Background: In clinical practice it is an ongoing challenge to distinguish between angular pregnancy and interstitial pregnancy. With the three-dimensional (3D) magnetic resonance imaging (MRI) being increasingly used, it is worth exploring its role in differentiating angular pregnancy from interstitial pregnancy. This study aims to investigate how 3D MRI can help reveal the differences between these two special pregnancies in the early diagnosis. Methods: We reviewed and analyzed the 3D MRI images of 50 patients with interstitial pregnancy and 55 patients with angular pregnancy retrospectively. Imaging features were identified to compare these two special pregnancies, and the ROC (Receiver Operating Characteristic) analysis was conducted to assess the diagnostic performance. Results: The significant differences of the 3D MRI imaging features between interstitial pregnancy and angular pregnancy were found in the outline of uterus cavity (p < 0.001), involvement of junctional zone (p < 0.001), the signal of surroundings (p = 0.005), the relationship with round ligament (p = 0.042), and the overlying myometrial thickness (p = 0.041). Furthermore, the multivariate logistic regression analysis identified a series of significant indicators for angular pregnancy, including the junctional zone involvement, being-surrounded by hyper/iso-intensity on 3D images, and the asymmetric outline of uterus cavity. Combining these three imaging features, the AUC (Area under the Curve) of ROC curve was 0.87 in distinguishing interstitial pregnancy from angular pregnancy. Conclusions: This study suggests that 3D MRI can help distinguish angular pregnancy from interstitial pregnancy in clinical practice, with the advantages that conventional MRI or ultrasound does not have. Through the significant image features, 3D MRI plays an important role in improving the timing of diagnosis, avoiding unnecessary interventions, and preventing hemorrhage in clinical practice.

BACKGROUND Understanding the blood supply pattern of cesarean scar pregnancy (CSP) can effectively help to determine the best choice of treatment. The aim of this study was to investigate the blood supply pattern and outcomes of patients with CSP through digital subtraction angiography (DSA) imaging. MATERIAL AND METHODS This was a retrospective cohort study. Patients were divided into 2 groups according to the type of CSP. The DSA images of these patients were reviewed, including the type of blood supply, dominant vessel, and collateral blood supply to the gestational sac. The clinical outcomes were analyzed between the 2 groups. RESULTS Thirty-seven patients with type I and 29 patients with type II CSP were enrolled in this study. Type II CSP showed a higher proportion of rich blood supply than type I (44.83% vs 29.72%, P>0.05). Compared with type II CSP, type I CSP tended to have bilateral dominant blood supply predominance (67.57% vs 41.38%, P<0.05). The incidence of collateral blood supply was 5.41% in the type I CSP group and 31.03% in the type II CSP group (P<0.05). In the type II CSP group, multiple collateral blood vessels were found in 4 patients. The superior vesicle artery was the most common source of collateral blood supply in both groups. Two patients with type II CSP suffered massive bleeding during surgery after uterine artery embolization (UAE). None of the patients received a hysterectomy. CONCLUSIONS UAE is safe and effective for both types of CSP. The blood supply pattern is more complex and abnormal in type II CSP. More attention should be paid to the collateral blood supply to achieve complete embolization during the UAE procedure in the case of type II CSP.

The aim of this study was to compare the reproductive outcomes of patients with cesarean scar pregnancies (CSP) following uterine artery embolization (UAE) and dilation and curettage (D&C) treatments, and to evaluate the impact of UAE on fertility. and methods: A retrospective case-control study was conducted. Patients diagnosed with CSP between 2019 and 2021 were included in the study. Clinical data and fertility outcomes were collected and reviewed retrospectively. Patients were divided into two groups based on their treatment option: the UAE combined with D&C group and the D&C alone group. A total of 91 CSP patients were enrolled in the study. Of these, 49 were treated with D&C, while 42 received UAE combined with D&C. The average gestational age in the UAE group was significantly longer than that in the D&C group. The average diameter of the gestational mass was significantly larger in the UAE group than in the D&C group (42.2 ± 19.8 mm vs 23.8 ± 15.9 mm). The other clinical features were not significantly different between the two groups. The average menstrual recovery time was 1.0 ± 0.20 months (range: 1–2 months) in the D&C group, and 2.0 ± 2.85 months (range: 1–18 months) in the UAE combined with D&C group, with a significant difference between the two groups. The average menstrual blood volume (MBV) decreased in 79 % of patients in the UAE group, compared to 18 % in the D&C group, with a significant difference between the two groups. There was no significant difference between the two groups in terms of pregnancy rate and birth rate (75 % vs 78 %, 63 % vs 56 %). UAE combined with D&C is an efficient and safe treatment for CSP. Our study showed that decreased MBV and longer menstrual recovery time in UAE combined with D&C group, but there are no statistical difference in fertility outcomes between the two groups, which suggests probably a reversible impact on the reproductive function.