经阴道及腹部超声诊断异位妊娠的对比

目的应用经阴道超声检查诊断异位妊娠,评估经阴道超声对异位妊娠的早期诊断价值. 方法 54例异位妊娠病人,均先经腹部超声检查(TAS),再经阴道超声检查(TVS)对比分析并描述了超声波特征分型. 结果根据病程的不同时期,声像图表现为3 种不同类型,据此54例患者超声诊断为异位妊娠TAS 42例,TVS 52 例,诊断符合率为TAS 77.8%、TVS 96.3%. 结论阴道超声对异位妊娠早期诊断有较高的价值,是早期异位妊娠简单、有效的首选检查方法.     

TVS、TAS在早期异位妊娠中诊断价值的对比研究

目的:探讨和比较经阴道超声检查(TVS)和经腹部超声检查(TAS)在早期异位妊娠中的诊断价值.方法:选取2020年3月至2021年3月天津市黄河医院与新疆军区总医院妇科收治的91例异位妊娠患者,患者均进行TVS和TAS两种检查,对比TVS和TAS两组检查结果.结果:TVS检查异位妊娠检出率(98.90％)高于TAS(9...     

腹部与阴道超声对宫内残留物诊断价值比较

对早期妊娠流产后不规则阴道流血患者120例分别用经阴道超声(TVS)及腹部超声(TAS)检查。超声诊断与病理诊断符合率,经TVS为118例(占98.3%),误诊2例(占1.7%),经TAS检查95例(占79.2%),误诊25例(占20.8%),二者有显著性差异(P<0.05)。TVS诊断准确率高,能发现更加微小病变,具有重要的临床价值。     

经阴道超声早期诊断异位妊娠的临床价值

目的介绍经阴道超声的诊断方法,并探讨其对早期异位妊娠的临床诊断价值。方法选取我院60例初步检查疑为异位妊娠的患者作为研究对象,随机分成对照组与研究组,各30例,对照组采用经腹部超声检查,研究组采用经阴道超声检查,比较两组确诊率。结果对照组的确诊率为73.3%,研究组为93.3%,研究组的确诊率明显高于对照组,两组数据差异均具有统计学意义（P＜0.01）。结论经阴道超声可以有效的提高早期诊断异位妊娠的准确率。     

经阴道超声对不同类型异位妊娠的诊断价值

目的 探讨经阴道超声对不同部位异位妊娠的诊断价值.方法 对150例经阴道超声检查异位妊娠患者的检查结果进行回顾分析,同时对经阴道超声对不同部位异位妊娠进行诊断过程中出现的误诊原因进行了分析.结果 150例B超检查与手术及病理诊断对照,符合142例,占94.67%,误诊8例,占5.33%.结论 异位妊娠声像图表现错综复杂,对超声表现不典型者,要结合临床病史、体征以及HCG综合分析,必要时重复检查.     

经腹部超声与经阴道超声诊断早期异位妊娠对比分析

【摘要】目的:探讨经腹部超声与经阴道超声在早期异位妊娠诊断中的临床价值。方法:对80例早期异位妊娠患者的临床资料进行统计分析,依据诊断方法分为经阴道超声组（n=40）和经腹部超声组（n=40）两组,对两组患者的诊断阳性情况、典型影像学表现检出情况进行统计分析。结果:经阴道超声组患者诊断阳性率为92.5%（37/40）,显著高于经腹部超声组的77.5%（31/40）（P<0.05）,经阴道超声组附件区团块、盆腔积液、子宫内假孕囊、胚芽反射、原始心血管搏跳检出率分别为95.0%（38/40）、92.5%（37/40）、17.5%（7/40）、22.5%（9/40）、10.0%（4/40）,均显著高于经腹部超声组的82.5%（33/40）、67.5%（27/40）、5.0%（2/40）、5.0%（2/40）、2.5%（1/40）（P<0.05）。结论:经阴道超声在早期异位妊娠诊断中的临床价值较经腹部超声高。     

经阴道超声检查对异位妊娠的诊断价值

目的 探讨经阴道超声诊断对异位妊娠的价值. 方法对68例临床疑为异位妊娠患者进行阴道超声诊断,并与病理或临床诊断作对照. 结果超声诊断为异位妊娠68例中,经手术或病理检查证实为异位妊娠65例,符合率为95%. 结论经阴道超声诊断对异位妊娠有重要的诊断价值.     

经阴道超声诊断异位妊娠756例声像图分析

目的探讨经阴道超声对异位妊娠的诊断价值。方法回顾性分析756例经阴道超声检查为异位妊娠的超声图像,找出其内在的声像图特征,所有病例均经腹腔镜或剖腹手术及病理证实。结果756例患者经阴道超声检查,正确诊断异位妊娠748例,诊断符合率达98.94%,其中输卵管妊娠743例,占98.28%。756例异位妊娠声像图中表现为子宫增大或轻度增大538例（71.1%）,子宫大小正常218例（28.83%）。内膜厚度在5～10mm604例（79.89%）,内膜厚度在10mm以上152例（20.1%）。其中80例阴道超声图像为附件区有完整胎囊型包块,60例见到卵黄囊、胎芽及心管搏动,664例在附件区探测到混合性、低回声或强回声包块。结论经阴道超声诊断异位妊娠准确率高,可作为异位妊娠早期诊断的首选方法。     

经阴道彩色多普勒像在早期诊断输卵管妊娠中的临床价值

目的探讨经阴道彩色多普勒血流显像(TV-CDFI)在早期诊断输卵管妊娠中的价值.方法对30例临床疑诊异位妊娠的病人行TV-CDFI检查并与手术病理结果对照分析.结果经阴道彩色多普勒超声诊断异位妊娠29例,宫内、外同时妊娠1例,均经病理证实,符合率100%.结论经阴道彩色多普勒超声检查对早期输卵管妊娠诊断与鉴别诊断有重要的临床价值.     

经阴道彩色多普勒像在早期诊断输卵管妊娠中的临床价值

目的 探讨经阴道彩色多普勒血流显像(TV—CDFI)在早期诊断输卵管妊娠中的价值．方法 对30例临床疑诊异位妊娠的病人行TV—CDFI检查并与手术病理结果对照分析．结果 经阴道彩色多普勒超声诊断异位妊娠29例，宫内、外同时妊娠1例，均经病理证实，符合率100％．结论 经阴道彩色多普勒超声检查对早期输卵管妊娠诊断与鉴别诊断有重要的临床价值．     

The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy

BACKGROUND: To determine the effectiveness of an initial transvaginal ultrasound scan (TVS) in the detection of ectopic pregnancy in consecutive women attending an early pregnancy unit (EPU). METHODS: This was a prospective observational study. Unselected women attending a dedicated EPU underwent a TVS. Women were classified as having an intrauterine pregnancy (IUP), ectopic pregnancy or pregnancy of unknown location (PUL). Women with a PUL were followed up until the final location of the pregnancy was determined. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) with 95% confidence intervals (CIs) for the initial TVS in the diagnosis of ectopic pregnancy were calculated. RESULTS: During a one-year study period, 5318 consecutive women attended the EPU. Outcome data were available for 5240 (98.5%) women. Of these, the initial TVS showed an IUP in 4693 (89.6%) cases and an ectopic pregnancy in 91 (1.7%) cases. The remaining 456 (8.7%) women were classified as PUL, and of these 31 (6.8%) were subsequently found to have ectopic pregnancies. The overall sensitivity of the initial TVS in the diagnosis of ectopic pregnancy was 73.9% (95% CI: 65.1-81.6) with a specificity of 99.9% (95% CI: 99.8-100), a PPV of 96.7% (95% CI: 90.7-99.3) and an NPV of 99.4% (95% CI: 99.2-99.6). CONCLUSIONS: In unselected women attending an EPU, pregnancy location can be diagnosed accurately in over 90% of all pregnancies and in 73.9% of ectopic pregnancies with a single TVS.     

经阴道与经腹部超声检查早期诊断宫颈机能不全的对照分析

目的探讨经阴道超声检查在早期诊断宫颈机能不全中的应用价值.方法对同一组(108例)习惯性流产的孕妇于中孕时分别应用经阴道与经腹部超声进行检查,并做对照分析.结果经阴道超声检查对宫颈的显示率和对宫颈机能不全的早期诊断率明显高于经腹超声检查.结论经阴道超声检查是早期诊断宫颈机能不全的一种安全、准确的方法.     

异位妊娠腹腔镜镜像与TVS表现及 血清β-HCG表达的相关性研究

目的 通过分析异位妊娠腹腔镜镜像与经阴道超声（TVS）表现及血清β-HCG的关系,探讨其之间的关联性。方法 本文采用回顾性研究,收集从2018年1月~12月广西中医药大学附属瑞康医院妇科收治住院的106例异位妊娠患者,术前常规行血清β-HCG测定及TVS诊断,并经腹腔镜手术证实,分析其镜像特征。结果 106例腹腔镜手术均成功,无一例中转开腹,腹腔镜下诊断为异位妊娠103例,并经病理确诊,腹腔镜诊断符合率为100.00%。术前最后一次阴道超声诊断符合率为97.17%,不符合者假阳性3例,误诊率2.83%,血清β-HCG表达与异位妊娠囊胚的大小、表面张力及血管扩张程度显著相关性（P＜0.01）,与子宫内膜厚度、包块内部及周围可见血流信号及与囊胚内可见卵黄囊、胚芽、心管搏动等影像学征之间存在相关关系（P＜0.05）,而与盆腔积液无关（P＞0.05）。结论 异位妊娠腹腔镜镜像与TVS表现及血清β-HCG存在内在的联系与规律性,这些规律为揭开异位妊娠发展机制和指导临床治疗提供理论支持,以提高异位妊娠的诊断率。     

The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery

BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo +/- cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.     

子宫内膜癌肌层浸润深度的阴道超声诊断

目的探讨阴道超声对子宫内膜癌的术前分期与病理诊断对照的准确性.方法术前应用经阴道超声(TVS)对54例子宫内膜癌患者进行了检查、测量子宫肌层浸润深度,并与术后组织病理学结果对照分析.结果 42例可见内膜回声,其平均厚度为14.5±5.4mm(4.8～25mm).TVS准确判断出85.2%患者的肌层浸润深度,44例患者(81.5%)的超声分期准确.多普勒显示深肌层浸润者的阻力指数和搏动指数明显低于无肌层浸润者.结论认为TVS对子宫内膜癌的术前分期和制定个体化治疗方案具有重要作用.     

Implementation of probabilistic decision rules improves the predictive values of algorithms in the diagnostic management of ectopic pregnancy.

Current algorithms for the diagnosis of ectopic pregnancy do not take into account the heterogeneity in patient profiles. Such heterogeneity can lead to differences in the pre-test probability of ectopic pregnancy. In patients with clinical symptoms, for example, the probability of presence of an ectopic pregnancy is higher than in symptom-free patients. Any additional tests should then be interpreted differently, depending on the pre-test probability. We present a diagnostic algorithm that uses probabilistic decision rules for the evaluation of women with suspected ectopic pregnancy with flexible cut-off levels for test positivity We compare it with a general algorithm that uses fixed cut-off levels. Fictitious cohorts, varying in prevalence of ectopic pregnancy were put together, using data obtained from a cohort of >800 women with suspected ectopic pregnancy. In the inflexible algorithm, ectopic pregnancy was diagnosed whenever it could be visualized at transvaginal sonography, or where serum human chorionic gonadotrophin (HCG) exceeded a rigid cut-off level; ectopic pregnancy was rejected if an intrauterine pregnancy was seen or when serum HCG decreased. In the flexible algorithm, a post-test probability was obtained after each test, using pre-test probabilities and test-based likelihood ratios. Ectopic pregnancy was diagnosed whenever the post-test probability for ectopic pregnancy exceeded 95%, whereas this diagnosis was rejected if the calculated post-test probability fell below 1%. For both algorithms, sensitivity and specificity as well as predictive values were calculated. At each prevalence, the inflexible algorithm was associated with a sensitivity of 93% and a specificity of 97%. In contrast, the sensitivity and specificity of the flexible, individualized algorithm depended on the prevalence of ectopic pregnancy. Consequently, predictive values varied strongly when the inflexible algorithm was used, whereas they were much more stable after using the flexible algorithm. For five possible valuations of false positive and false negative diagnoses, the flexible algorithm reduced the expected disutility, compared with the inflexible algorithm. It is concluded that clinicians should incorporate probabilistic decision rules in algorithms used for the diagnosis of ectopic pregnancy.     

Endovaginal sonography for the early diagnosis of intrauterine and ectopic pregnancies.

Endovaginal sonography, together with beta-HCG titre, was used to diagnose ectopic pregnancy in 58 patients. Transabdominal ultrasound failed to conclude this diagnosis. The data from endovaginal sonography revealed the presence of a gestational sac in all 15 patients with normal pregnancies at a beta-HCG level of 1042 mIU/ml. Of the 23 patients with pathological pregnancies only 61% had an intrauterine gestational sac. Only 15% of the 20 patients with ectopic pregnancies showed an increase in beta-HCG greater than 66% in 48 h, while in normal pregnancy, this increase was found in 71% of the patients. The endovaginal findings of the ectopic gestation revealed a complex adnexal mass in 55%, a cystic mass in 30% and fluid in the cul-de-sac in 20%. The diagnostic indices of adnexal and cul-de-sac sonographic findings in the ectopic group further improved specificity and positive predictive accuracy. The detection of ectopic versus intrauterine gestation showed a high sensitivity of 95%, a specificity of 100%, a positive predictability of 100% and a negative predictability of 97%. The data confirm the value and reliability of endovaginal and cul-de-sac sonography, combined with measurement of the beta-HCG level in the early diagnosis of ectopic pregnancy. This combined approach not only makes the differentiation between normal and extrauterine gestation more accurate but also helps to avoid unnecessary diagnostic laparoscopy and hospitalization.     

Chorionic Bump in First-trimester Sonography

Objectives

The present research was motivated by providing new insight into early pregnancies with a chorionic bump diagnosis in first-trimester sonography and its impact on live birth rate.

Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison

BACKGROUND: Endometriosis and possible rectal involvement are difficult to assess by physical examination. Previous studies have shown the diagnostic value of magnetic resonance imaging and rectal endoscopic sonography (RES) in this setting, but not that of transvaginal sonography (TVS). The aims of this study were to compare the accuracy of TVS and RES for the diagnosis of pelvic endometriosis, and to compare the results with histological findings. PATIENTS AND METHODS: In a prospective study, 30 consecutive patients referred with clinical signs of endometriosis underwent TVS and RES; the images were interpreted blindly with regard to physical findings. RESULTS: Endometriosis was confirmed histologically in 28 (93%) of the 30 patients. Endometriomas were also present in 67% of cases. For the diagnosis of uterosacral endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 75 and 75%, 83 and 67, 95 and 90%, and 45 and 40% respectively. For the diagnosis of rectosigmoid endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 95 and 82%, 100 and 88%, 100 and 95%, and 89 and 64% respectively. CONCLUSION: Despite the large proportion of our patients who had intestinal endometriosis, representing a possible source of bias, our results suggest that TVS is as efficient as RES for detecting posterior pelvic endometriosis and should therefore be used as the first-line examination.