The application of transvaginal three-dimensional ultrasound combined with TUI in the diagnosis of early ectopic pregnancy

Abstract

Objective To investigate the application value of transvaginal three-dimensional ultrasound combined with tomographic ultrasound imaging (TUI) in the diagnosis of early ectopic pregnancy. Methods One hundred and twenty patients with 4 to 6 weeks menopause were collected. All of the cases were clinical suspected of ectopic pregnancy and the surgical pathology and clinical follow-up results of each case were obtained. Both transvaginal two dimensional ultrasound imaging and three-dimensional ultrasound imaging combined with TUI technique were applied in order to make a diagnosis based on ultrasonographic characteristics for each of the case; surgical pathology and clinical follow-up results were compared with the ultrasonographic diagnosis so as to analysis and conclude the ultrasonographic imaging characteristics of cases misdiagnosed or missed diagnosed by transvaginal two-dimensional ultrasound imaging and three-dimensional ultrasound imaging joint TUI technique. Results One hundred and two cases were confirmed as ectopic pregnancy by surgical pathology and clinical follow-up results among 120 patients and eighteenth cases were confirmed as intrauterine pregnancy. Comparing surgical pathology and clinical follow-up results with the ultrasonographic diagnosis showed: (1) Ninety-two cases of tubal pregnancy: 80 cases were correctly diagnosed by transvaginal two-dimensional ultrasound imaging (86.9%, 80/92) while 84 cases by three-dimensional combined with TUI technique (91.3%, 84/92); 8 cases were missed diagnosed by both two methods; 4 cases were misdiagnosed by transvaginal two-dimensional ultrasound imaging while zero case by three-dimensional combined with TUI technique. Ultrasonographic imaging characteristics: adnexal masses presented as Donut sign which was similar to gestational-sac or masses with irregular boundary. The majority of the masses presented as clear boundaries and internal structure and had obvious margins with fallopian tube. A total 36 cases of unruptured tubal pregnancy were correctly diagnosed by the two methods while 43 cases of abortion type and 5 cases of ruptured type were correctly diagnosed. (2) Ten cases of uterine cornual pregnancy: 6 cases were correctly diagnosed by transvaginal two-dimensional ultrasound imaging (60.0%, 6/10) while 9 cases by three-dimensional ultrasound imaging joint TUI technique (90.0%, 9/10); 4 cases were misdiagnosd by transvaginal two-dimensional ultrasound imaging and 1 case by three-dimensional ultrasound imaging joint TUI technique. Ultrasonographic imaging characteristics: the gestational-sac was located in the uterine horn, 6 cases of gestational-sac was not connected with endometrium showed by transvaginal two-dimensional ultrasound imaging while 9 cases were clearly showed by three-dimensional ultrasound imaging joint TUI technique that the gestational-sac was connected with endometrium, especially in the coronal-section. The surrounding decidua circumvoluted the gestational-sac was unclear in 4 cases by transvaginal two-dimensional ultrasound imaging and in 9 cases by three-dimensional ultrasound imaging joint TUI technique. And 'interstitial line’ sign appeared in 4 cases showed by transvaginal two-dimensional ultrasound imagingwhile 6 cases by three-dimensional ultrasound imaging joint TUI technique. (3) Cases missed diagnosed and misdiagnosed: 8 cases of early ectopic pregnancy were missed diagnosed both by transvaginal two-dimensional ultrasound imaging and three-dimensional ultrasound imaging joint TUI. The reasons we concluded were as follow: 'false gestational-sac’ located in the uterine cavity; the location of the gestational-sac was so closed to uterine cavity. Four cases of tubal pregnancy and 4 cases of uterine cornual pregnancy were misdiagnosed by transvaginal two-dimensional ultrasound imaging. The location of the ectopic pregnancy mass and the gestational-sac of 7 cases of uterine cornual pregnancy were clearly showed by three-dimensional ultrasound imaging joint TUI and only 1 case was misdiagnosed. Conclusions Transvaginal three-dimensional ultrasound imaging combined with TUI technique can provide more detailed ultrasound diagnostic information and reduced missed diagnosis and misdiagnosis of the early ectopic pregnancy. The clinical application value of transvaginal three-dimensional ultrasound imaging combined with TUI technique in the diagnosis of early ectopic pregnancy was good. Key words: Ultrasonography, three-dimensional; Diagnestic imaging; Pregnancy, ectopic pregnancy