title: Clinical usefulness of contrast-enhanced color Doppler ultrasonography in invasive and noninvasive gestational trophoblastic diseases: a preliminary study.
abstract: OBJECTIVE
  To examine the usefulness of contrast-enhanced color Doppler ultrasonography (CDU) in differentiating between invasive and noninvasive gestational trophoblastic disease (GTD).
  
  
  METHODS
  In 23 patients with findings suggestive of GTD by transvaginal gray-scale ultrasonography, the presence or absence of blood flow within uterine lesions was assessed by contrast-enhanced CDU using Levovist (Schering, Berlin, Germany) microbubble contrast agent. Intratumoral blood flow waveforms were analyzed using resistance indices. Tumor size in each invasive or malignant GTD was assessed by magnetic resonance imaging.
  
  
  RESULTS
  Intratumoral blood flow was detected in all invasive or malignant GTDs (7/7: 5 invasive moles, 1 choriocarcinoma and 1 placental site trophoblastic tumor), whereas it was not seen in any noninvasive GTD (0/16:10 complete moles, 5 partial moles and 1 exaggerated placental site) (p <0.0001). A marked increase in uterine vascularity was thus shown in all invasive or malignant GTDs following enhancement. In small invasive moles (<2 cm) in the uterine myometrium, color flow was remarkably increased by contrast-enhanced CDU. Intratumoral blood flow waveforms showed low resistance indices in all invasive and malignant GTDs.
  
  
  CONCLUSIONS
  Contrast-enhanced CDU may be useful in differentiating invasive or malignant GTDs from noninvasive GTDs. By enhancing color flow, this minimally invasive approach may be helpful for detecting small invasive GTD lesions within the uterine myometrium.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. emoto@kouhoukai.or.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Emoto
authors.forename: Riko
authors.initials: R
authors.lastname: Sadamori
authors.forename: Toru
authors.initials: T
authors.lastname: Hachisuga
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kawarabayashi
authors.forename: Shingo
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D000792:Angiography; D003287:Contrast Media; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000098:blood supply / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011134:Polysaccharides; D011247:Pregnancy; D018615:Ultrasonography, Doppler, Color; D014594:Uterine Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508