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Sonographic Comparison of the Tubal Ring of Ectopic Pregnancy With the Corpus Luteum

Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center (M.W.S., Z.J.R., J.H.R., M.K.), and Albert Einstein College of Medicine (L.N.), Bronx, New York USA.

Address correspondence and reprint requests to Marjorie W. Stein, MD, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 USA. E-mail: mstein17{at}aol.com.

Objective. Pregnant patients without a sonographically visible intrauterine pregnancy and with a thick-walled cystic adnexal structure present a dilemma. This study compared the utility of various sonographic features in differentiating between the tubal ring of ectopic pregnancy and the corpus luteum. Methods. Retrospective review of first-trimester transvaginal sonograms revealed a cystic adnexal structure in 79 women. Each structure was evaluated for 6 specific sonographic characteristics: echogenicity of its wall compared with that of the ovary and endometrium, wall thickness in 2 planes, color Doppler flow distribution and percentage of wall circumference, and internal texture. Results. Forty-one (52%) of the 79 women had ectopic pregnancies, and 38 (48%) had corpora lutea. Eleven (32%) of 35 ectopic walls were more echogenic than the endometrium, compared with none of the corpora lutea. A cyst wall less echogenic than the endometrium was more likely in corpora lutea (84% versus 31%; P < .0001). More than twice as many ectopic rinds were more echogenic than ovarian tissue compared with corpora lutea (76% versus 34%; P < .0001). The only predictive internal texture feature was a clear pattern, which was more common in the corpora lutea (P < .01, Fisher exact test). There was no significant difference in mural flow distribution or extent between the 2 groups. Conclusions. Ancillary sonographic signs to distinguish between an ectopic pregnancy and a corpus luteum include decreased wall echogenicity compared with the endometrium and an anechoic texture, which suggests a corpus luteum.

Key Words: color Doppler sonography • corpus luteum • ectopic pregnancy • endometrium • sonography

Abbreviations: hCG • human chorionic gonadotropin

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