Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum.
OBJECTIVE
Pregnant patients without a sonographically visible intrauterine pregnancy and with a thick-walled cystic adnexal structure present a dilemma. This study compared the utility of various sonographic features in differentiating between the tubal ring of ectopic pregnancy and the corpus luteum.


METHODS
Retrospective review of first-trimester transvaginal sonograms revealed a cystic adnexal structure in 79 women. Each structure was evaluated for 6 specific sonographic characteristics: echogenicity of its wall compared with that of the ovary and endometrium, wall thickness in 2 planes, color Doppler flow distribution and percentage of wall circumference, and internal texture.


RESULTS
Forty-one (52%) of the 79 women had ectopic pregnancies, and 38 (48%) had corpora lutea. Eleven (32%) of 35 ectopic walls were more echogenic than the endometrium, compared with none of the corpora lutea. A cyst wall less echogenic than the endometrium was more likely in corpora lutea (84% versus 31%; P < .0001). More than twice as many ectopic rinds were more echogenic than ovarian tissue compared with corpora lutea (76% versus 34%; P < .0001). The only predictive internal texture feature was a clear pattern, which was more common in the corpora lutea (P < .01, Fisher exact test). There was no significant difference in mural flow distribution or extent between the 2 groups.


CONCLUSIONS
Ancillary sonographic signs to distinguish between an ectopic pregnancy and a corpus luteum include decreased wall echogenicity compared with the endometrium and an anechoic texture, which suggests a corpus luteum.
Stein
Marjorie W
MW
Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA. mstein17@aol.com
Ricci
Zina J
ZJ
Novak
Leon
L
Roberts
Jeffrey H
JH
Koenigsberg
Mordecai
M
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003338:Corpus Luteum / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal