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妊娠期间的诊断性影像学操作

Author
Jonathan B Kruskal, MD, PhD
Section Editors
Louise Wilkins-Haug, MD, PhD
Deborah Levine, MD
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
任芸芸, 主任医师

引言

妊娠前卵巢暴露于诊断水平的电离辐射，对将来妊娠没有可检测出的影响。因此，如果可能，安排育龄期女性进行放射检查的理想时间是月经周期的最初10日。在接受放射检查时，应询问所有存在生育潜能的女性是否可能妊娠[1]。如果存在任何怀疑，在检查前应获得妊娠试验的结果。

在妊娠过程中，有时有必要进行诊断性影像学检查，其使用率似乎在增加[2]。在妊娠女性中，经常通过超声检查子宫及其内容物，但可能也需进行其他类型的放射学评估。虽然妊娠期间辐射暴露的安全性是一个普遍关心的问题，但与电离辐射相关的任何危害相比，遗漏诊断或延迟诊断对妊娠女性和胎儿的风险更大[3]。在很多情况下，感知到的胎儿风险高于实际风险[4,5]。对于妊娠女性本人，无论其是否妊娠，电离辐射的影响是相同的，本专题将不对此进行讨论。

指南

多个国家及国际组织均有关于在妊娠女性中进行影像学检查的书面指南。2011年发表了包括这些组织中17个组织的名称及其33篇报道在内的综合资源[6]。下列讨论包括来源于这些报道中的几篇报道的信息。

辐射的基础知识

对辐射的影响进行任何讨论均需了解辐射术语及剂量测定的背景知识。辐射的吸收剂量以“rads”表示，代表每公斤组织吸收的能量。当1g物质吸收100ergs的能量时，其吸收剂量为1rad。下列关系式适用于软组织的诊断性X线。

●1rad=0.01gray(Gy)=0.01sievert(Sv)=1rem(人体伦琴当量)

                             

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-08.
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References
Top
  1. Applegate K. Pregnancy screening of adolescents and women before radiologic testing: does radiology need a national guideline? J Am Coll Radiol 2007; 4:533.
  2. Lazarus E, Debenedectis C, North D, et al. Utilization of imaging in pregnant patients: 10-year review of 5270 examinations in 3285 patients--1997-2006. Radiology 2009; 251:517.
  3. McCollough CH, Schueler BA, Atwell TD, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007; 27:909.
  4. Ratnapalan S, Bona N, Chandra K, Koren G. Physicians' perceptions of teratogenic risk associated with radiography and CT during early pregnancy. AJR Am J Roentgenol 2004; 182:1107.
  5. Bentur Y, Horlatsch N, Koren G. Exposure to ionizing radiation during pregnancy: perception of teratogenic risk and outcome. Teratology 1991; 43:109.
  6. Austin LM, Frush DP. Compendium of national guidelines for imaging the pregnant patient. AJR Am J Roentgenol 2011; 197:W737.
  7. http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/bio-effects-radiation.html (Accessed on September 04, 2012).
  8. http://www.gpo.gov/fdsys/pkg/CFR-2011-title10-vol1/xml/CFR-2011-title10-vol1-part20.xml (Accessed on September 04, 2012).
  9. Castronovo FP Jr. Teratogen update: radiation and Chernobyl. Teratology 1999; 60:100.
  10. United Nations Scientific Committee on the Effects of Atomic Radiation, Sources and Effects of Ionizing Radiation, UN Publication E.94.IX.2, UN Publications, United Nations, New York, 1993.
  11. Hall EJ. Scientific view of low-level radiation risks. Radiographics 1991; 11:509.
  12. Committee on Biological Effects of Ionizing Radiation, Board on Radiation Effects Research Commission on Life Sciences, National research Council. Health effects of exposure to low levels of ionizing radiation: BEIR V. Washington, DC, 1990. p. 352.
  13. Schull, WJ, Otake, M. Neurological deficit among the survivors exposed to the atomic bombing of Hiroshima and Nagasaki: A reassessment and new directions. In: Radiation risks to the developing nervous system, Schmahl, W, Gerber, GB, Stive, FE (Eds), Gustave Fischer Verlag, New York 1986.
  14. Otake M, Schull WJ, Yoshimaru H. A review of forty-five years study of Hiroshima and Nagasaki atomic bomb survivors. Brain damage among the prenatally exposed. J Radiat Res 1991; 32 Suppl:249.
  15. Wertelecki W. Malformations in a chornobyl-impacted region. Pediatrics 2010; 125:e836.
  16. Yamazaki JN, Schull WJ. Perinatal loss and neurological abnormalities among children of the atomic bomb. Nagasaki and Hiroshima revisited, 1949 to 1989. JAMA 1990; 264:605.
  17. Brent RL. Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy. Am J Obstet Gynecol 2009; 200:4.
  18. Brent RL. The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: counseling the pregnant and nonpregnant patient about these risks. Semin Oncol 1989; 16:347.
  19. www.bt.cdc.gov/radiation/prenatalphysician.asp (Accessed on July 09, 2012).
  20. Stewart A, Kneale GW. Radiation dose effects in relation to obstetric x-rays and childhood cancers. Lancet 1970; 1:1185.
  21. Kato H. Mortality in children exposed to the A-bombs while in utero, 1945-1969. Am J Epidemiol 1971; 93:435.
  22. American College of Obstetricians and Gynecologists. Guidelines for diagnostic imaging during pregnancy and lactation. Committee Opinion No. 656. Obstet Gynecol 2016; 127:e75.
  23. Preston DL, Cullings H, Suyama A, et al. Solid cancer incidence in atomic bomb survivors exposed in utero or as young children. J Natl Cancer Inst 2008; 100:428.
  24. www.icrp-84.org.
  25. De Santis M, Cesari E, Nobili E, et al. Radiation effects on development. Birth Defects Res C Embryo Today 2007; 81:177.
  26. Bentur, Y. Ionizing and nonionizing radiation in pregnancy. In: Maternal-fetal toxicology, 2nd ed, Koren, G (Ed), Marcel Dekker, New York 1994.
  27. Mettler, FA, Upton, AC. Medical Effects of Ionizing Radiation, 2nd ed, WB Saunders, Philadelphia, 1995.
  28. De Santis M, Di Gianantonio E, Straface G, et al. Ionizing radiations in pregnancy and teratogenesis: a review of literature. Reprod Toxicol 2005; 20:323.
  29. Ritenour ER. Health effects of low level radiation: carcinogenesis, teratogenesis, and mutagenesis. Semin Nucl Med 1986; 16:106.
  30. Kereiakes, JG, Rosenstein, M. Handbook of Radiation Doses in Nuclear Medicine and Diagnostic X-ray, CRC Press, Boca Raton 1980.
  31. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources and Effects of ionizing radiation. Report to the General Assembly, 1977. p. 319.
  32. Laing FC, Benson CB, DiSalvo DN, et al. Distal ureteral calculi: detection with vaginal US. Radiology 1994; 192:545.
  33. Butler EL, Cox SM, Eberts EG, Cunningham FG. Symptomatic nephrolithiasis complicating pregnancy. Obstet Gynecol 2000; 96:753.
  34. Hujoel PP, Bollen AM, Noonan CJ, del Aguila MA. Antepartum dental radiography and infant low birth weight. JAMA 2004; 291:1987.
  35. Ilett KF, Hackett LP, Paterson JW, McCormick CC. Excretion of metrizamide in milk. Br J Radiol 1981; 54:537.
  36. FitzJohn TP, Williams DG, Laker MF, Owen JP. Intravenous urography during lactation. Br J Radiol 1982; 55:603.
  37. Nielsen ST, Matheson I, Rasmussen JN, et al. Excretion of iohexol and metrizoate in human breast milk. Acta Radiol 1987; 28:523.
  38. Bona G, Zaffaroni M, Defilippi C, et al. Effects of iopamidol on neonatal thyroid function. Eur J Radiol 1992; 14:22.
  39. ACR Committee on Drugs and Contrast Media. Administration of Contrast Medium to Breastfeeding Mothers. ACR Bulletin 2001.
  40. Webb JA, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005; 15:1234.
  41. Grigsby PW, Siegel BA, Baker S, Eichling JO. Radiation exposure from outpatient radioactive iodine (131I) therapy for thyroid carcinoma. JAMA 2000; 283:2272.
  42. Cattani F, Vavassori A, Polo A, et al. Radiation exposure after permanent prostate brachytherapy. Radiother Oncol 2006; 79:65.
  43. Winer-Muram HT, Boone JM, Brown HL, et al. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002; 224:487.
  44. www.easternisotopes.com/products/package_insert.html. (Accessed November 10, 2005).
  45. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108:776.
  46. Sachs HC, Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013; 132:e796.
  47. Strizek B, Jani JC, Mucyo E, et al. Safety of MR Imaging at 1.5 T in Fetuses: A Retrospective Case-Control Study of Birth Weights and the Effects of Acoustic Noise. Radiology 2015; 275:530.
  48. De Wilde JP, Rivers AW, Price DL. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol 2005; 87:335.
  49. Kanal E. Pregnancy and the safety of magnetic resonance imaging. Magn Reson Imaging Clin N Am 1994; 2:309.
  50. Ray JG, Vermeulen MJ, Bharatha A, et al. Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA 2016; 316:952.
  51. Expert Panel on MR Safety, Kanal E, Barkovich AJ, et al. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 2013; 37:501.
  52. Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007; 188:1447.
  53. De Santis M, Straface G, Cavaliere AF, et al. Gadolinium periconceptional exposure: pregnancy and neonatal outcome. Acta Obstet Gynecol Scand 2007; 86:99.
  54. Barkhof F, Heijboer RJ, Algra PR. Inadvertent i.v. administration of gadopentetate dimeglumine during early pregnancy. AJR Am J Roentgenol 1992; 158:1171.
  55. Shoenut JP, Semelka RC, Silverman R, et al. MRI in the diagnosis of Crohn's disease in two pregnant women. J Clin Gastroenterol 1993; 17:244.
  56. Marcos HB, Semelka RC, Worawattanakul S. Normal placenta: gadolinium-enhanced dynamic MR imaging. Radiology 1997; 205:493.
  57. Rofsky NM, Weinreb JC, Litt AW. Quantitative analysis of gadopentetate dimeglumine excreted in breast milk. J Magn Reson Imaging 1993; 3:131.
  58. Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, et al. Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology 2000; 216:555.
  59. Schmiedl U, Maravilla KR, Gerlach R, Dowling CA. Excretion of gadopentetate dimeglumine in human breast milk. AJR Am J Roentgenol 1990; 154:1305.
  60. LactMed: Gadopentetate https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~ZWHrmg:1 (Accessed on September 21, 2016).
  61. American College of Radiology Committee on Drugs and Contrast Media. Administration of contrast media to breast-feeding mothers. In, ACR manual on contrast media. 2015;Version 10.1:99-100. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/2015_Contrast_Media.pdf (Accessed on September 21, 2016).
  62. Contrast Media Safety Committee of the European Society of Urogenital Radiology. Contrast Media Guidelines. Version 8.0 http://www.esur.org/guidelines/ (Accessed on September 22, 2016).