Phillips Catherine H, Benson Carol B, Durfee Sara M, Heller Howard T, Doubilet Peter M
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Radiology, Memorial Healthcare System, Hollywood, Florida, USA.
J Ultrasound Med. 2020 Aug;39(8):1547-1551. doi: 10.1002/jum.15243. Epub 2020 Feb 11.
To determine whether an intrauterine round or oval fluid collection ("saclike structure") can prove to be either an intrauterine pregnancy or intrauterine fluid in conjunction with an ectopic pregnancy (sometimes termed "pseudogestational sac") and whether ultrasound features, including the presence or absence of an echogenic rim, "double sac sign" (DSS), or "intradecidual sign" (IDS), are helpful for establishing the diagnosis or predicting the prognosis.
We identified all sonograms obtained from women with positive serum human chorionic gonadotropin results at our institution between January 1, 2012, and June 30, 2018, meeting the following criteria: presence of an intrauterine saclike structure without a yolk sac or embryo; no extraovarian adnexal mass; and follow-up information identifying the location of the pregnancy as intrauterine or ectopic. Study authors reviewed sonograms in all cases and recorded the following information: presence or absence of each of an echogenic rim around the collection, a DSS, and an IDS, as well as the mean sac diameter. The indications for the initial ultrasound examinations were recorded.
A total of 649 sonograms met the inclusion criteria. Of these, 598 fluid collections showed an echogenic rim, 182 a DSS, and 347 an IDS (findings not mutually exclusive). In all 649 cases, a subsequent sonogram or other clinical follow-up confirmed that the patient had an intrauterine pregnancy. That is, none of the fluid collections proved to be a pseudogestational sac. In total, 41.2% were live at the end of the first trimester, and 58.8% miscarried. The prognosis was better in cases with, compared to without, an IDS (P = .01, χ ), but no ultrasound feature was clinically useful for ruling in or excluding a good prognosis.
In a woman with positive human chorionic gonadotropin results and no extraovarian adnexal mass, the ultrasound finding of an intrauterine saclike structure is virtually certain to be a gestational sac. Ultrasound features of the structure are of no diagnostic or clinically useful prognostic value. Concepts introduced 30 to 40 years ago when ultrasound equipment had far lower resolution than currently, including a DDS, an IDS, and a pseudogestational sac, have no role today in assessing early pregnancy.
确定子宫内圆形或椭圆形液性暗区（“囊样结构”）是否可证实为宫内妊娠或与异位妊娠并存的宫内积液（有时称为“假妊娠囊”），以及超声特征，包括有无回声晕、“双囊征”（DSS）或“蜕膜内征”（IDS），是否有助于确立诊断或预测预后。
我们识别了2012年1月1日至2018年6月30日期间在本机构获得的所有血清人绒毛膜促性腺激素结果呈阳性的女性的超声图像，这些图像符合以下标准：子宫内存在囊样结构但无卵黄囊或胚胎；无卵巢外附件包块；以及有随访信息确定妊娠部位为宫内或异位。研究作者回顾了所有病例的超声图像并记录了以下信息：液性暗区周围有无回声晕、DSS和IDS，以及囊的平均直径。记录了首次超声检查的指征。
共有649幅超声图像符合纳入标准。其中，598个液性暗区显示有回声晕，182个有DSS，347个有IDS（这些发现并非相互排斥）。在所有649例病例中，随后的超声检查或其他临床随访证实患者为宫内妊娠。也就是说，没有一个液性暗区被证明是假妊娠囊。总的来说，41.2%在孕早期结束时存活，58.8%发生流产。与无IDS的病例相比，有IDS的病例预后更好（P = .01，χ），但没有超声特征在临床上有助于判断预后良好或排除预后良好。
对于人绒毛膜促性腺激素结果呈阳性且无卵巢外附件包块的女性，子宫内囊样结构的超声表现几乎肯定是妊娠囊。该结构的超声特征无诊断价值或临床有用的预后价值。30至40年前引入的概念，当时超声设备的分辨率远低于目前，包括双囊征、蜕膜内征和假妊娠囊，如今在评估早期妊娠中已无作用。
