Role Of Contrast-enhanced Real-time Gray-scale Ultrasonography And Quantitative Analysis In The Diagonosis Of Incomplete Medical Abortion

Objective: To assess the role of the second-generation contrast agent SonoVuecombined with real-time gray-scale contrast tuned imaging(CnTI) technology in diagnosing incomplete medical abortion, and the value of quantitative analysis in it.Methods: 32 patients with persistent scant vaginal bleeding for more than 14 daysafter medical abortion were underwent contrast-enhanced ultrasonography. All the patients had an endometrial mass in the sonographic findings. Before CEUS examination, both urinary HCG and serum beta-HCG were tested. The contrast-enhanced examination was performed with the Knit technology applied to the transvaginal probe and with Sonovue. The perfusion process of agent and characteristic imaging were recorded. The Contract software QontraXt was used to analyze the parameter of the ROI. All patients underwent curettage and histopathology examination of the residua after CEUS was performed. According to the histopathology result, all cases were divided into two groups: residual group and normal group. Statistical analysis was performed with a statistical package (SPSS 11.5). The t-test and nonparametric statistics exact probability were used to compare the related parameters between the two groups. The role of the new technology in the diagnosis of the incomplete medical abortion was evluated combined with the lab tests and the standard ultrasound examination.Results: In CEUS, gray scale of residual lesions were enhanced obviously in theresidual group. The contrast agent perfusion in the lesion was much more than that of uterine tissue. In the normal group, some lesions showed little perfusion of agent, and the whole uterine corpus was heterogeneously enhanced slowly in the other cases, which showed no intralesional contrast perfusion.Based on quantitative analysis, Peak (51.368) and AUC (2.318) in residual group were much higher than that of the normal group, (P<0.05) while the other parameters such as TP, Sharpness showed no statistic difference between the two groups. In the residual group, Peak (43.1),AUC (1.368) of the local uterine tissue where the residua adhered to were much higher than that of thither side(P<0.01), whereas all the parameters showed no statistic significance between the two sides in the normal group. Receiver operator characteristic curve was establish by Peak. It showed that the sensitivity (90.91%) and specificity (90%) were higher when the cut-off was 46. When urinary HCG test and ultrasound PWD examination was combined as a serial test first, and CEUS quantitative analysis as parallel test, validity of this diagnosing test could be improved significantly with a higher sensitivity (95.45%).Conclusion: CEUS could make the boundary and the shape of the lesion moreclearly. It could reveal the vascular pattern and the basement of intrauterine lesion also. Combined with HCG test and standard ultrasound examination, quantitative analysis test of CEUS shows a definitely more valuable future in diagnosing incomplete medical abortion, with its improved sensitivity and specificity.