Dubinsky T J, Parvey H R, Maklad N
Department of Radiology, University of Texas-Houston, LBJ General Hospital, Houston 77026, USA.
J Clin Ultrasound. 1997 Mar-Apr;25(3):103-9. doi: 10.1002/(sici)1097-0096(199703)25:3<103::aid-jcu2>3.0.co;2-k.
Visualization of an intrauterine pregnancy with transvaginal ultrasound virtually excludes an ectopic pregnancy. However, findings that might lower patients' risk for ectopic pregnancy have not been extensively investigated. We prospectively performed transvaginal color flow/image-directed Doppler imaging of the endometrium to determine the predictive value of endometrial blood flow for excluding ectopic pregnancy.
From April 1994 to August 1995, 211 consecutive women underwent transvaginal ultrasound examination to exclude an ectopic pregnancy. Color flow/image-directed Doppler imaging of the endometrium was performed on each patient. Flow was considered to be present only if a Doppler signal could be obtained with the cursor located completely within the endometrium. All Doppler imaging parameters were optimized for each patient. Resistive indices were obtained if arterial signal was present, and receiver operator characteristic curves were constructed for RI and peak systolic velocity. Findings were correlated with surgical and pathology results.
Of 211 total patients, there were 55 ectopic pregnancies (52 diagnosed for a sensitivity of 95%), 89 incomplete spontaneous abortions, 40 completed spontaneous abortions, and 27 intrauterine pregnancies. Of 55 ectopic pregnancies diagnosed with real time imaging, 9 had areas of endometrial blood flow (6 venous, 3 arterial), and 46 did not. Of the 156 patients that did not have an ectopic pregnancy, 107 had arterial blood flow within the endometrium, and 49 had no flow. Using only cases with arterial signal, the negative predictive value of endometrial blood flow for excluding an ectopic pregnancy was 97% (107/107 + 3). The optimal cutoff values (5% false-positive rate) for peak systolic velocity and refractive index (RI) were 15 cm/s and 0.55.
Arterial blood flow within the endometrium lowers the risk for ectopic pregnancy even when other findings that might indicate a high risk are present. Venous flow within the endometrium does not exclude an ectopic pregnancy.
经阴道超声检查显示宫内妊娠实际上可排除异位妊娠。然而，可能降低患者异位妊娠风险的相关发现尚未得到广泛研究。我们前瞻性地对子宫内膜进行经阴道彩色血流/图像引导的多普勒成像，以确定子宫内膜血流对排除异位妊娠的预测价值。
1994年4月至1995年8月，211例连续的女性接受经阴道超声检查以排除异位妊娠。对每位患者进行子宫内膜的彩色血流/图像引导的多普勒成像。仅当光标完全位于子宫内膜内且能获得多普勒信号时，才认为有血流。针对每位患者优化所有多普勒成像参数。若存在动脉信号，则获取阻力指数，并为阻力指数和收缩期峰值流速构建受试者工作特征曲线。研究结果与手术及病理结果进行关联分析。
在211例患者中，有55例异位妊娠（52例经诊断，敏感性为95%），89例不全流产，40例完全流产，27例宫内妊娠。在经实时成像诊断的55例异位妊娠中，9例有子宫内膜血流区域（6例为静脉血流，3例为动脉血流），46例没有。在156例没有异位妊娠的患者中，107例子宫内膜内有动脉血流，49例没有血流。仅使用有动脉信号的病例，子宫内膜血流排除异位妊娠的阴性预测值为97%（107/107 + 3）。收缩期峰值流速和阻力指数（RI）的最佳截断值（假阳性率为5%）分别为15 cm/s和0.55。
即使存在其他可能提示高风险的发现，子宫内膜内的动脉血流也会降低异位妊娠的风险。子宫内膜内的静脉血流不能排除异位妊娠。
