The Research Of Uterine Gestational Trophoblastic Neoplasia By Contrast-enhanced Ultrasound

ObjectiveTo (1) observe the characteristics of gestational trophoblastic neoplasia (GTN) and benign pregnancy-associated uterine disease by contrast-enhanced ultrasound (CEUS); (2) assess the clinical value of CEUS in differentiating the benign and malignant pregnancy-associated uterine disease.Material and methodsSeventy-three pregnancy-associated uterine disease cases (malignant:n=48; benign: n=25) were evaluated by contrast-enhanced ultrasound using the microbubble contrast agent SonoVue under a low mechanical index. The characteristics of enhancement were observed from five aspects including orientation, size, margin, enhancement pattern and the proportion of unenhanced area. The enhancement patterns were divided into four types:diffuse enhancement, regional enhancement, reticular enhancement and ring-like enhancement.The time-intensity curves (TIC) were created from the lesion and the normal myometrium in the same patient.ResultsSeventy-three cases include 48 gestational trophoblastic neoplasia(invasive mole: n=26; choriocarcinoma:n=21; placental site trophoblastic tumor, n=1) and 25 benign pregnancy-associated uterine disease cases (mass-type cornual pregnancy:n=11; mass-type cesarean scar pregnancy:n=5; intramural pregnancy:n=2; residual trophoblastic tissue:n=7).(1) Invasive mole:80.0% of the untreated lesions showed diffuse enhancement, 64.7% of the lesions after chemotherapy showed regional enhancement.(2) Choriocarcinoma:untreated lesions showed diffuse enhancement (50.0%) and ring-like enhancement (50.0%), the enhancement patterns had a relationship with the size of lesion. After chemotherapy,73.3% of the lesions showed ring-like enhancement. (3) Mass-type cornual pregnancy and mass-type scar pregnancy showed the ring-like enhancement (100%); intramural pregnancy showed the diffuse enhancement (50.0%) and the ring-like enhancement (50.0%); 85.7% of the residual trophoblastic tissue showed regional enhancement.(4) There are significant differences of the enhancement patterns between the benign and malignant pregnancy-associated uterine disease (P<0.05).(5) There are significant differences of the perfusion dynamic between the lesion and the normal myometrium in both of the benign and malignant pregnancy-associated uterine disease (P<0.05). The start time and the peak time of the lesions are earlier than the normal myometrium, the enhancement rate and peak intensity are greater than the normal myometrium.(6) There are not significant differences of the parameters of TIC between the benign and the malignant pregnancy-associated uterine disease (P> 0.05).(7) The size of the lesion in the CEUS is greater than the gray-scale ultrasound, especially in the malignant lesions.Conclusion(1) The enhancement patterns are different between the benign and malignant pregnancy-associated uterine diseases. CEUS is valuable for diagnosis and differentiation of these diseases.(2) There are significant differences of the perfusion dynamic between the lesion and surrounding normal myomerium, so it is helpful to distinguish the margin of the lesion.