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Managing a pregnant patient with a suspected nonobstetric abdominopelvic disorder is challenging. Information from imaging affects the treatment options, which range from operating emergently and risking miscarriage to terminating the pregnancy or delaying treatment until after delivery. The most common indications for MR imaging during pregnancy are disorders of the central nervous and cardiovascular systems. In the evaluation of the abdomen and pelvis, sonography plays the pivotal role; however, sonography may be inconclusive because of its limited specificity in tissue characterization and technical difficulties caused by the enlarged uterus. For these reasons MR imaging has emerged as a valuable adjunct to sonography. In this pictorial essay we describe a variety of nonobstetric abdominopelvic disorders during pregnancy in which MR imaging contributed to patient management.

High-resolution real-time sonography was used at the time an allograft biopsy was performed on 58 renal transplant recipients to elucidate the cause of posttransplantation decline in renal function. These procedures were performed within 3 months of transplantation. Fifty-four out of 58 patients were on a cyclosporine-steroid regimen. Acute rejection was diagnosed if one or more of the following findings was present on sonogram: transplant swelling, increased conspicuity of the medullary pyramids, medullary pyramid enlargement, decreased renal-sinus fat, and pelvi-infundibular thickening. Correlation of sonography and histopathologic findings showed that sonography cannot be used independently to diagnose rejection or to distinguish between cyclosporine nephrotoxicity and rejection. A creatinine level of 2.5 mg/dl was then randomly selected as a threshold level to possibly improve the sonographic results, anticipating that above this threshold an abnormal sonogram would invariably be recorded in the presence of rejection. This threshold was not found to be discriminatory. Only at a higher threshold level of creatinine (6.9 mg/dl or more) was there 100% correlation between acute rejection and the presence of abnormal sonographic findings. Furthermore, whereas most patients with four or five abnormal sonographic criteria tended to have acute rejection, this group of patients constituted a minority and, even within this group, sonography was not entirely reliable in detecting transplant rejection.

The sonographic features of intrauterine contraceptive devices (IUD), which allow identification of their intrauterine location, were evaluated in vitro and clinically in 50 patients. Posterior acoustic shadowing was seen in 90% of patients, entrance-exit reflections in 65%, and type-specific morphology in 94% of patients with Lippes Loops and in 81% with Copper 7 devices. Recognition of the characteristic features of the IUD and identification of endometrial mucosa around the IUD will allow unequivocal and accurate determination of its correct intrauterine location.

Recent advances in techniques for fetal catheterization and surgical manipulation have made intrauterine therapy of certain anomalies a reality [1 -4]. With a variety of treatment options now available, the fetus must be afforded as cornprehensive a diagnostic evaluation as possible. It may be insufficient to identify an abnormality and await delivery to perform a more complete diagnostic workup. Precise and detailed anatomic information is necessary to select appropriate cases for prenatal therapy and to plan the most efficacious therapeutic approach. We recently encountered a fetus with urinary tract obstruction in whom combined radiologic and sonographic imaging was necessary to establish the level of obstruction.