial
(transient)
cavitation:
genetic
damage
in
vitro
or
▪
Non-inertial
(stable)
cavitation:
inconclusive
effects
in
vivo
studies
▪
No
significant
effects
of
US
unless
fetal
exposure
is
prolonged
(longer
than
60
minutes).
ABOUBAKR
ELNASHAR
▪
Safety
indices:
▪
Thermal
index
&
▪
Mechanical
index.
▪
should
be
kept
as
low
as
possible
to
obtain
optimal
images.
ABOUBAKR
ELNASHAR

12. III.
Magnetic
resonance
imaging
▪
Enables
the
visualisation
of
deep
soft
tissue
structures
▪
Does
not
rely
on
the
use
of
ionising
radiation.
▪
Useful
for
assessing:
▪
Posterior
reversible
encephalopathy
syndrome,
▪
Cerebral
venous
thrombosis,
▪
Acute
appendicitis,
▪
Crohn’s
disease
▪
Morbidly
adherent
placenta.
▪
Structural
fetal
anomalies:
cranial
lesions
(ventriculomegaly,
agenesis
of
the
corpus
callosum,
gyral
or
sulcation
pattern),
▪
NTD
▪
Congenital
pulmonary
airway
malformations,
▪
Congenital
diaphragmatic
hernia
▪
CVS
anomalies
(teratoma,
rhabdomyoma
or
vascular
abnormalities).
ABOUBAKR
ELNASHAR
▪
Can
be
technically
challenging
to
perform
and
interpret
{movement
of
the
fetus
and
variable
lie
and
presentation}
▪
Advantages
over
antenatal
US.
1.
MRI
has
improved
resolution,
and
cranial
imaging:
direct
visualisation
of
both
sides
of
the
fetal
brain.
2.
Limitations
of
US
{oligohydramnios,
fetal
positioning
and
acoustic
shadowing
from
the
ossifying
calvaria},
can
be
overcome
using
fetal
MRI.
▪
Factors
affecting
the
quality
of
fetal
MRI
1.
Fetal
movement:
a
need
for
repeated
image
acquisition
2.
Small
size
of
the
fetal
anatomical
structures
3.
Increased
distance
between
the
fetus
and
the
receiver
coil.
ABOUBAKR
ELNASHAR

13. ▪
Maternal
complications
1.
Claustrophobia
and
discomfort,
particularly
at
advanced
gestations.
2.
Hypotension
▪
{compression
of
the
inferior
vena
cava
by
the
gravid
uterus
▪
Reduced
by
avoidance
of
prolonged
supine
positioning,
particularly
in
the
third
trimester
ABOUBAKR
ELNASHAR
▪
Fetal
complications:
▪
MRI
is
not
associated
with
any
radiation
exposure
but
does
expose
the
fetus
to
a
magnetic
field
more
than
10
000
times
greater
than
that
of
Earth
(50
lT).
▪
Theoretical
concerns
include
teratogenesis
due
to
▪
static
magnetic
field
and
potential
cell
damage
▪
{cell
migration,
proliferation
and
differentiation;
tissue
heating
and
possible
disruption
of
organogenesis
owing
to
exposure
to
pulsed
radiofrequency
fields;
and
acoustic
damage
given
fetal
exposure
to
high-
gradient
electromagnetic
fields
used
with
the
fast
acquisition
sequences
required
for
fetal
imaging}.
ABOUBAKR
ELNASHAR

14. ▪
American
College
of
Radiology
(ACR)
▪
MRI
can
be
carried
out
at
any
time
during
pregnancy
if
the
maternal
benefits
outweigh
fetal
risks
▪
First-trimester
MRI
▪
Effects
on
fetal
growth,
the
risk
of
miscarriage
and
ophthalmic
anomalies
have
not
been
borne
out
in
human
studies.
▪
often
performed
for
maternal
indications
and
not
to
aid
prenatal
diagnosis.
▪
No
neonates
with
hearing
impairment
in
the
exposure
group
▪
No
significant
differences
in
birthweight
ABOUBAKR
ELNASHAR
▪
Third
trimester
MRI:
▪
1.5-T
fetal
MRI
using
single-shot
fast
spin
echo
(SSFSE)
▪
Age-appropriate
scores
in
the
communication,
daily
living,
socialisation
and
motor
skills,
normal
hearing
at
preschool
age.
▪
No
adverse
functional
outcomes
or
hearing
impairment.
ABOUBAKR
ELNASHAR

15. ❑
Use
of
gadolinium
contrast
▪
useful
in
enhancing
MRI
of
CNS
as
they
cross
the
blood–
brain
barrier.
▪
Lesions
disrupting
this
barrier
–
such
as
tumours,
abscesses
or
demyelination
–
are
therefore
more
readily
identifiable
with
the
use
of
contrast.
▪
1
st
T:
Possible
risk
of
teratogenicity
during
organogenesis.
▪
2
nd
&3
rd
T:
cross
the
placenta:
excreted
by
the
fetal
kidneys
into
the
amniotic
fluid
and
recirculated:
nephrogenic
systemic
fibrosis
in
the
child.
ABOUBAKR
ELNASHAR
▪
Comparing
first-trimester
MRI
with
no
MRI:
(Ray
et
al.,2016)
▪
no
sign
difference
in
stillbirth
or
neonatal
death
rate
▪
No
additional
risk
of
congenital
anomalies,
neoplasm,
visual
loss
or
hearing
loss
▪
Comparing
gadolinium
MRI
with
no
MRI,
▪
The
hazard
ratio
(HR)
for
nephrogenic
systemic
fibrosis-like
outcomes
was
not
statistically
significant
▪
Rheumatological,
inflammatory
and
infiltrative
skin
conditions
were
more
likely
▪
stillbirth
and
neonatal
death
rate
ABOUBAKR
ELNASHAR

16. ❖
Gadolinium
contrast
▪
be
avoided
in
pregnancy
unless
the
benefits
clearly
outweigh
the
possible
risks
to
the
fetus.
▪
If
gadolinium
is
used,
ACR
recommends
▪
informed
consent:
▪
information
requested
from
the
MRI
cannot
be
acquired
without
the
use
of
IV
contrast
or
by
using
other
imaging
▪
information
needed
affects
the
care
of
the
patient
and/or
fetus
during
the
pregnancy
▪
it
is
the
opinion
of
the
referring
physician
that
it
is
not
prudent
to
wait
to
obtain
this
information
until
after
the
delivery.
ABOUBAKR
ELNASHAR
IV.
Nuclear
medicine
imaging
▪
Useful
to
determine
organ
function
by
tagging
a
chemical
agent
with
a
radioisotope
(radiotracer).
▪
Include
▪
Pulmonary
ventilation/perfusion(V/Q),
▪
Thyroid,
bone
and
renal
scans
▪
Fetal
exposure
depends
on
both
the
physical
and
biochemical
properties
of
the
radioisotope.
ABOUBAKR
ELNASHAR

17. 1.
Technetium-99m:
▪
commonly
used
in
V/Q
scanning
to
diagnose
pulmonary
embolism
in
pregnancy.
▪
It
is
a
gamma
ray
emitter
and
has
a
half-life
of
approximately
6
hours.
▪
V/Q
scans:
fetal
radiation
exposure
of
<5
mGy.
▪
To
reduce
fetal
radiation
exposure
1.
normal
chest
radiograph
can
be
used
as
a
surrogate
marker
of
ventilation
2.
half-dose
perfusion
scans
could
be
considered.
ABOUBAKR
ELNASHAR
2.
Radioactive
iodine
(iodine-131),
▪
For
assessment
of
thyroid
pathology,
▪
Readily
crosses
the
placenta,
▪
Half-life
of
8
days
▪
±
fetal
hypothyroidism,
especially
if
used
after
10–
12
ws
of
gestation.
▪
Not
routinely
recommended
for
use
in
pregnancy.
▪
If
a
diagnostic
scan
of
the
thyroid
is
essential,
technetium-99m
is
the
isotope
of
choice.
ABOUBAKR
ELNASHAR

18. 3.
Positron
emission
tomography
(PET)
scan.
▪
Uses
radioactive-labelled
tracers:
increasing
the
risk
of
exposing
the
fetus
to
radiation.
▪
The
amount
of
fetal
radiation
exposure
depends
on
▪
weight
of
the
fetus
▪
type
of
radiotracer
▪
administered
dose
▪
physiological
changes
during
pregnancy.
▪
The
most
commonly
used
radiotracer
is
2-deoxy-2
[fluorine-18]-fluoro-D-glucose
(18F-FDG).
ABOUBAKR
ELNASHAR
▪
1
st
T:
▪
Fetus
is
at
highest
radiation
exposure
risk
▪
The
total
absorbed
dose
of
radiation
is
well
below
the
threshold
for
non-cancer
health
effects
throughout
pregnancy.
▪
2
nd
&3
rd
T:
▪
Fetal
radiation
dose
is
low.
▪
When
indicated
in
pregnant
women,
18F-FDG
PET
scanning
should
therefore
not
be
withheld
for
fear
of
excessive
radiation
exposure
to
the
fetus
ABOUBAKR
ELNASHAR

19. B.
RADIOLOGICAL
INVESTIGATION
OF
COMMON
MEDICAL
SYMPTOMS
IN
PREGNANCY
ABOUBAKR
ELNASHAR
1.
Venous
thromboembolism
(VTE)
▪
The
leading
direct
causes
of
maternal
death
during
pregnancy&
in
immediate
postpartum
period
in
UK
▪
Subjective
clinical
assessment
of
(DVT)
and
PE
▪
unreliable
in
pregnancy
▪
only
a
minority
of
women
with
clinically
suspected
VTE
have
the
diagnosis
confirmed
when
objective
testing
is
used
(2–6%).
ABOUBAKR
ELNASHAR

20. ▪
Calf
pain/swelling
▪
Compression
duplex
ultrasound,
and
women
should
remain
on
therapeutic
anticoagulation
until
imaging
is
completed.
▪
If
the
ultrasound
is
negative
and
a
high
level
of
clinical
suspicion
remains,
anticoagulant
treatment
should
be
discontinued
but
the
ultrasound
repeated
on
days
3
and
7.
ABOUBAKR
ELNASHAR
▪
Shortness
of
breath
▪
Common
presenting
complaint
in
pregnancy
with
a
wide
range
of
dd.
▪
Signs
or
symptoms
of
an
acute
PE
▪
an
electrocardiogram
▪
chest
radiograph.
▪
Suspected
PE
but
without
symptoms
and
signs
of
DVT
▪
a
V/Q
scan
or
▪
CT
pulmonary
angiogram
(CTPA).
ABOUBAKR
ELNASHAR

21. ▪
CTPA
has
advantages
over
V/Q
imaging
Cochrane
review
▪
availability,
▪
relatively
low
fetal
radiation
exposure
▪
superior
identification
of
other
pathology
including
pneumonia
(5–7%)
and
pulmonary
oedema
(2–6%).
▪
No
significant
difference
for
diagnosis
of
PE
▪
Drawback
to
the
use
of
CTPA
in
pregnancy,
▪
delivery
of
up
to
20
mGy
radiation
to
maternal
breast
tissue:
an
increased
risk
of
breast
cancer.
▪
Delivery
of
10
mGy
radiation
to
a
woman’s
breast
before
the
age
of
35
y:
increase
her
lifetime
risk
of
developing
breast
cancer
by
13.6%
above
that
of
the
general
population.
ABOUBAKR
ELNASHAR
▪
V/Q
scanning
▪
has
a
high
negative
predictive
value
for
PE
▪
delivers
a
lower
radiation
dose
to
the
breast
tissue
In
women
with
a
personal
or
significant
family
history
of
breast
cancer:
V/Q
scan
as
the
first-line
investigation.
▪
May
carry
an
increased
childhood
malignancy
risk
when
compared
with
CT
owing
to
a
slightly
higher
fetal
radiation
dose.
▪
in
utero
radiation
exposure
of
0.006%
per
mGy,
which
equates
to
a
risk
of
one
in
17
000
per
mGy.
ABOUBAKR
ELNASHAR

22. 2.
Abdominal
pain
▪
Can
be
attributed
to
▪
hepatobiliary,
gastrointestinal,
genitourinary,infectious,
▪
inflammatory,
vascular
and
malignant
aetiologies.
▪
The
most
common
causes
of
non-obstetric
pain
in
pregnancy
are
appendicitis
and
cholecystitis.
▪
Primary
imaging
modalities
▪
US:
image
appendix,
bowel,
hepatobiliary
tree,
renal
tract
and
adnexae.
▪
MRI(without
contrast)
help
identify
bowel
obstruction,
fistulas
or
abscess
formation.
▪
Abdominal
radiography
may
also
be
indicated.
ABOUBAKR
ELNASHAR
3.
Headache
▪
The
most
frequent
reason
for
referral
to
an
neurology
clinic.
▪
Causes:
▪
Most
are
benign
but
can
herald
intracranial
catastrophe.
▪
Primary:
migraine,
tension-type
headache,
cluster
headache
▪
Secondary:
▪
PET,
posterior
reversible
encephalopathy
syndrome
▪
Reversible
cerebral
VC
syndrome,
acute
arterial
hypertension,
cerebral
venous
thrombosis
▪
intracranial
hge,
subarachnoid
hge,
ischaemic
stroke,
pituitary
adenoma
and
malignancy.
ABOUBAKR
ELNASHAR

23. 1.
History
taking
▪
Red
flag
symptoms
associated
with
headache
that
require
further
investigation
in
pregnancy.
2.
Clinical
assessment,
3.
Urgent
intracranial
imaging
for
women
with
1.
Focal
neurological
deficits
or
2.
Signs
of
raised
intracranial
pressure
(papilloedema,
ocular
palsy,
hypertension)
▪
Fetal
exposure
following
CT
of
the
maternal
head
is
estimated
at
0.001–0.01
mGy
ABOUBAKR
ELNASHAR
Red
flag
symptoms
associated
with
headache
in
pregnancy
▪
Sudden-onset
headache
reaching
maximal
intensity
in
<1
minute
▪
New
onset
of
severe
headache
▪
Significant
change
in
chronic
headaches
▪
Headache
fever,
meningism
▪
Headaches
triggered
by
cough,
valsalva,
sneezing
or
exercise
▪
Orthostatic
headache
▪
New-onset
focal
neurological
deficit,
cognitive
dysfunction
or
seizure
▪
Head
or
neck
trauma
(within
last
3
months)
▪
Headache
with
aura
including
motor
weakness
(lasting
>1
hour)
▪
Worsening
headache
(weeks
or
months)
▪
Visual
disturbances/visual
field
defects
▪
Other
considerations
▪
Patient
blood
pressure
▪
Past
history
of
neurological
conditions
▪
Pituitary
disease
▪
Immunocompromise
(HIV
infection,
immunosuppression)
▪
Malignancy
▪
Conditions
associated
with
procoaguable
state
(thrombophilia,
antiphospholipid
syndrome,
etc.)
▪
Current
medication
(medication
overuse/abuse)
▪
Family
history
ABOUBAKR
ELNASHAR

24. ABOUBAKR
ELNASHAR
4.
Breast
mass
▪
The
leading
cause
of
death
in
women
aged
35–54
y
(lifetime
risk
of
one
in
nine).
▪
Women
presenting
with
a
breast
mass
in
pregnancy
persisting
for
more
than
2
ws
should
be
referred
to
a
multidisciplinary
team.
1.
Ultrasound
of
the
affected
breast
is
recommended
2.
Tissue
biopsy.
3.
Mammography
If
malignancy
is
identified
▪
To
assess
the
extent
of
disease
▪
visualise
microcalcifications
▪
assess
the
contralateral
breast.
ABOUBAKR
ELNASHAR

25. ▪
Mammography
is
often
challenging
to
interpret
▪
{physiological
hyper-vascularisation
and
the
increased
density
of
breast
tissue
in
pregnancy}
▪
Sensitivity:
78%
and
90%
▪
To
reduce
exposure
of
the
fetus
to
ionizing
radiation,
fetal
shielding
is
recommended.
▪
The
overall
dose
of
radiation
exposure
from
mammography
is
0.001–0.01
mGy
ABOUBAKR
ELNASHAR
4.
Additional
imaging
▪
may
be
required
to
stage
the
malignancy.
▪
When
there
is
a
high
index
of
clinical
suspicion
of
metastases
in
pregnancy,
women
should
have
▪
chest
radiograph
▪
liver
ultrasound.
▪
MRI
with
gadolinium
contrast
▪
Counselling
▪
If
malignancy
is
not
assessed
and
treated
appropriately:
risk
of
maternal
morbidity,
and
fetal
morbidity
and
mortality
▪
Risks
to
the
neonate
with
use
of
gadolinium
contrast
▪
Prompt
optimal
treatment
is
the
most
crucial
factor
ABOUBAKR
ELNASHAR

26. CONCLUSION
▪
The
appropriate
use
of
imaging
in
pregnancy
is
necessary
for
prompt
investigation
and
management
of
acute
and
chronic
medical
symptoms.
▪
The
effects
of
diagnostic
imaging
studies
on
the
fetus
involving
<50
mGy
radiation
at
any
gestation
are
likely
to
be
negligible.
▪
The
use
of
shielding
techniques
significantly
reduces
the
dose
of
ionising
radiation
to
which
the
fetus
is
exposed.
▪
Theoretical
concerns
regarding
magnetic
resonance
imaging
use
in
pregnancy
have
not
been
supported
in
human
studies.
▪
MRI
remains
preferable
to
studies
using
ionising
radiation
▪
Gadolinium
contrast
should
be
avoided
in
pregnancy
unless
the
maternal
benefits
outweigh
fetal
and
neonatal
risks
ABOUBAKR
ELNASHAR
▪
Timely
investigation
and
management
of
complex
medical
symptoms
in
pregnancy
is
essential
to
reduce
maternal
morbidity
and
mortality.
▪
Safety
of
imaging
in
pregnancy
is
improved
by
1.
careful
history
taking
and
examination,
2.
clear
identification
of
the
clinical
question
to
be
answered
and
the
timeframe
in
which
it
should
be
investigated,
3.
advice
from
a
senior
radiologist
regarding
the
most
suitable
imaging
modality
4.
appropriate
counselling
of
the
woman
by
a
competent
clinician.
ABOUBAKR
ELNASHAR