Abstract
Response to: van Dam LR, Han SN, Dierickx D, Amant F. Optimal staging of lymphoma during pregnancy is crucial. Womens Health 11(2), 101–102 (2015).
Although available data have not conclusively documented any deleterious effects of MRI imaging exposure on the developing fetus, potential risks associated with heating effects of radiofrequency pulses and with acoustic noise are increased [1]. According to the recommendations of the American College of Radiology, pregnant patients may undergo MRI scans at any stage of pregnancy, if the risk–benefit ratio to the patient warrants that the study be performed. According to the American College of Radiology, the application of MRI in pregnant women should be considered if the information required from the MRI study cannot be acquired using ultrasonography and the data obtained may potentially affect the patient management during the pregnancy [2].
Since the vast majority of patients with both Hodgkin lymphoma and non-Hodgkin lymphoma are initially treated with chemotherapy irrespective of the disease stage, staging of a pregnant patient with lymphoma should be limited and based on the history, physical examination, routine blood tests, bone marrow biopsies and chest x-ray performed with abdominal shielding [3]. Ultrasound may be safely employed to obtain additional information regarding the disease stage. MRI should be used only if the study results could influence treatment decisions. Given that in most cases this will not occur, MRI is not routinely recommended for pregnant women and should be used in selected cases only.
Gadolinium is known to cross the placenta barrier. The risk of gadolinium-based MRI contrast agent to the fetus remains unknown. Moreover, lymphoma staging using MRI without the administration of a contrast agent may be sufficient in most cases. Accordingly, if MRI is planned to be conducted for lymphoma staging during pregnancy, a consultation with an expert radiologist is recommended, with a special focus on the value of contrast agent administration in each case.
Our recommendations are consistent with those by the European Society for Medical Oncology Guidelines Working Group [4]. According to the European Society for Medical Oncology guidelines, ultrasound is the preferred imaging modality for breast, abdomen and pelvis imaging during pregnancy. Chest x-ray and mammography with abdominal shielding can be safely performed during pregnancy. MRI without gadolinium can be used if any of the previously mentioned modalities were inconclusive or in case of suspicious bone or brain metastases.
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