Kohorn E I, McCarthy S M, Taylor K J
Department of Obstetrics and Gynecology, and Diagnostic Imaging, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
J Reprod Med. 1998 Jan;43(1):14-20.
To determine whether routine imaging using grey-scale ultrasound, pulse and color Doppler flow, endovaginal ultrasound and magnetic resonance imaging (MRI) provide information that significantly helps determine therapy in patients with nonmetastatic gestational trophoblastic disease.
A literature search was performed to seek all publications in English and German that reported on investigations of imaging by ultrasound and MRI in patients with a diagnosis of trophoblastic tumor without evidence of metastases. Studies performed to make a diagnosis of hydatidiform mole were excluded. Included were studies that investigated the clinical usefulness and efficacy of these imaging methods in the diagnosis of invasive mole as a visual confirmation of the diagnosis based on human chorionic gonadotropin (hCG) and histology. Furthermore, the usefulness and efficiency of imaging in determining the effectiveness of chemotherapy were investigated.
Analysis of these reports showed that lesions are detectable by imaging modalities at relatively high levels of hCG but may not be visualized at lower levels of hCG, when chemotherapy is nevertheless indicated and the diagnosis of neoplasia is fully justified. Moreover, myometrial lesions have been observed by MRI in patients who subsequently achieved spontaneous resolution of their disease without chemotherapy. At lower levels of hCG (< 700 mIU/mL), intramyometrial lesions may not be visualized by either ultrasound or MRI. Myometrial abnormalities may persist with resolution of the tumor. Thus, the sensitivity of either method is no better than 70% and the specificity is even lower.
Weekly serial levels of serum hCG remain the most accurate, reliable and definitive arbiter of treatment management. Pelvic ultrasound or MRI need not be an integral part of pretreatment assessment. Imaging techniques are expensive yet not decisive in managing nonmetastatic trophoblastic disease. This finding applies to nonmetastatic disease only. With metastases, ultrasound, MRI and computed tomography do play an integral role in diagnosis, staging and management.
确定使用灰阶超声、脉冲和彩色多普勒血流、经阴道超声以及磁共振成像（MRI）进行的常规成像检查，是否能提供有助于显著确定非转移性妊娠滋养细胞疾病患者治疗方案的信息。
进行文献检索，查找所有以英文和德文发表的、报道了对诊断为无转移证据的滋养细胞肿瘤患者进行超声和MRI成像检查的研究。排除为诊断葡萄胎而进行的研究。纳入的研究包括调查这些成像方法在诊断侵袭性葡萄胎方面的临床实用性和有效性，作为基于人绒毛膜促性腺激素（hCG）和组织学诊断的视觉确认。此外，还研究了成像在确定化疗效果方面的实用性和效率。
对这些报告的分析表明，在hCG水平相对较高时，病变可通过成像方式检测到，但在hCG水平较低时可能无法显影，而此时仍需进行化疗且肿瘤诊断完全合理。此外，MRI观察到一些患者的子宫肌层病变随后在未进行化疗的情况下自行消退。在hCG水平较低（<700 mIU/mL）时，超声或MRI可能均无法显示子宫肌层内病变。子宫肌层异常可能会随着肿瘤消退而持续存在。因此，这两种方法的敏感性均不超过70%，特异性甚至更低。
血清hCG的每周连续水平仍然是治疗管理中最准确、可靠和决定性的仲裁指标。盆腔超声或MRI无需成为预处理评估的必要组成部分。成像技术费用高昂，在管理非转移性滋养细胞疾病方面并非决定性因素。这一发现仅适用于非转移性疾病。对于转移性疾病，超声、MRI和计算机断层扫描在诊断、分期和管理中确实发挥着不可或缺的作用。
