Doppler study of myometrium in invasive gestational trophoblastic disease

Abstract

Transvaginal color Doppler study can easily detect invasive GTD. When the depth and the width of the myometrial invasion increase and when there is a low diastolic/systolic ratio, the number of courses and the need for combination of chemotherapy increase.

Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study

“…In the early diagnosis of invasive GTD, DFV clearly shows an advantage over classical hCG measurements because it can detect the presence of post-evacuation invasive GTD weeks before an hCG rise or plateau occurs 10,18. Doppler uterine artery PI is inversely proportional to tumor vascularity, and a low uterine artery PI indicates increased arteriovenous shunting 11, a feature that leads to large low-resistance blood vessels, an inherent characteristic of trophoblastic invasion.…”

“…Doppler US of the pelvis, an important tool in the diagnosis of GTN 8,9, is also used as part of GTN routine staging to assess the uterine volume and blood flow. Changes in flow resistance can reliably determine the appropriate chemotherapeutic regimen for GTN as well as predict the GTN response to chemotherapy 10,11. Moreover, the highly abnormal flow patterns seen in invasive gestational trophoblastic neoplasia can be measured by Doppler US as early as two weeks post-evacuation, which is before the appearance of lesions 12 or an hCG plateau or rise 10.…”

“…Changes in flow resistance can reliably determine the appropriate chemotherapeutic regimen for GTN as well as predict the GTN response to chemotherapy 10,11. Moreover, the highly abnormal flow patterns seen in invasive gestational trophoblastic neoplasia can be measured by Doppler US as early as two weeks post-evacuation, which is before the appearance of lesions 12 or an hCG plateau or rise 10. However, it remains controversial whether uterine artery Doppler flow velocimetry (DFV) parameters can predict GTN following CHM 13.…”

Invasive Hydatidiform Mole Showing Resistance to Single Etoposide Chemotherapy

“…The remarkable curability of GTDs with chemotherapy might reflect the great blood flow of the tumor and the underlying immune response of the host (the mother) to paternal antigens expressed on the surface of the trophoblastic cells 15) . Doppler study of the myometrium in invasive gestational trophoblastic disease has proven to be a useful diagnostic tool 16) . A score of 6 or less indicates a low-risk disease treatable by single agent chemotherapy.…”

First-Trimester Ultrasound in Gestational Trophoblastic Disease

“…TVUS with Doppler can identify small foci of resistant intrauterine disease [ 29 ] and can be used to evaluate depth of myometrial invasion which may also be prognostic for resistant disease [ 34 ]. Doppler can also be utilized to monitor and measure uterine artery blood fl ow and a RI and PI can be calculated.…”