“The dilemma of GTN versus benign causes of secondary PPH that were indeterminate by ultrasound examination: How to differentiate?: A new prospective diagnostic criterion of functional MRI and ultrasound"

Abstract

Objectives

Early differentiation between causes of secondary postpartum hemorrhage (PPH) can sometimes be difficult and can cause serious complications if diagnosis and treatment are delayed. The study aimed to assess the efficacy of different imaging diagnostic criteria, which would help in differentiating between gestational trophoblastic neoplasia (GTN) from indeterminate benign causes; thus, aiding in making clinical decisions in a timely fashion.

Methods

A comparative prospective study, were 33 patients complaining of 2ry PPH, with indeterminate diagnosis referred to the Radiology department female imaging unit between October 2020 and November 2022 for further assessment. Transvaginal ultrasound examination as well as functional MRI was done. The lesions were characterized and certain diagnostic criteria were evaluated.

Results

The lesion epicenter, margin and depth of myometrial invasion detected by dynamic MRI have significant role to differentiate between GTN and other benign conditions mainly RPOC with higher sensitivity, specificity and accuracy of MRI compared to US. The p value, sensitivity and specificity as well as the accuracy of MRI were: 0.006, 50 %, 92 %, and 81.8 %; 0.000, 87.5 %, 92 % and 90.9 %; 0.002, 87.5 %, 92 % and 90.9 % compared to 0.5, 50 %, 64 % and 60.6 %; 0.01, 87.5 %, 64 % and 69.7 %; 0.2, 87.5 %, 40 % and 51.5 % by US respectively. The overall performance of MRI to reach accurate final diagnosis is higher than the US with accuracy rate of 97 % compared to 63.6 % in indeterminate cases.

Conclusions

MRI was found to show higher performance, compared to US in differentiating inconclusive cases of 2ry PPH.