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Transvaginal Ultrasound and Contrast-enhanced Ultrasound for Diagnosis of Cesarean Scar PregnancyObjective: To investigate the significance of transvaginal ultrasound(TVS)and contrast-enhanced ultrasound(CEUS)on diagnosis of cesarean scar pregnancy(CSP).Methods: TVS and CEUS were carried out on 106 cases suspected of CSP lesions near lower segment of uterine body by abdominal ultrasound.The results of TVS and CEUS were completely collected.All patients should sign Informed Consent and Study Informed Consent prior to angiography.TVS was performed firstly to explore the relationships among uterus,bilateral adnexas of uterus,pelvic and peritoneal cavities.For the lesions suspected of CSP at lower segment of uterine body,it should observe their sizes and morphologies,whether protruding outside the capsule,and surrounding color Doppler flow imaging(CDFI)signals.C5-9 probe and imaging conditions of CSP were selected;frequency was set at 8MHz and mechanical index(MI)at 0.08.Bolus injection of 1.2ml Sono Vue was given through median cubital vein.The tube was flushed with 5ml normal saline.The whole process of CEUS was recorded in real time,the imaging models of lesion were continuously observed for 2-3 minutes,and the whole imaging process was stored on the hard disk.Two associate senior and above physicians were appointed to analyze the collected imaging figures of 2D ultrasound and CEUS for diagnosis,and the final results were subject to the pathological report,which served as golden standard.Results: The study collected 94 CSP patients and 12 non-CSP patients.A total of 88 cases were diagnosed with CSP by TVS(88/94)and 4 cases with non-CSP by TVS(4/12).The accuracy was 86.79%,sensitivity 93.61%,specificity 33.33%,positive predictive value 91.67%,negative predictive value 40.00% and YI 0.269 by TVS.A total of 92 cases were diagnosed with CSP by CEUS(92/94)and 4 cases with non-CSP by CEUS(8/12).The accuracy was 94.34%,sensitivity 97.87%,specificity 66.67%,positive predictive value 95.83%,negative predictive value 80.00% and YI 0.269 by CEUS.Statistical analysis showed statistical difference between lesion morphology(?2=23.128,p<0.001)and the diagnosis of CSP(p<0.05),but no statistical difference was found for the relationship of whether the lesion protruding out of envelope(p=0.163>0.05),Whether imaging model presenting as “Donut”(p=0.700>0.05)and the degree of CDFI blood flow signals(p=0.693>0.05)with CSP.Conclusion:(1)CEUS is superior to TVS in the diagnosis of CSP;(2)CEUS have directive significance on the identification of CSP,intrauterine pregnancy,incomplete abortion,missed abortion,inevitable abortion and cervical pregnancy.Part ? Pre-evaluation Research on Massive Hemorrhage during the Surgery of Scar Pregnancy by Transvaginal Ultrasound and Contrast-enhanced UltrasoundObjective: To discuss the clinical significance of transvaginal ultrasound(TVS)and contrast-enhanced ultrasound(CEUS)on predicting massive hemorrhage during surgery of cesarean scar pregnancy(CSP).Methods: A total of 88 cases,who was admitted to Sichuan Provincial People's Hospital for treatment of CSP from January 2015 to December 2017,was enrolled in the study.All patients received TVS and CEUS before surgery and were confirmed with CSP by postoperative pathology.All clinical data and ultrasonic information were collected.All patients were divided into two groups according to the volume of intra-operative blood loss(?400ml;<400ml).The comparison was done on age,minimum distance from chorion of lesion to serosal layer before imaging,minimum distance from chorion of lesion to serosal layer after imaging,thickness of chorion frondosum of lesion after imaging,maximum diameter of lesion after imaging(including chorion),mean diameter of lesion protruding into incision after imaging,times of cesarean section and the time since the last cesarean section(calculate as a year if the time less than a year)between the two groups.Analysis steps:(1)Analyze the correlation between ultrasound data and intra-operative bleeding;(2)Factors affecting intra-operative hemorrhage with univariate analysis;(3)Factors affecting intra-operative hemorrhage with multivariate analysis;(4)Establish Logistic regression model after nonlinear multivariate analysis;(5)Evaluate the risk of massive hemorrhage during CSP surgery with the area under ROC curve.Results:(1)No statistical difference was found in age(P=0.854>0.05)or the time since the last cesarean section(P=0.823>0.05)between the patient having massive hemorrhage or not.(2)Univariate analysis showed that minimum distance from chorion of lesion to serosal layer before imaging correlated with amount of bleeding during surgery(P=0.01<0.05),but it cannot be the independent influencing factor in multiple regression model by multivariate Logistic stepwise regression analysis;(3)Univariate analysis showed statistical differences in correlation of minimum distance from chorion of lesion to serosal layer after imaging(P<0.001),thickness of chorion frondosum of lesion after imaging(P<0.001),mean diameter of lesion protruding into incision after imaging(P<0.001)and times of cesarean section(P<0.001)with amount of bleeding during surgery,and above indexes can be regarded as independent influencing factors to establish multiple regression model.Logit(P)=-7.192-14.135(minimum distance from chorion of lesion to serosal layer after imaging)+2.566(thickness of chorion frondosum of lesion after imaging)+0.867(mean diameter of lesion protruding into incision after imaging)+ 2.436(times of cesarean section);(4)The closer the distance from chorion of lesion to serosal layer after imaging,the thicker the thickness of chorion frondosum of lesion after imaging,the larger the mean diameter of lesion protruding into incision after imaging and the more the times of cesarean section,the higher risk of massive hemorrhage during surgery.Conclusion: TVS and CEUS can provide risk factors for massive hemorrhage during CSP surgery and assist the choice of clinical surgical methods of CSP. |
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