HDlive Flow with HDlive silhouette mode in diagnosis of molar pregnancy

Abstract

Conventional two-dimensional (2D) sonography is employed frequently for the diagnosis of complete hydatidiform mole, which presents with mass formation and marked cystic changes; however, partial hydatidiform mole is usually associated with minor cystic changes rendering its sonographic diagnosis challenging1. We present our experience using HDlive Flow with HDlive silhouette mode to diagnose partial and complete molar pregnancies. One partial and three complete hydatidiform moles were studied using HDlive Flow with HDlive silhouette mode (Voluson E10, GE Healthcare Japan, Tokyo, Japan) following 2D sonographic examination at 6–9 weeks' gestation. Volume acquisition lasted 10 s and one to three recordings were obtained using a 5–13-MHz four-dimensional (4D) transvaginal probe. Acquisition angles ranged from 90° to 120°. Datasets were stored in the device and 4D reconstruction was carried out offline using HDliveFlow with HDlive silhouette mode. All volumes were analyzed by one examiner (T.H.). Ultrasound diagnosis was subsequently confirmed by histopathological examination following evacuation. The partial molar pregnancy was seen at 6 weeks in a woman with arcuate uterus. 2D sonography depicted several cysts on the right side of the uterine cavity and a large echogenic mass with adjacent moderately echogenic fluid collection on the left side of the uterine cavity (Figure 1a). Color Doppler with Radiantflow mode revealed moderate vascularity in the echogenic mass (Figure 1b). 3D surface rendering demonstrated clearly the arcuate uterus and confirmed the findings of 2D sonography (Figure 1c). HDlive Flow with HDlive silhouette mode showed clearly cysts of various sizes on the right side of the uterine cavity surrounded by myometrium with abundant blood flow, and an echogenic mass with moderate blood flow and adjacent fluid collection on the left side of the uterine cavity surrounded by myometrium with poor vascularity (Figure 1d). In the first case of early-stage non-hydropic mole diagnosed at 7 + 3 weeks, intrauterine fluid collection and a large echogenic mass with small vesicles were noted in the uterine cavity surrounded by moderate myometrial vascularity, on both color Doppler and HDlive Flow with HDlive silhouette mode (Figure 2). However, no blood flow was noted in the echogenic mass. Similarly, in the second case of early-stage non-hydropic mole diagnosed at 8 + 2 weeks, color Doppler with Radiantflow mode showed intrauterine anechoic fluid collection and a large echogenic mass with small vesicles in the uterine cavity surrounded by abundant myometrial vascularity, but no blood flow was evident in the mass (Figure 3a). HDlive Flow with HDlive silhouette mode showed clearly fluid collection and several small vesicles in the uterine cavity (Figure 3b). The third case of typical complete mole, diagnosed at 9 + 5 weeks, has been reported previously by our group2. Color Doppler imaging depicted numerous small vesicles inside the mass surrounded by a well-vascularized uterine myometrium (Figure 4a). However, no blood flow was evident inside the mass. HDlive Flow with HDlive silhouette mode showed clearly numerous small vesicles and fluid collection in the uterine cavity surrounded by abundant blood flow in the myometrium (Figure 4b). There have been several reports on the 3D ultrasound features of molar pregnancy in the first trimester2-5; however, the spatial relationship between molar vesicular structures, fluid collection and surrounding vascularity remains unclear. In this study, the unique characteristics of the combination of HDlive Flow with HDlive silhouette mode allowed the observation of overlapping blood vessels, showed with vitreous-like clarity the outline and borders of molar vesicles or cysts with a transparent core, and revealed fluid collection folds and curves with inner structures. Moreover, a moderate number of blood vessels were noted in the echogenic mass of the partial mole, whereas no blood flow was noted in the echogenic mass of the complete moles. HDlive Flow with HDlive silhouette mode could be a valuable adjunctive diagnostic tool for the diagnosis of molar pregnancy early in the first trimester.