Abstract
BackgroundIn clinical practice it is an ongoing challenge to distinguish between angular pregnancy and interstitial pregnancy. With the three-dimensional (3D) magnetic resonance imaging (MRI) being increasingly used, it is worth exploring its role in differentiating angular pregnancy from interstitial pregnancy. This study aims to investigate how 3D MRI can help reveal the differences between these two special pregnancies in the early diagnosis.MethodsWe reviewed and analyzed the 3D MRI images of 50 patients with interstitial pregnancy and 55 patients with angular pregnancy retrospectively. Imaging features were identified to compare these two special pregnancies, and the ROC (Receiver Operating Characteristic) analysis was conducted to assess the diagnostic performance.ResultsThe significant differences of the 3D MRI imaging features between interstitial pregnancy and angular pregnancy were found in the outline of uterus cavity (p < 0.001), involvement of junctional zone (p < 0.001), the signal of surroundings (p = 0.005), the relationship with round ligament (p = 0.042), and the overlying myometrial thickness (p = 0.041). Furthermore, the multivariate logistic regression analysis identified a series of significant indicators for angular pregnancy, including the junctional zone involvement, being-surrounded by hyper/iso-intensity on 3D images, and the asymmetric outline of uterus cavity. Combining these three imaging features, the AUC (Area under the Curve) of ROC curve was 0.87 in distinguishing interstitial pregnancy from angular pregnancy.ConclusionsThis study suggests that 3D MRI can help distinguish angular pregnancy from interstitial pregnancy in clinical practice, with the advantages that conventional MRI or ultrasound does not have. Through the significant image features, 3D MRI plays an important role in improving the timing of diagnosis, avoiding unnecessary interventions, and preventing hemorrhage in clinical practice.
Highlights
In clinical practice it is an ongoing challenge to distinguish between angular pregnancy and interstitial pregnancy
We retrospectively reviewed the 3D images of angular pregnancy and interstitial pregnancy, and further investigated magnetic resonance imaging (MRI) features of the 3D images between these two conditions
We demonstrate that 3D MRI is helpful in the differential diagnosis between the interstitial and angular pregnancy
Summary
In clinical practice it is an ongoing challenge to distinguish between angular pregnancy and interstitial pregnancy. With the three-dimensional (3D) magnetic resonance imaging (MRI) being increasingly used, it is worth exploring its role in differentiating angular pregnancy from interstitial pregnancy. Due to the different causes, treatments and outcomes, timely and accurate diagnosis of angular pregnancy and interstitial pregnancy is of great significance in clinical practice. The role of MRI in diagnosing interstitial pregnancy has been described in a few case reports, but the MRI image analysis criteria has not been comprehensively addressed [1, 12,13,14,15]. The two-dimensional T2-weighted (T2W) sequence plays a significant role in EP cases in the current clinical practice, but it requires multiple planes [10, 13]. Very few studies have reported the role of 3D MRI in the EP diagnosis, especially for angular and interstitial pregnancy
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