Early diagnosis of ectopic pregnancy using modern medical imaging techniques: prospective study

Abstract

INTRODUCTION: The algorithm for diagnosing ectopic pregnancy (EP), including b-chorionic gonadotropin in the blood and ultrasound of the pelvic organs, does not allow detecting its localization in the next 7 days after treatment in 10% of women.OBJECTIVE: Тo improve the algorithm of diagnostics of EP by correcting the ultrasound protocol, as well as adding MRI studies.MATERIALS AND METHODS: 290 patients with suspected EP, of which 278 were operated on. Women were divided according to menstrual delay: up to 6 weeks (Group 1, n=119), 6–9 weeks (Group 2, n=135), more than 9 weeks (Group 3, n=36). Ultrasound studies were performed in dynamics up to 144 hours on the VOLUSON-730 expert (GE); MR studies — on a 1.5T tomograph «Magnetom Avanto» (Siemens). Statistics: Statistical analysis of the study results was performed using the Statistica for Windows 10.0 software package (StatSoft, Inc., USA).RESULTS: Ultrasound symptoms of EP: group 1 (n=94) — ectopic fetal egg (EPO) and tubal ring (TC) 5 times more often than hematosalpinx (HS) and heterogeneous adnexal formation (NPO) (χ12=14.28; p=0.0002 and χ22=13.75, р=0.0003); 2 (n=116) — EPO and TC 3 times more often than GS (χ121=4.8; р12=0.028 and χ222=8.1; р22=0.004) and NPO (χ12=6.65; р1=0.009 and χ22=10.4; р2=0.001); 3 (n=31) — TC and NPO more often than EPO (χ12=8.00; p1=0.004; χ22=14.28; p2=0.0002). Ultrasound is not informative: group 1 — more than half of the cases; 2 — 24.5%; 3 — 65% of cases. In pregnancies of unknown location (PUL, n=30), MR patterns of EP were studied : in 1⁄3 of cases, progressive early EP was found, in 1⁄3 — undilated fallopian tubes, and in 1⁄3 of cases of HS. Sensitivity of ultrasound in relation to EP: group 1 — 42%; 2 — 76.5%; 3 — 35%; it depends on the period of menstrual delay (r=0.507, p=0.01).DISCUSSION: In PUL, MRI is indicated for all patients who have a menstrual delay of more than 6 weeks, regardless of the level of b-HCG in their blood, and with a menstrual delay of up to 6 weeks, only if the increase in b-HCG in the blood is less than 50% of physiological values.CONCLUSION: The inclusion of MRI in the algorithm for diagnosing EP increases its sensitivity and specificity to almost 100%, regardless of the period of menstrual delay.