MRI of early unruptured ectopic pregnancy: detection of gestational sac.

We report two cases of unruptured tubal pregnancy that were evaluated on MRI at 5 weeks' gestation. In both cases, MRI revealed gestational sac-like structures surrounded by thickened walls outside the ovaries. At the periphery of gestational sac-like structures, small amounts of fresh blood were also identified. These findings highly indicate ectopic pregnancy in a patient with elevated human chorionic gonadotropin level.     

Co-existent intrauterine and ectopic tubal pregnancy

A case of co-existent intrauterine and ectopic pregnancy is described in a patient from overseas. The difficulty in diagnosis and management is discussed, together with recent literature.     

Efficacy of the intradecidual sign and fallacy of the double decidual sac sign in the diagnosis of early intrauterine pregnancy

PURPOSE: To assess ultrasonographically (US) guided needle aspiration of breast abscesses as an alternative to surgical incision and drainage or indwelling catheter placement. MATERIALS AND METHODS: The authors reviewed hospital records from 1995 to 1997 for patients undergoing US-guided aspiration of breast abscesses. Two radiologists reviewed the US, mammographic, and US-guided aspiration studies for the size, appearance, and drainage of abscesses. The medical records were reviewed for follow-up data. RESULTS: Thirteen patients aged 15-69 years underwent US-guided percutaneous aspiration of 13 breast abscesses. All patients presented with a palpable mass, nine of which were retroareolar. At US, four abscesses were oval, nine (including three with septa) were irregularly shaped, and five had a thick rind. Of seven abscesses 2.4 cm or smaller, two were almost completely drained and five were completely aspirated. All seven abscesses resolved without surgery. Of six women with incompletely aspirated abscesses larger than 2.4 cm (one 3 cm, four 4 cm, one 7 cm), five required surgical referral; one of these cases was referred after repeat aspiration had been performed. CONCLUSION: Percutaneous aspiration of breast abscesses can enable diagnosis of abscesses and be used to treat small abscesses if they are completely drained. Partial drainage of abscesses larger than 3 cm may be palliative, but incision and drainage still may be necessary for definitive treatment.     

CT and MRI of early intrauterine pregnancy

OBJECTIVE: The objective of this article is to describe the CT and MRI findings of early intrauterine pregnancy. CONCLUSION: Early pregnancy should be considered when CT or MRI shows a fluid-filled cystlike structure in the uterus of a woman of reproductive age especially if there is a coexistent ovarian corpus luteum cyst.     

Role of MRI in the early diagnosis of tubal ectopic pregnancy

Objective

To determine the role of MRI in the early diagnosis of tubal ectopic pregnancy (EP).

Methods

Clinical and MRI features of 27 cases of tubal pregnancy were reviewed.

Results

A thick-walled gestational sac (GS)-like structure was demonstrated lateral to the uterus in all cases. On T2-weighted images, the thick wall typically exhibited 3 discrete rings in 22 cases (81 %), among which 17 cases (63 %) displayed small vessels and 6 cases (33 %) exhibited small areas of fresh haemorrhage inside the thick wall. The contents demonstrated non-specific liquid in 26 %, papillary solid components in 56 %, and fresh blood or fluid-fluid level in 19 % of the cases. Dilatation of the affected fallopian tube associated with hematosalpinx was demonstrated in 18 cases (67 %) and marked enhancement of the tubal wall was observed in 22 cases (81 %). No correlation was found between the size of the GS and the estimated gestational age (r?=?0.056).

Conclusion

MRI plays an important role in the early diagnosis and management of tubal pregnancy. The characteristic MRI features include a GS-like structure with a “three rings” appearance on T2-weighted images, presence of solid components in the sac, dilatation of the affected fallopian tube with hematosalpinx, and tubal wall enhancement.

Key Points

? MR imaging has served as a problem-solving procedure in ectopic pregnancy. ? MR imaging features can be criteria for early diagnosis of tubal pregnancy. ? Detailed assessment of ectopic implantation is necessary for management decision-making.

     

子宫动脉栓塞联合孕囊注射甲氨蝶呤序贯清宫术治疗瘢痕妊娠

【摘要】　目的?探讨子宫动脉栓塞（UAE）联合超声引导孕囊内注射甲氨蝶呤（MTX）在瘢痕妊娠（CSP）清宫术术前应用的有效性和安全性。方法?收治住院的确诊为瘢痕妊娠的患者38例,其中接受超声引导下于孕囊内MTX注射联合UAE清宫术者16例为观察组,UAE并行MTX全身化疗清宫术者为22例为对照组。对比两组患者清宫术出血情况、住院时间、住院期间β-HCG变化情况、MTX使用剂量、β-HCG恢复时间、阴道流血时间、月经恢复时间及并发症情况。结果?两组患者在剖宫产β-HCG恢复时间、术中出血量及月经恢复时间差异均无统计学意义。观察组患者在住院期间β-HCG下降速度和程度较对照组快,观察组患者局部MTX使用剂量低于对照组。对照组中2例（2/22,9.1%）在清宫术中发生大出血,1例经输血、水囊压迫治疗后好转,1例清宫术中大出血中转子宫切除。结论?UAE联合孕囊注射MTX可以有效降低瘢痕妊娠大出血发生率。超声引导下局部孕囊内MTX注射对快速下降β-HCG水平有一定优势,尤适用于高β-HCG水平患者。     

经腹与经阴道超声检查早早孕及宫外孕的临床意义

 目的 探讨经腹(TAS)及经阴道彩色多普勒超声(TVCS)诊断早早孕及宫外孕的临床意义.方法 对160例临床疑为早早孕,TAS不能确诊者109例进行TVCS检查,检出宫内早早孕101例,宫外孕7例.结果 TAS对早早孕及宫外孕诊断的灵敏度及特异度分别为32.1%(51/159)、100%(1/1).TVCS对早早孕及宫外孕诊断的灵敏度及特异度分别为95.6%(152/159)、100%(1/1).结论 TVCS在早早孕及宫外孕诊断中明显优于TAS;联合TAS与TVCS检查,可大大提高早早孕及宫外孕的检出率.     

经阴道超声在宫外孕早期诊断中的临床应用

超声诊断中经腹部超声检查对非典型宫外孕及早期宫外孕易漏诊或误诊[1,2].我院利用经阴道超声检查对宫外孕患者实施早期诊断,明显提高了诊断率.本文对2009年6月～2012年6月间对320例早期宫外孕患者经腹超声(transabdominal sonography,TAS)与经阴道超声(transvag-inal sonography,TVS)检查临床资料进行回顾性分析,探讨经腹部及经阴道超声检查对早期宫外孕的诊断价值.     

Quadruplet heterotopic pregnancy; ectopic managed successfully with laparotomy with subsequent viable intrauterine pregnancy: A case report

Heterotopic pregnancy is characterized by a concurrent intrauterine and ectopic pregnancy. It can occur after natural conception, however, it is more common with assisted reproductive techniques , when over one embryo is transferred. Quadruplet heterotopic pregnancy is an exceedingly rare subset. Our case describes a woman who presented to the emergency room with amenorrhea for 9 weeks and lower abdominal pain for 3 days. Transvaginal ultrasound revealed three alive intrauterine fetuses and one left tubal ectopic pregnancy (Quadruplet heterotopic pregnancy). Patient benefited from emergent laparotomy with favorable outcome both in the short term and in the long term. In a patient with a history of assisted reproductive techniques, a high index of suspicion is warranted towards extra-uterine pregnancy. Sonologists should precisely look for adnexal mass. The presence of peritoneal free-fluid requires further investigation. The prognosis of intrauterine fetuses is good, provided the ectopic pregnancy is managed timely and in an effective manner.     

196例宫外孕声像图分析

目的 探讨超声在宫外孕中的应用价值。材料与方法对196例经手术及病理结果证实为宫外孕的超声声像图进行回顾性分析。结果196例中术前超声检出184例，诊断符合率达93．8％；误诊12例。结论宫外孕的声像图具有特征性表现．超声的应用可大大提高临床宫外孕诊断率。     

A ruptured ectopic pregnancy in a patient with an intrauterine device: A case report

Intrauterine devices (IUDs) are used worldwide. The 2 types that are used are the levonorgestrel IUD and a copper containing IUD. This is a case study of a 30-year-old female with a levonorgestrel IUD who was diagnosed with a ruptured ectopic pregnancy in the emergency department (ED). Point-of-care urine pregnancy test and point-of-care ultrasound (POCUS) were vital in making this diagnosis and should be utilized in patients assigned female at birth who present with abdominal pain.     

Logistic回归模型对不明位置妊娠患者早期异位妊娠的预测价值

目的:初步建立预测不明位置妊娠患者(PUL)早期异位妊娠(EP)的Logistic回归模型,评价该模型的应用价值。方法:对妊娠试验阳性的受检者常规进行经阴道能量多普勒超声检查(TV-PDU),对子宫内膜形态学及内膜下血流动力学参数进行测定,联合临床、生化资料行单变量非条件Logistic回归分析,筛选出有意义的变量,在此基础上行多变量Logistic回归,对有意义的研究因素采用逐步法,经优化组合后建立预测EP的Logistic回归模型并进行模型稳定性验证。利用ROC曲线确定诊断阈值和评估各单项指标及其不同指标组合的诊断价值。结果:最终197例(28.8%)为PUL患者,184例资料完整,62例(33.7%)确诊为EP,90例(48.9%)为宫内早孕,32例(17.4%)为宫内早孕流产。多变量Logistic回归分析显示只有4种超声参数对于鉴别EP有统计学意义(P<0.001),以此而建立了三个Logistic回归模型,Youden指数分别为81.2、95.2和97.6,以内膜形态 内膜厚度 对称性 内膜下动脉血流(M3)这一指标组合最优,联合评价诊断价值最高,模型稳定性较好,其ROC曲线下面积(AUC)最大,灵敏度98.4%,特异度99.2%,阳性预测值98.4%,阴性预测值99.2%。结论:Logistic回归分析为研究子宫内膜形态学、血流动力学与EP之间的关系提供了有效的方法,TV-PDU检查早期PUL患者子宫内膜的多变量Logistic回归模型可更早期地估测EP,在临床上无创性预测早期妊娠结局的危险性是可行的。     

Sonographic differentiation between blighted ovum and early viable pregnancy

Thirty-five patients referred either for confirmation of pregnancy or because of vaginal bleeding associated with early pregnancy were examined sonographically. The sonograms were evaluated prospectively to determine whether a blighted ovum or early missed abortion could be differentiated from an early viable pregnancy lacking fetal echoes. A well defined trophoblastic reaction, continuous around the gestational sac, is a very good prognostic sign for continued viability; a sac greater than 2 cm in diameter without embryonic echoes is a poor prognostic sign. However, no sonographic features were found to be reliable in differentiating viable from nonviable pregnancy (presenting as an empty gestational sac) on a single sonographic examination. The authors recommend follow-up sonographic evaluation in 10-14 days.