In pregnancy-related stroke, which imaging choice minimizes fetal exposure while providing diagnostic information?

• A. MRI without gadolinium contrast.
• B. CT head with contrast.
• C. CT angiography with contrast.
• D. MRI with gadolinium.

Answer: (A)

Minimizing fetal exposure while still getting essential diagnostic information is best achieved with MRI without gadolinium contrast. MRI offers excellent sensitivity for acute stroke findings, especially with diffusion-weighted imaging, and can identify hemorrhage with additional sequences, all without ionizing radiation. Avoiding gadolinium in pregnancy is preferred because the contrast agent can cross the placenta and carries potential fetal risks, so non-contrast MRI provides the needed diagnostic detail without exposing the fetus to contrast or radiation. In contrast, CT-based studies involve ionizing radiation and sometimes iodinated contrast, increasing fetal exposure, and MRI with gadolinium introduces a contrast agent that is generally avoided in pregnancy when non-contrast MRI suffices.