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

Salim A Wehbe¹ , Labib M Ghulmiyyah¹ , Kenneth T Carroll² , Mark Perloe³ , Daniel G Schwartzberg⁴ and E Scott Sills³

¹Department of Obstetrics & Gynecology, Atlanta Medical Center; Atlanta, Georgia, USA

²Department of Obstetrics & Gynecology, Northside Hospital; Atlanta, Georgia, USA

³Georgia Reproductive Specialists LLC/Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Atlanta Medical Center; Atlanta, Georgia, USA

⁴Department of Radiology, Atlanta Medical Center; Atlanta, Georgia, USA

author email corresponding author email

BioMagnetic Research and Technology 2003, 1:3doi:10.1186/1477-044X-1-3


Published:	14 November 2003

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 × 34 × 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.