Sonographic patterns of pelvic and hepatic lesions in persistent trophoblastic disease

The sonographic findings of the pelvic lesions in persistent trophoblastic disease were evaluated prospectively in 57 patients. The appearance ranged from minimal lesions in the myometrium to complex lesions extending into the parametrium. A grading system was devised based upon the extent of the disease in the pelvis. The different grades correlated well with the plasma human chorionic gonadotrophin level at the time of the ultrasound examination. Findings of the hepatic lesions were evaluated in 69 patients managed during the same period. Thirteen were diagnosed to have metastatic disease on hepatic arteriography, of which 11 were correctly diagnosed by ultrasonography. The sensitivity and specificity of sonography in detecting metastasis in the liver from trophoblastic disease were 86.7 and 91.8 per cent, respectively. Two sonographic patterns were observed: a) the discrete hyperechoic lesions in three patients and b) the diffuse hyperechoic lesions in eight patients. In addition, ultrasonography could depict the size and internal structure of the pelvic and hepatic lesions much better than arteriography. Therefore, it is concluded that sonography is a very useful tool in the assessment of these lesions in persistent trophoblastic disease.