Correlations from gadopentetate dimeglumine-enhanced magnetic resonance imaging after methotrexate chemotherapy for hemorrhagic placenta increta

Salim A. Wehbe, Labib M. Ghulmiyyah, Kenneth T. Carroll, Mark Perloe, Daniel G. Schwartzberg, E. Scott Sills

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To describe pre- and post-methotrexate (MTX) therapy images from pelvic magnetic resonance imaging (MRI) with gadopentetate dimeglumine contrast following chemotherapy for post-partum hemorrhage secondary to placenta increta. Material and method: A 28-year-old Caucasian female presented 4 weeks post-partum complaining of intermittent vaginal bleeding. She underwent dilatation and curettage immediately after vaginal delivery for suspected retained placental tissue but 28 d after delivery, the serum β-hCG persisted at 156 IU/mL. Office transvaginal sonogram (4 mHz B-mode) was performed, followed by pelvic MRI using a 1.5 Tesla instrument after administration of gadolinium-based contrast agent. MTX was administered intramuscularly, and MRI was repeated four weeks later. Results: While transvaginal sonogram suggested retained products of conception confined to the endometrial compartment, an irregular 53 x 34 x 28 mm heterogeneous intrauterine mass was noted on MRI to extend into the anterior myometrium, consistent with placenta increta. Vaginal bleeding diminished following MTX treatment, with complete discontinuation of bleeding achieved by ∼20 d post-injection. MRI using identical technique one month later showed complete resolution of the uterine lesion. Serum β-hCG was <5 IU/mL. Conclusion: Reduction or elimination of risks associated with surgical management of placenta increta is important to preserve uterine function and reproductive potential. For selected hemodynamically stable patients, placenta increta may be treated non-operatively with MTX as described here. A satisfactory response to MTX can be ascertained by serum hCG measurements with pre- and post-treatment pelvic MRI with gadopentetate dimeglumine enhancement, which offers advantages over standard transvaginal sonography.

Original languageEnglish (US)
Article number1
Pages (from-to)1-5
Number of pages5
JournalBioMagnetic Research and Technology
Volume1
DOIs
StatePublished - Nov 14 2003
Externally publishedYes

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Placenta Accreta
Gadolinium DTPA
Methotrexate
Magnetic Resonance Imaging
Drug Therapy
Uterine Hemorrhage
Serum
Hemorrhage
Dilatation and Curettage
Myometrium
Gadolinium
Therapeutics
Contrast Media
Ultrasonography
Injections

ASJC Scopus subject areas

  • Biophysics

Cite this

Correlations from gadopentetate dimeglumine-enhanced magnetic resonance imaging after methotrexate chemotherapy for hemorrhagic placenta increta. / Wehbe, Salim A.; Ghulmiyyah, Labib M.; Carroll, Kenneth T.; Perloe, Mark; Schwartzberg, Daniel G.; Sills, E. Scott.

In: BioMagnetic Research and Technology, Vol. 1, 1, 14.11.2003, p. 1-5.

Research output: Contribution to journalArticle

Wehbe, Salim A. ; Ghulmiyyah, Labib M. ; Carroll, Kenneth T. ; Perloe, Mark ; Schwartzberg, Daniel G. ; Sills, E. Scott. / Correlations from gadopentetate dimeglumine-enhanced magnetic resonance imaging after methotrexate chemotherapy for hemorrhagic placenta increta. In: BioMagnetic Research and Technology. 2003 ; Vol. 1. pp. 1-5.
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