| Objective1.To analyze the ultrasonography of cesarean scar pregnancy and to evaluate the diagnostic value of tomographic ultrasound imaging in the diagnosis of cesarean scar pregnancy.2.To analyze the contrast-enhanced ultrasound findings of cesarean scar pregnancy,and to summarize the contrast enhancement features of cesarean scar pregnancy.3.Using pathological results and surgical results as criteria,the value of tomographic ultrasound imaging and contrast-enhanced ultrasound and the combination of the two in the diagnosis and differential diagnosis of cesarean scar pregnancy were evaluated.MethodsSeventy-six patients wich clinically suspected cesarean scar pregnancy were selected and tomographic ultrasound imaging and contrast-enhanced ultrasonography were performed.To analyze the characteristics of transvaginal three-dimensional tomographic ultrasonography and contrast-enhanced ultrasound in cesarean scar pregnancy,and to evaluate the sensitivity and specificity of tomographic ultrasound imaging,contrast-enhanced ultrasound and tomographic ultrasound imaging and contrast-enhancedultrasound in the diagnosis of cesarean scar pregnancy.Positive predictive value,negative predictive value,false positive rate,false negative rate and accuracy.Results1.There were 56 cases of cesarean scar pregnancy in 1.76 cases,and 20 cases of non-cesarean scar pregnancy(intrauterine pregnancy)in the lower part of the uterine cavity.Transvaginal three-dimensional tomographic ultrasonography correctly diagnosed 50 cases of cesarean scar pregnancy and intrauterine pregnancy,respectively,15 cases,the error diagnosis was 6 cases,5 cases,there was a statistical difference between them(χ2= 30.456,p<0.05 The sensitivity,specificity,positive predictive value,negative predictive value,false positive rate,false negative rate and accuracy of the diagnostic cesarean scar pregnancy were 89.3%,75%,90.9%,71.4%,28.6%,9.1%,respectively.And 85.5%.Contrast-enhanced ultrasonography correctly diagnosed cesarean scar pregnancy and intrauterine pregnancy were 53 cases and 16 cases respectively.The misdiagnosis was 3 cases and 4 cases respectively.There was statistical difference between them(χ2 =43.790,p<0.05).Sensitivity,specificity,positive predictive value,negative predictive value,false positive rate,false negative rate and accuracy of cesarean scar pregnancy were 94.6%,80%,92.9%,84.2%,15.8%,7.1%and 90.7%,respectively.Tomographic ultrasound imaging and contrast-enhanced ultrasound were used to correctly diagnose 54 cases and 19 cases of cesarean scar pregnancy and intrauterine pregnancy,respectively.The error diagnosis was 2 cases and 1 case respectively.There was a statistical difference between them(χ2 = 61.605,p<0.05),its diagnostic sensitivity,specificity,positive predictive value,negative predictive value,false positive rate,false negative rate and accuracy were 96.4%,95%,98.2%,90.5%,5%,9.5,respectively.%and 96.1%.2.According to different echo performance,cesarean scar pregnancy can be divided into two types:gestational cyst type(49 cases),uneven mixed echo type(7 cases).The lesion position,pregnancy can be divided into partial cutout(38 cases)and complete cutout of pregnancy(18).3.Transvaginal three-dimensional ultrasound showed that 56 cases of cesarean scar pregnancy were located in the anterior isthmus of thelower uterus,and the uterine anterior isthmus muscle layer was unclear.33 cases of gestational sac were oval,16 cases were dumbbell-shaped or gourd-like,7 cases showed no The rules mix the echoes.38 lesions showed growth in the uterine cavity,and a small part of the lesion was wedge-shaped into the anterior isthmus incision.The partial section of the anterior isthmus was shown by tomographic ultrasound imaging.Eighteen lesions showed growth outside the uterus,protruding to the bladder,and the anterior wall of the uterus was thin.Three-dimensional color Doppler showed abundant blood flow signals around the gestational sac,44 cases were C-shaped,semi-annular and annular blood flow signals of the anterior isthmus,and 12 cases showed plexiform blood flow signals of the former isthmus.4.Ultrasonography of 49 cases of gestational sac type incision showed ring enhancement,that is,the ring around the lesion was enhanced and there was no enhancement inside.In 7 cases of uneven echogenic mass angiography,the irregular edge of the incision was highly enhanced,and 3 cases showed irregular internal enhancement and 4 cases had no enhancement inside.Ultrasound angiography of complete cesarean scar pregnancy showed that the anterior isthmus muscle layer and the villus were almost synchronously enhanced,the villus of the incision site was enhanced by "C" shape,and the villus of the posterior margin was slightly weaker.Partial incision ultrasonography showed continuous infusion and early enhancement of the anterior isthmus muscle layer and part of the villi.5.The average volume of cesarean scar pregnancy lesions was(4.51±0.64)cm3,the average distance from the anterior isthmus was(0.53±0.54)cm,and the thickness of the anterior isthmus muscle was(0.23±0.14)cm.The average time of contrast villus increased(15.87±3.74)s.The average volume of intrauterine pregnancy was 13.25114.27cm3,the average distance from the anterior isthmus was 1.38±0.65 cm,the thickness of the anterior isthmus was 0.36±0.17 cm,and the average time of contrasting villus was increased(23.60±3.44).)s.The difference between cesarean scar pregnancy and intrauterine pregnancy lesion volume,lesion and anterior isthmus incision distance,anterior isthmus muscle thickness,and contrast villus enhancement time were statistically significant(p<0.05).Themean RI of the cesarean scar pregnancy was(0.44 ± 0.43),and the mean RI of the intrauterine pregnancy was(0.45±0.42).There was no significant difference between the two(p>0.05).Conclusion:1.Transvaginal three-dimensional ultrasound can provide a more three-dimensional spatial structure than two-dimensional ultrasound.In particular,tomographic ultrasound imaging can show the subtle structure relationship between the lesion and the anterior isthmu,s,and provide more information for the diagnosis of clinical cesarean scar pregnancy.2.Contrast-enhanced ultrasonography is more sensitive to the microscopic blood flow signal of the lesion.By analyzing the contrast-enhanced ultrasound of the cesarean scar pregnancy,the diagnosis and differential diagnosis ability of the cesarean scar pregnancy can be improved.3 Cesarean scar pregnancy and intrauterine pregnancy in the anterior isthmus muscle thickness,the contrast enhancement time is significantly different.4.Tomographic ultrasound imaging and contrast-enhanced ultrasound is a better diagnostic method for cesarean scar pregnancy.Combining tomographic ultrasound imaging and contrast-enhanced ultrasound can improve the specificity and accuracy of cesarean scar pregnancy diagnosis. |
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