ARTICLE REVIEW :
FOLLOWING IS A BRIEF REVIEW OF AVAILBLE
LITERATURE ON ROLE OF SONOGRAPHY IN
GESTATIONAL TROPHOBLASTIC DISEASE
B – MODE CRITERIA FOR GTD:-
1.A large mass dimension; a mass with a maximal mass dimension of
greater than 3.45 cm.
2. A thin endometrium; a maximum endometrial thickness of less than 12 mm;
3.A myometrial-based, rather than endometrial-based, mass.
A depth of myometrial invasion of greater than one third of the myometrial
thickness.
4. The presence of placental sinusoids (cystic vascular pools)
ROLE OF COLOUR DOPPLER :-
In a molar pregnancy, invasion of myometrial arteries by the
trophoblastic tissue occurs with abnormal trophoblastic proliferation.
Doppler shows high-velocity, low-impedance flow in the first
and early second trimesters
.
Typically, sonography shows abnormal
hydropic placental tissue, appearing solid and hyperechoic with cystic
components, completely filling the uterine cavity. Doppler demonstratres
low-resistance arterial flow within the myometrium and placental tissue.
When low-resistance arterial flow extends into the myometrium, invasion
is suggested. Identification of ovarian theca lutein cysts is often confirmatory
and coincides with a markedly elevated serum hCG level.
In hydatidiform mole -abnormal molar tissue is confined to the
endometrial cavity.In Invasive mole and choriocarcinoma,
soft tissue invasion and cystic vascular spaces within the
myometrium are seen. The abnormal sonographic and Doppler
findings in invasive disease resolve when chemotherapy is
successful.The greatest utility of the Doppler flow studies was in
their ability to show the presence of invasive disease and in
following disease response to chemotherapy. Cystic vascular
spaces showing low-impedance flow were seen in all cases of
INVASIVE MOLES and CHORIOCARCINOMA. Regression
of these cystic vascular masses during successful chemotherapy
followed declining hCG levels. When the depth and the width of
the myometrial invasion increase and when there is a low
diastolic/systolic ratio, the number of courses and the need
for combination of chemotherapy increase In aspect of blood
flow changes in malignant trophoblastic tumors after
chemotherapy, remitted group showed entirely disappeared
blood flow, while non-remitted group had persistent blood flow. |
