超声特征有助于识别疑似妊娠组织残留患者，这些患者可以接受非侵入性治疗：单机构经验。
Ultrasound features help identify patients who can undergo noninvasive management for suspected retained products of conception: a single institutional experience.
机构信息
Dept of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Floor 02, Room 255, Box 0628, San Francisco, CA, 94117, USA.
Dept of Obstetrics and Gynecology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94117, USA.
出版信息
Abdom Radiol (NY). 2021 Jun;46(6):2729-2739. doi: 10.1007/s00261-020-02948-y. Epub 2021 Jan 18.
OBJECTIVES
To evaluate ultrasound (US) features associated with successful noninvasive management for suspected retained products of conception (RPOC).
METHODS
In this IRB-approved retrospective study, the radiology report database was queried for pelvic US with keywords of postpartum hemorrhage (PPH) and/or RPOC over a 2-year period. Follow-up exams, US exams without clinical follow-up, suboptimal image quality, and > 1 year from delivery or pregnancy termination were excluded. Charts were reviewed for clinical presentation and management. Two radiologists reviewed images for endometrial thickness, endometrial echogenicity, endometrial vascularity, and enhanced myometrial vascularity (EMV), as well as inner myometrial peak systolic velocity (PSV) and resistive index (RI) where available. Features were assessed for associations with management approach, and test characteristics were calculated.
RESULTS
Initial query yielded 196 exams, and 48 were excluded. A total of 148 patients were included. Mean age was 34.2 years (21-47), and mean time from delivery or pregnancy termination was 40.4 days (0-223). 81 (55%) underwent noninvasive management: 72 (48%) expectant and 9 (6%) medical. 67 (45%) underwent invasive management: 60 (41%) surgical and 7 (5%) uterine artery embolization. There was substantial inter-reader agreement for assessment of EMV (K = 0.78) and endometrial vascularity (K = 0.72). Thin endometrial stripe, avascular endometrium, and absence of EMV were associated with successful noninvasive management (p < 0.05). Thin endometrium (< 10 mm) had specificity (90%), PPV (88%), and likelihood ratio (5.91) in predicting successful noninvasive management.
CONCLUSION
Endometrial thickness < 10 mm, avascular endometrium, and absence of EMV are the sonographic features associated with successful noninvasive management for PPH or suspected RPOC.
目的
评估与疑似妊娠物残留（RPOC）的成功非侵入性管理相关的超声（US）特征。
方法
在这项经过机构审查委员会批准的回顾性研究中，通过产后出血（PPH）和/或 RPOC 的关键词对放射学报告数据库进行了查询，时间跨度为 2 年。排除了随访检查、无临床随访的 US 检查、图像质量不佳以及距分娩或妊娠终止时间超过 1 年的病例。对图表进行了回顾，以评估临床表现和管理情况。两位放射科医生对子宫内膜厚度、子宫内膜回声、子宫内膜血管化以及增强的子宫肌层血管化（EMV）进行了评估，以及可获取的内子宫肌层收缩期峰值速度（PSV）和阻力指数（RI）。对这些特征与管理方法的相关性进行了评估，并计算了检验特征。
结果
最初的查询结果为 196 项检查，其中 48 项被排除。共纳入 148 名患者。平均年龄为 34.2 岁（21-47 岁），距分娩或妊娠终止的平均时间为 40.4 天（0-223 天）。81 例（55%）接受了非侵入性管理：72 例（48%）期待治疗，9 例（6%）药物治疗。67 例（45%）接受了侵入性管理：60 例（41%）手术治疗，7 例（5%）子宫动脉栓塞术。对于 EMV（K=0.78）和子宫内膜血管化（K=0.72）的评估，两位放射科医生之间存在较高的一致性。薄的子宫内膜带、无血管化的子宫内膜以及不存在 EMV 与成功的非侵入性管理相关（p<0.05）。子宫内膜厚度<10mm 预测成功非侵入性管理的特异性为 90%，阳性预测值（PPV）为 88%，似然比（LR）为 5.91。
结论
子宫内膜厚度<10mm、无血管化的子宫内膜以及不存在 EMV 是与 PPH 或疑似 RPOC 的成功非侵入性管理相关的超声特征。
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