More Related Content Similar to Imaging in pregnancy 2 in1 (20) More from Aboubakr Elnashar (20) Imaging in pregnancy 2 in112. 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
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