Abstract：
BACKGROUND: The pregnancy outcomes in women with surgery-categorized upper-lateral intracavitary pregnancy (ULIP), previously named angular pregnancy, demonstrate higher heterogeneity than in women with ultrasonography-categorized ULIP. We aimed to use preoperative MRI and correlated clinical characteristics to explore whether the surgery-categorized ULIP comprises obstetric conditions undefined by the current ultrasonography-based diagnostic criteria.
METHODS: This retrospective study involved 28 women with surgically and pathologically confirmed ULIP from January 2016 to July 2022. Two board-certified radiologists, blinded to the patients\' information, independently reviewed the MRI images, and determined each MRI feature, including endometrial thickness (EMT) and peri-gestational sac (GS) endometrial interruption. Disagreements were resolved by discussion to achieve a consensus. Based on the cutoff value of EMT (11.5 mm), the patients were divided into above-cutoff EMT (n = 22) and below-cutoff EMT (n = 6) groups.
RESULTS: Two subtypes of surgery-categorized ULIP were identified. Type-I ULIP (n = 22; EMT ≥ 11.5 mm), when compared to the type-II ULIP (n = 6; EMT < 11.5 mm), demonstrated lower incidence of peri-GS endometrial interruption (2/22 [9.1%] vs 6/6 [100%]; P = 0.001), higher logarithmic ß-human chorionic gonadotropin (ß-hCG) concentration (4.7 ± 0.4 mIU/ml vs 4.2 ± 0.6 mIU/ml; P = 0.026), lower rate of repeated dilatation and curettage (1/22 [4.6%] vs 4/6 [66.7%]; P = 0.003), less intraoperative blood loss (10.1 ± 6.3 ml vs 28.3 ± 18.3 ml; P = 0.001), and shorter hospital stay (2.8 ± 1.7 days vs 7.5 ± 3.8 days; P = 0.001). The peri-GS endometrial interruption negatively correlated with EMT (Odds ratio [OR] = 0.55; P = 0.001) and logarithmic ß-hCG concentration (OR = 0.08; P = 0.045). The below-cutoff EMT negatively correlated with ß-hCG concentration (OR = 0.06; P = 0.021).
CONCLUSIONS: Surgery-categorized ULIP comprised two obstetric conditions among which the type-II ULIP, possessing unique imaging features undocumented in the literature, requires further attention during clinical practice.
METHODS: This retrospective study involved 28 women with surgically and pathologically confirmed ULIP from January 2016 to July 2022. Two board-certified radiologists, blinded to the patients\' information, independently reviewed the MRI images, and determined each MRI feature, including endometrial thickness (EMT) and peri-gestational sac (GS) endometrial interruption. Disagreements were resolved by discussion to achieve a consensus. Based on the cutoff value of EMT (11.5 mm), the patients were divided into above-cutoff EMT (n = 22) and below-cutoff EMT (n = 6) groups.
RESULTS: Two subtypes of surgery-categorized ULIP were identified. Type-I ULIP (n = 22; EMT ≥ 11.5 mm), when compared to the type-II ULIP (n = 6; EMT < 11.5 mm), demonstrated lower incidence of peri-GS endometrial interruption (2/22 [9.1%] vs 6/6 [100%]; P = 0.001), higher logarithmic ß-human chorionic gonadotropin (ß-hCG) concentration (4.7 ± 0.4 mIU/ml vs 4.2 ± 0.6 mIU/ml; P = 0.026), lower rate of repeated dilatation and curettage (1/22 [4.6%] vs 4/6 [66.7%]; P = 0.003), less intraoperative blood loss (10.1 ± 6.3 ml vs 28.3 ± 18.3 ml; P = 0.001), and shorter hospital stay (2.8 ± 1.7 days vs 7.5 ± 3.8 days; P = 0.001). The peri-GS endometrial interruption negatively correlated with EMT (Odds ratio [OR] = 0.55; P = 0.001) and logarithmic ß-hCG concentration (OR = 0.08; P = 0.045). The below-cutoff EMT negatively correlated with ß-hCG concentration (OR = 0.06; P = 0.021).
CONCLUSIONS: Surgery-categorized ULIP comprised two obstetric conditions among which the type-II ULIP, possessing unique imaging features undocumented in the literature, requires further attention during clinical practice.
摘要：
背景：手术分类的上外侧腔内妊娠（ULIP）妇女的妊娠结局，以前称为角孕，与超声分类的ULIP女性相比，异质性更高。我们旨在使用术前MRI和相关临床特征来探索手术分类的ULIP是否包含当前基于超声检查的诊断标准未定义的产科条件。
方法：这项回顾性研究涉及2016年1月至2022年7月28例经手术和病理证实为ULIP的女性。两名经过董事会认证的放射科医生,对病人的信息视而不见，独立审查MRI图像，并确定了每个MRI特征，包括子宫内膜厚度（EMT）和孕周囊（GS）子宫内膜中断。通过讨论达成共识解决了分歧。根据EMT的截止值（11.5mm），将患者分为高于临界值的EMT组(n=22)和低于临界值的EMT组(n=6).
结果：确定了两种手术分类的ULIP亚型。I型ULIP(n=22;EMT≥11.5mm),与II型ULIP（n=6；EMT<11.5mm）相比，显示出围GS子宫内膜中断的发生率较低（2/22[9.1％]vs6/6[100％]；P=0.001），较高的对数β-人绒毛膜促性腺激素（β-hCG）浓度（4.7±0.4mIU/mlvs4.2±0.6mIU/ml；P=0.026），反复扩张和刮治率较低(1/22[4.6%]vs4/6[66.7%];P=0.003),术中出血量少（10.1±6.3mlvs28.3±18.3ml；P=0.001），住院时间较短（2.8±1.7天比7.5±3.8天；P=0.001）。周围GS子宫内膜中断与EMT（比值比[OR]=0.55；P=0.001）和对数β-hCG浓度（OR=0.08；P=0.045）呈负相关。低于临界值的EMT与β-hCG浓度呈负相关(OR=0.06;P=0.021)。
结论：手术分类的ULIP包括两种产科疾病，其中II型ULIP，具有文献中没有记载的独特成像特征，在临床实践中需要进一步关注。
方法：这项回顾性研究涉及2016年1月至2022年7月28例经手术和病理证实为ULIP的女性。两名经过董事会认证的放射科医生,对病人的信息视而不见，独立审查MRI图像，并确定了每个MRI特征，包括子宫内膜厚度（EMT）和孕周囊（GS）子宫内膜中断。通过讨论达成共识解决了分歧。根据EMT的截止值（11.5mm），将患者分为高于临界值的EMT组(n=22)和低于临界值的EMT组(n=6).
结果：确定了两种手术分类的ULIP亚型。I型ULIP(n=22;EMT≥11.5mm),与II型ULIP（n=6；EMT<11.5mm）相比，显示出围GS子宫内膜中断的发生率较低（2/22[9.1％]vs6/6[100％]；P=0.001），较高的对数β-人绒毛膜促性腺激素（β-hCG）浓度（4.7±0.4mIU/mlvs4.2±0.6mIU/ml；P=0.026），反复扩张和刮治率较低(1/22[4.6%]vs4/6[66.7%];P=0.003),术中出血量少（10.1±6.3mlvs28.3±18.3ml；P=0.001），住院时间较短（2.8±1.7天比7.5±3.8天；P=0.001）。周围GS子宫内膜中断与EMT（比值比[OR]=0.55；P=0.001）和对数β-hCG浓度（OR=0.08；P=0.045）呈负相关。低于临界值的EMT与β-hCG浓度呈负相关(OR=0.06;P=0.021)。
结论：手术分类的ULIP包括两种产科疾病，其中II型ULIP，具有文献中没有记载的独特成像特征，在临床实践中需要进一步关注。
