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Sonographic and Doppler Imaging in the Diagnosis and Treatment of Gestational Trophoblastic Disease

A 12-Year Experience

Second Hospital of Xi’an Jiaotong University, Xi’an, China (Q.Z., X.-Y.L.); Xi’an Central Hospital, Xi’an, China (Q.X.); and Bay Imaging Consultants Medical Group and Alta Bates-Summitt Medical Center, Oakland, California USA (J.D.C.).

Address correspondence and reprint requests to Jim D. Cardoza, MD, Bay Imaging Consultants Medical Group, 5730 Telegraph Ave, Oakland, CA 94609 USA.

Objective. To evaluate the clinical utility of sonography with Doppler examination in the diagnosis and treatment of gestational trophoblastic disease (GTD). Methods. A retrospective analysis of 355 cases of GTD seen over a 12-year period in 2 large university referral hospitals in China was performed. Clinical appearances, sonographic findings, Doppler waveforms, and patient outcomes were reviewed. Sonographic and Doppler examinations were performed to diagnose the presence of molar tissue, detect invasive disease, assess disease recurrence, and monitor the efficacy of chemotherapy. Doppler waveforms of 13 patients with normal early pregnancies were also examined for comparison. Results. Of the 355 patients with GTD, 106 had a classic hydatidiform mole (CHM), 33 had a partial hydatidiform mole (PHM), 184 had an invasive hydatidiform mole (IHM), and 32 had choriocarcinoma. Sonography showed abnormal molar tissue confined to the endometrial cavity in all cases of CHM. In cases of IHM and choriocarcinoma, soft tissue invasion and cystic vascular spaces within the myometrium were shown. Cases of PHM had a thickened, hydropic placenta with a concomitant fetus. Doppler waveforms showed resistive indices of 0.55 (SD, 0.06) for CHM, 0.56 (SD, 0.04) for PHM, 0.28 (SD, 0.06) for IHM, 0.25 (SD, 0.05) for choriocarcinoma, and 0.66 (SD, 0.04) for normal pregnancies. The abnormal sonographic and Doppler findings in invasive disease resolved when chemotherapy was successful. Conclusions. Sonography and Doppler imaging were helpful in diagnosing GTD, in determining whether invasive disease was present, in detecting recurrence of disease, and in following the effectiveness of chemotherapy.

Key Words: choriocarcinoma • Doppler sonography • gestational trophoblastic disease • hydatidiform mole

Abbreviations: CHM, classic hydatidiform mole • GTD, gestational trophoblastic disease • hCG, human chorionic gonadotropin • IHM, invasive hydatidiform mole • PHM, partial hydatidiform mole • PSTT, placental site trophoblastic tumor

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