部分性与完全性葡萄胎妊娠的超声诊断：重新评估
Sonographic diagnosis of partial versus complete molar pregnancy: A reappraisal.
作者信息
Savage Julia L, Maturen Katherine E, Mowers Erika L, Pasque Katherine B, Wasnik Ashish P, Dalton Vanessa K, Bell Jason D
机构信息
Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109.
Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109.
出版信息
J Clin Ultrasound. 2017 Feb;45(2):72-78. doi: 10.1002/jcu.22410. Epub 2016 Oct 3.
PURPOSE
To assess the prospective sonographic diagnosis of molar pregnancy and compare sonographic features of complete versus partial molar pregnancy.
METHODS
This institutional review board--approved retrospective chart review conducted between 2001 and 2011 identified 70 women with a histopathologic diagnosis of molar pregnancy and with available sonograms. Clinical data, images, and reports were reviewed, and features enumerated by radiologists blinded to the final diagnosis.
RESULTS
Mean age of patients was 30.5 ± 7.0 (SD) years (range, 16-49 years) with a mean gravidity of 3.2 ± 2.3 (SD) (range 1-11). Mean gestational age was 74.0 ± 19.1 day (range 39-138) and serum β-human chorionic gonadotropin was 131 ± 156 mIU/ml (range 447-662,000). Pathologic results showed 48 partial and 22 complete molar pregnancies. Sonographically, partial moles more commonly showed a yolk sac (56.3% versus 0%, p < 0.0001), fetal pole (62.5% versus 4.6%, p < 0.0001), fine septa within the sac (25.0% versus 4.6%, p = 0.05), and normal (31.3% versus 0%, p = 0.002) or minimally cystic placenta (27.1% versus 4.6%, p = 0.49), while complete moles had larger gestational sacs (612 versus 44 mm, p = 0.005), were more often avascular on color Doppler imaging (45.5% versus 18.8%, p = 0.02), had more often abnormal tissue in the uterus (82.6% versus 20.8%, p < 0.0001) and placental masses (86.9% versus 16.7%, p < 0.0001), and were more often diagnosed prospectively (86.4% versus 41.7%, p = 0.0005).
CONCLUSIONS
Complete molar pregnancy is associated with marked cystic changes and mass formation and is often diagnosed sonographically. Partial molar pregnancy often presents with minor cystic changes of the placenta and remains underdiagnosed sonographically. However, correct prospective diagnosis was made more frequently in this study than in older reports, perhaps due to improved spatial resolution of sonographic equipment. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:72-78, 2017.
目的
评估葡萄胎妊娠的超声前瞻性诊断，并比较完全性与部分性葡萄胎妊娠的超声特征。
方法
本机构审查委员会批准的回顾性病历审查在2001年至2011年间进行，确定了70例经组织病理学诊断为葡萄胎妊娠且有可用超声图像的女性。回顾临床数据、图像和报告，由对最终诊断不知情的放射科医生列举特征。
结果
患者的平均年龄为30.5±7.0（标准差）岁（范围16 - 49岁），平均妊娠次数为3.2±2.3（标准差）（范围1 - 11次）。平均孕周为74.0±19.1天（范围39 - 138天），血清β-人绒毛膜促性腺激素为131±156 mIU/ml（范围447 - 662,000）。病理结果显示48例部分性葡萄胎和22例完全性葡萄胎。超声检查中，部分性葡萄胎更常见有卵黄囊（56.3%对0%，p<0.0001）、胎芽（62.5%对4.6%，p<0.0001）、囊内细隔（25.0%对4.6%，p = 0.05），以及正常（31.3%对0%，p = 0.002）或轻度囊性胎盘（27.1%对4.6%，p = 0.49），而完全性葡萄胎有更大的妊娠囊（612对44 mm，p = 0.005），在彩色多普勒成像上更常表现为无血管（45.5%对18.8%，p = 0.02），子宫内更常出现异常组织（82.6%对20.8%，p<0.0001）和胎盘肿块（86.9%对16.7%，p<0.0001），且更常被前瞻性诊断（86.4%对41.7%，p = 0.0005）。
结论
完全性葡萄胎妊娠与明显的囊性改变和肿块形成相关，常通过超声诊断。部分性葡萄胎妊娠常表现为胎盘的轻微囊性改变，在超声检查中仍诊断不足。然而，本研究中正确的前瞻性诊断比以往报告更频繁，可能是由于超声设备空间分辨率的提高。©2016威利期刊公司。《临床超声杂志》45:72 - 78，2017年。
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