ArticleFrontiers in surgery2026
Contrast-enhanced ultrasound enhancement-pattern classification for procedure selection and perioperative outcomes in cesarean scar pregnancy.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To develop a pragmatic contrast-enhanced ultrasound (CEUS) enhancement-pattern classification for cesarean scar pregnancy (CSP) and evaluate its association with procedure selection and perioperative outcomes. Methods: We retrospectively analyzed consecutive CSP patients who underwent pre-procedural CEUS at The People's Hospital of Yingshang (Yingshang County, Anhui, China) between August 2021 and January 2026. In our center, once outpatient two-dimensional ultrasound raised suspicion for CSP and the patient was admitted, CEUS was routinely performed as part of the preoperative assessment to evaluate the relationship between the scar lesion and contrast enhancement morphology. CSP severity was recorded using the 2016 transvaginal ultrasound (TVS) Type I-III system. CEUS patterns were classified into five predefined subtypes (ICSPF, ICSPB, CCSPF, CCSPB, and MA) according to early wash-in distribution, extent of enhancement, and vascular architecture, and then linked to a three-tier procedure recommendation. Two experienced ultrasound physicians reviewed representative cases after standardized training, showing substantial interobserver agreement for the TVS classification ( Results: Among 131 patients, CEUS patterns were strongly associated with conventional ultrasound severity markers, including TVS type, residual myometrial thickness, and scar thickness. CEUS-based recommendations showed 90.1% concordance with definitive management ( Conclusion: CEUS enhancement-pattern classification aligns with established ultrasound severity indicators and supports real-world procedure selection in CSP. The CCSPB pattern may provide incremental value beyond selected TVS parameters for identifying patients who ultimately require scar repair, although this finding should be interpreted cautiously. Prospective multicenter validation is warranted.
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