Xie Meng, Zhang Xuyin, Wang Wenping, Hua Keqin
Department of Ultrasound, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
J Ultrasound Med. 2018 Feb;37(2):417-422. doi: 10.1002/jum.14348. Epub 2017 Aug 29.
The purpose of this study was to evaluate the application of ultrasound elastography in the assessment of methotrexate (MTX) treatment for tubal pregnancy and the association with the elasticity score and human chorionic gonadotropin (hCG) concentration.
A total of 73 cases of unruptured tubal pregnancy were diagnosed and treated systemically with MTX. The sonographic characters of conventional transvaginal sonography and elastography and serum hCG concentrations before and after MTX therapy were retrospectively reviewed and analyzed.
The mean elasticity score was statistically significantly lower for the ectopic tubal masses of the success group (mean ± SD, 2.58 ± 0.68) than for the failure group (3.33 ± 0.47) on day 7 (P < .001) and similar on day 0. The median elasticity score for the success group on day 7 was 3, and for the failure group, it was 4. When elasticity scores of 3 and 2 were used for the criterion of successful MTX treatment, the elastography had 94.5% sensitivity, 61.1% specificity, 88.1% positive predictive value, and 78.6% negative predictive value. Elastography of the ectopic masses and subsequent hCG concentration at 1 week after the MTX injection in the success group had a strong relationship.
Our results suggest that transvaginal elastography was a useful tool in the evaluation of tubal pregnancy after pharmacologic management.
本研究旨在评估超声弹性成像在甲氨蝶呤（MTX）治疗输卵管妊娠中的应用，以及与弹性评分和人绒毛膜促性腺激素（hCG）浓度的相关性。
共诊断出73例未破裂输卵管妊娠患者，并采用MTX进行系统治疗。回顾性分析MTX治疗前后常规经阴道超声和弹性成像的超声特征以及血清hCG浓度。
成功组异位输卵管肿块的平均弹性评分在第7天（均值±标准差，2.58±0.68）显著低于失败组（3.33±0.47）（P<0.001），第0天两组相似。成功组第7天的弹性评分中位数为3，失败组为4。以弹性评分3和2作为MTX治疗成功的标准时，弹性成像的敏感度为94.5%，特异度为61.1%，阳性预测值为88.1%，阴性预测值为78.6%。成功组中，MTX注射1周后异位肿块的弹性成像与随后的hCG浓度密切相关。
我们的结果表明，经阴道弹性成像在药物治疗后输卵管妊娠的评估中是一种有用的工具。
