超声造影在异位妊娠保守治疗疗效评估中的研究进展

Research Progress of Contrast-Enhanced Ultrasound in the Efficacy Evaluation of Conservative Treatment for Ectopic Pregnancy

摘要: 异位妊娠是导致早期妊娠相关孕产妇死亡的主要原因之一，甲氨蝶呤(MTX)药物保守治疗是其重要的管理策略。然而，当前基于血清β-人绒毛膜促性腺激素(β-hCG)水平动态监测的疗效评估体系存在监测周期长、无法直观反映病灶活性的局限性。超声造影(CEUS)作为一种无创、实时的微循环成像技术，通过静脉注射微泡造影剂，能够动态显示异位妊娠病灶的血流灌注情况。本文综述了CEUS在异位妊娠MTX保守治疗疗效评估中的研究进展，重点探讨了其通过特定的增强模式(如“环形增强”)及定量参数在早期预测治疗反应、判断胚胎活性方面的应用价值。同时，本文也深入分析了CEUS在早孕期应用的安全性、定量分析面临的标准化挑战以及其成本效益问题，并对未来研究方向，如建立标准化方案、探索影像组学与人工智能的融合应用等进行了展望，以期为推动CEUS在该领域的精准临床应用提供参考。

Abstract: Ectopic pregnancy (EP) is one of the leading causes of maternal mortality in the first trimester. Methotrexate (MTX) conservative treatment is an important management strategy. However, the current efficacy evaluation system, based on dynamic monitoring of serum beta-human chorionic gonadotropin (β-hCG) levels, has limitations, including a long monitoring period and the inability to visually reflect lesion viability. Contrast-enhanced ultrasound (CEUS), as a non-invasive, real-time microcirculation imaging technique, can dynamically display blood perfusion in ectopic pregnancy lesions by intravenous injection of microbubble contrast agents. This article reviews the research progress of CEUS in evaluating the efficacy of MTX conservative treatment for EP, focusing on its application value in early prediction of treatment response and assessment of embryonic viability through specific enhancement patterns (e.g., “ring-like enhancement”) and quantitative parameters. Furthermore, this article analyzes the safety of CEUS application during early pregnancy, the standardization challenges faced by quantitative analysis, and its cost-effectiveness. Finally, it prospects future research directions, such as establishing standardized protocols and exploring the integration of radiomics and artificial intelligence, aiming to provide references for promoting the precise clinical application of CEUS in this field.