Blaivas Michael, Lyon Matthew
Department of Emergency Ultrasound, Medical College of Georgia, 1120 15th St, AF-2056, Augusta, GA 30912-4007, USA.
J Ultrasound Med. 2005 May;24(5):599-603; quiz 605. doi: 10.7863/jum.2005.24.5.599.
The purpose of this study was to evaluate the utility of paraovarian pelvic mass mobility as an indicator of mass identity, corpus luteum versus other, in ruling out ectopic pregnancy.
This was a retrospective study of all pelvic sonographic examinations on patients with first-trimester complications seen over an 18-month period at a large urban emergency department. All pregnant patients with signs or symptoms of concern for ectopic pregnancy were scanned to evaluate for intrauterine pregnancy. Masses suggestive of either a corpus luteum or an ectopic pregnancy were separated from the ovary with abdominal palpation and endovaginal transducer movement. The ultrasound director and assistant director reviewed videos of all scans. Results of mass separation and outcome were recorded. Independent movement of a mass and ovary was defined as movement of the mass away from the ovary, sliding past the ovary or rotation past the ovary. Statistical analysis included descriptive statistics, inter-rater reliability, the Fisher exact test, and sensitivity, specificity, and negative and positive predictive values.
A total of 78 patient scans fit the criteria, and in 27 of them, the mass separated from the ovary. Twenty-three patients had ectopic pregnancy as the final diagnosis, and in 2 of these, no independent mass movement occurred. Lack of independent movement of the mass and ovary was significantly more common in patients without a final diagnosis of ectopic pregnancy (P < .0001). The negative predictive value was 96.1%.
Lack of independent movement of an adjacent mass and ovary was strongly associated with absence of ectopic pregnancy.
本研究旨在评估卵巢旁盆腔肿块的活动度作为判断肿块性质（黄体与其他肿块）以排除异位妊娠指标的效用。
这是一项对一家大型城市急诊科18个月内就诊的有孕早期并发症患者进行的所有盆腔超声检查的回顾性研究。对所有有异位妊娠相关体征或症状的孕妇进行扫描，以评估宫内妊娠情况。通过腹部触诊和经阴道探头移动，将疑似黄体或异位妊娠的肿块与卵巢分离。超声主任和副主任审查了所有扫描的视频。记录肿块分离结果和结局。肿块与卵巢的独立移动定义为肿块远离卵巢、滑过卵巢或绕过卵巢旋转。统计分析包括描述性统计、评分者间信度、Fisher精确检验以及敏感度、特异度、阴性预测值和阳性预测值。
共有78例患者的扫描符合标准，其中27例肿块与卵巢分离。23例患者最终诊断为异位妊娠，其中2例未出现肿块的独立移动。在最终未诊断为异位妊娠的患者中，肿块与卵巢缺乏独立移动的情况明显更为常见（P < .0001）。阴性预测值为96.1%。
相邻肿块与卵巢缺乏独立移动与无异位妊娠密切相关。
