Learning objectives
To review the sonographic findings of the different types of gestational trophoblastic disease.
To illustrate the role of MRI in the management of GTD as a key tool for evaluating depth of disease invasion and extra uterine spread.
Background
Gestational trophoblastic disease (GTD) is a spectrum of both benign and malignant gestational tumors,
including hydatidiform mole (complete and partial),
invasive mole,
Choriocarcinoma,
placental site trophoblastic tumor,
and epithelioid trophoblastic tumor.
The latter four entities are referred to as gestational trophoblastic neoplasia (GTN).
These conditions are aggressive with a propensity to widely metastasize.
GTN can result in significant morbidity and mortality if left untreated.
Early diagnosis of GTD is essential for prompt and successful management while preserving fertility.
Initial diagnosis of GTD is based on...
Findings and procedure details
Clinical findings:
Initial diagnosis of GTD is based on a combination of history,
examination,
quantitativeβ-hCG titers,
and pelvic sonography.
Diagnosis of hydatiform mole based on clinical features may be difficult due to non-specificity of signs and symptoms.
Patients present with irregular vaginal bleeding,
excessive vomiting,
transvaginal expulsion of grape-like vesicles,
abnormally enlarged uterus,
and features of preeclampsia,
anemia,
or hyperthyroidism.β-hCG levels show large variation in normal,
multiple,
and abnormal gestations and when considered in isolation may be misleading for diagnosis of hydatiform mole.
Hence,
early...
Conclusion
Multimodality approach is adopted for the diagnosis of gestational trophoblastic disease including ultrasonography in conjunction with clinical features and abnormally elevated B-hCG,
as early detection is important for excellent prognosis and better outcome.
MRI plays a key role in the evaluation of myometrial invasion and extra uterine disease spread.
References
1.Sunita D,
et al.
Gestational Trophoblastic Disease: A Multimodality Imaging Aproach with Impact on Diagnosis and Mnagement.
Radiology Research and Practice (2014); 2014:12.
2.Lima L de LA,
et al.
Clinical and Radiological Correlations in Patients with Gestational Trophoblastic Disease.Radiologia Brasileira(2016); 241–250.
3.Wagner BJ,
Woodward PJ,
and Dickey GE.
From the archives of the AFIP.
Gestational trophoblastic disease: radiologic-pathologic correlation.
Radiographics (1996); 16:131–148.
4.Allen SD,
et al.
Radiology of gestational trophoblastic neoplasia.Clinical Radiology (2006); 61:301–313.
5.Jain KA.
Gestational trophoblastic disease: pictorial review,
Ultrasound Quarterly (2005); 21:245–253....