妊娠和哺乳期计算机断层扫描(CT)和磁共振成像(MRI)的使用已大大增加。在一些医生和病人中,然而,对风险有误解,安全,并在怀孕期间适当使用这些方式。我们为CT的使用制定了一套基于证据的指南,MRI,和怀孕期间的造影剂选择适应症,包括疑似急性阑尾炎,肺栓塞,肾绞痛,创伤,头盆比例不均.超声检查是疑似阑尾炎的首选方法,但如果超声检查结果是阴性,可以获得MRI或CT。计算机断层扫描应该是可疑肺栓塞的初始诊断成像方式。超声检查应该是可疑肾绞痛的首选初步研究。超声检查可以作为创伤的初始影像学评估,但如果怀疑有严重损伤,应进行CT检查。现在很少用于可疑的头骨盆比例失调,但是当需要时,低剂量CT骨盆测量可以以最小的风险进行。虽然在怀孕期间使用碘化造影剂似乎是安全的,静脉注射钆是禁忌的,只有在绝对必要时才能使用。在接受碘化造影剂或钆后立即继续母乳喂养似乎是安全的。尽管暴露于产前诊断辐射后,致畸并不是主要问题,致癌是一个潜在的风险。如果使用得当,CT和MRI可能是孕妇和哺乳期妇女成像的有价值的工具;风险和益处始终应考虑并与患者讨论。
There has been a substantial increase in the use of computed tomography (CT) and magnetic resonance imaging (MRI) in pregnancy and lactation. Among some physicians and patients, however, there are misperceptions regarding risks, safety, and appropriate use of these modalities in pregnancy. We have developed a set of evidence-based
guidelines for the use of CT, MRI, and contrast media during pregnancy for selected indications including suspected acute appendicitis, pulmonary embolism, renal colic, trauma, and cephalopelvic disproportion. Ultrasonography is the initial modality of choice for suspected appendicitis, but if the ultrasound examination is negative, MRI or CT can be obtained. Computed tomography should be the initial diagnostic imaging modality for suspected pulmonary embolism. Ultrasonography should be the initial study of choice for suspected renal colic. Ultrasonography can be the initial imaging evaluation for trauma, but CT should be performed if serious injury is suspected. Pelvimetry now is used rarely for suspected cephalopelvic disproportion, but when required, low-dose CT pelvimetry can be performed with minimal risk. Although iodinated contrast seems safe to use in pregnancy, intravenous gadolinium is contraindicated and should be used only when absolutely essential. It seems to be safe to continue breast-feeding immediately after receiving iodinated contrast or gadolinium. Although teratogenesis is not a major concern after exposure to prenatal diagnostic radiation, carcinogenesis is a potential risk. When used appropriately, CT and MRI can be valuable tools in imaging pregnant and lactating women; risks and benefits always should be considered and discussed with patients.