Gestatational Trophoblastic Disease: Multimodality Imaging Assessment With Special Emphasis on Spectrum of Abnormalities and Value of Imaging in Staging and Management of Disease

A 36-year-old woman with complete molar pregnancy. (A) Grayscale ultrasound image demonstrates a heterogenous mass (arrows) located centrally within the uterus. (B) The mass demonstrates mild internal vascularity on color Doppler ultrasound. (Color version of figure is available online.)

Theca lutein cysts in a patient with partial molar pregnancy. Ultrasound images of (A) right and (B) left ovaries show enlarged, multicystic ovaries. This appearance in a patient with partial molar pregnancy is suggestive of theca lutein cysts.

Evolution of placental cystic changes in partial molar pregnancy. (A) Sagittal image from a first-trimester ultrasound demonstrates an anterior placenta with a homogenous appearance. Fetus was alive, although small for gestational age (not shown). (B) Sagittal image from an ultrasound performed a month later demonstrates development of several cystic foci within the placenta (arrows) along with fetal demise (not shown). Fetal karyotype was 69,XXX.

Hydropic placental degeneration, with fetal demise (not shown). The placenta (arrows) appears thick and demonstrates cystic changes. However, pathologically this was due to hydropic changes after fetal demise and was not secondary to partial molar pregnancy.

Invasive mole presenting as rising serum hCG levels after evacuation of a complete molar pregnancy. (A) Sagittal transvaginal ultrasound image demonstrates an echogenic multicystic mass (calipers) within the posterior myometrium. Endometrium (arrow). (B) Increased vascularity is seen in the mass as color aliasing on the Color Doppler image. The anechoic cystic spaces seen on B-mode image are seen to fill in with color, confirming their vascular nature (compare this florid vascularity with the relatively scattered foci of blood flow in the complete molar pregnancy depicted in Fig 1B). (Color version of figure is available online.)

A 23-year-old woman presenting with a third recurrent molar pregnancy. (A) Coronal-oblique SPIR shows a hyperintense mass expanding the endometrial cavity. Observe the intact junctional zone (arrows) surrounding the mass. (B) On the postcontrast THRIVE image, the multicystic nature of the mass is reflected in its lattice-like pattern of enhancement.

Invasive mole occurring 3 months after an abortion. Coronal-oblique T2-weighted SPAIR image demonstrates a heterogeneous mass expanding the endometrial cavity. Areas of hemorrhage are seen as low signal intensity foci in the left aspect of the lesion. Observe the disrupted junctional zone (arrows). There is no evidence of extrauterine extension of disease.

Choriocarcinoma in a 33-year-old-female patient presenting with vaginal bleeding and markedly elevated hCG levels after an abortion. (A) Sagittal T2-weighted image depicts a heterogeneous, lower uterine segment/cervical mass. Hemorrhage is noted within the mass (white arrows). (B) The mass enhances heterogeneously as seen on the sagittal postcontrast THRIVE image. A homogeneously enhancing fibroid is noted incidentally in the anterior uterine wall (black arrow).

Invasive mole extending through Caesarean section scar. (A) Sagittal and (B) coronal-oblique T2-weighted images. Note the decreased conspicuity of the uterine zonal anatomy and extension of the signal voids both within the mass (black arrow) and as engorged arcuate (white arrow) and uterine venous plexus (arrowhead) vasculature, suggesting the hypervascular nature of the mass. There is no evidence of involvement of the adjacent wall of the urinary bladder on image (A).

Invasive mole occurring 2 months after a complete molar pregnancy. Consecutive axial, contrast-enhanced CT scans demonstrate a heterogeneous, hypervascular central uterine mass (white arrows). Engorged vessels both within the mass (short black arrow) and in the parametrium (long black arrows).

Pulmonary metastases in choriocarcinoma. Axial CT scan shows multiple, bilateral lung nodules, some of which are surrounded by ground-glass opacity (suggestive of hemorrhage).