Ectopic pregnancy: MRI findings and clinical utility

To assess the utility of magnetic resonance imaging (MRI) in patients with clinically suspected ectopic pregnancy (EP).

We retrospectively reviewed MRIs of 26 consecutive patients who were clinically suspected of having an EP. The diagnostic utility of MRI features of EP was analyzed retrospectively as follows: (1) Direct sign detection of ectopic gestational sac (GS); (2) Indirect signs tubal dilatation with hemosalpinx, adnexal hematoma, and hemorrhagic ascites. The diagnostic accuracy of each sign and their combination was compared to surgical records. The MRI findings of an ectopic GS were reviewed as follows: size, shape, signal intensity, and enhancement pattern.

Of 26 patients, 24 had a tubal pregnancy; 22 of these 24 patients (92%) had a direct sign (sensitivity: 91.3%; specificity: 100%; positive predictive value: 100%). The diagnostic accuracy of the direct sign was 92%; this was more accurate than that of any single indirect sign (39%, 54%, and 50%, respectively). However, the diagnostic accuracy of EP increased to 100% when diagnostic criteria required the presence of a direct sign or at least two indirect signs.

MRI is an effective modality for diagnosing EP with a high detection rate of extrauterine GSs. The combination of direct and indirect signs is useful for establishing the correct diagnosis.