Li Haiying, Liu Xinxiu, Xie Lijun, Ye Zhen, Gan Ling
Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
Department of Medical Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:117-122. doi: 10.1016/j.ejogrb.2020.01.036. Epub 2020 Jan 27.
To investigate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) and to search for cut-offs in caesarean scar pregnancy (CSP) patients for making quantitative diagnoses.
Thirty patients in the first trimester of pregnancy were enrolled in our study. They were suspected as being at risk of caesarean scar pregnancy by conventional ultrasound and insisted on abortions. Transvaginal ultrasonography (TVU) and CEUS were performed, and parameters were analysed on the time-intensity curve (TIC). Laparotomy, laparoscopy, hysteroscopy or curettage under the guidance of ultrasound were performed, and pathological finding of villi in the uterine scar is the gold standard for a diagnosis of CSP. The area under the receiver operating characteristic (ROC) curve (AUC) was used to estimate the probability of the correct prediction of CSP.
CSP was diagnosed in 27 patients: pathological diagnosis revealed villus tissue in the scar. The peak intensity ratios of caesarean scar to myometrium have the overall best diagnostic performances (AUC: 0.877, 95 % CI: 0.74-1.00). Using a cut-off value of 1.08 for the peak intensity ratio of caesarean scar to myometrium, the diagnosis sensitivity, specificity, PPV and NPV for CSP were 77.8, 100, 100, and 81.8 %, respectively.
CEUS offers good diagnostic performance, and the peak intensity ratio of caesarean scar to myometrium can be used as a quantitative index to diagnose CSP accurately.
探讨超声造影（CEUS）的诊断准确性，并寻找剖宫产瘢痕妊娠（CSP）患者进行定量诊断的临界值。
本研究纳入了30例妊娠早期患者。她们经传统超声检查怀疑有剖宫产瘢痕妊娠风险，并坚持要求终止妊娠。进行了经阴道超声检查（TVU）和CEUS，并在时间-强度曲线（TIC）上分析参数。在超声引导下进行剖腹手术、腹腔镜检查、宫腔镜检查或刮宫术，子宫瘢痕处绒毛的病理发现是诊断CSP的金标准。采用受试者操作特征（ROC）曲线下面积（AUC）来估计正确预测CSP的概率。
27例患者被诊断为CSP：病理诊断显示瘢痕处有绒毛组织。剖宫产瘢痕与子宫肌层的峰值强度比具有总体最佳的诊断性能（AUC：0.877，95%CI：0.74 - 1.00）。以剖宫产瘢痕与子宫肌层的峰值强度比为1.08作为临界值，CSP的诊断敏感性、特异性、阳性预测值和阴性预测值分别为77.8%、100%、100%和81.8%。
CEUS具有良好的诊断性能，剖宫产瘢痕与子宫肌层的峰值强度比可作为准确诊断CSP的定量指标。
