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The Intradecidual Sign: Is It Reliable for Diagnosis of Early Intrauterine Pregnancy?

Gloria Chiang1, Deborah Levine2,3, Michelle Swire2, Ann McNamara2 and Tejas Mehta2

1 Harvard Medical School, 25 Shattuck St., Boston, MA 02115.
2 Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.
3 Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215.



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  		Fig. 1. —35-year-old woman with normal early intrauterine pregnancy. Sagittal transvaginal sonogram shows intradecidual sign scored as 5, intradecidual sign is definitely present. Echogenic gestational sac is seen to one side of central endometrial echo (arrows).

 


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  		Fig. 2. —32-year-old woman with normal early intrauterine pregnancy. Transverse transvaginal sonogram of intradecidual sign scored as 4, intradecidual sign is probably present. Echogenic ring is seen to one side of central endometrial echo (arrows); however, endometrial echo is not as well visualized as in Figure 1.

 


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  		Fig. 3. —27-year-old woman with indeterminate intrauterine fluid collection. Transverse transvaginal sonogram shows indeterminate fluid collection, scored as 3, findings are indeterminate. Slightly echogenic fluid collection is visualized, but endometrial stripe is not.

 


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  		Fig. 4. —35-year-old woman with possible ectopic pregnancy. Transverse transvaginal sonogram shows case scored as 2, intradecidual sign is probably not present. Fluid collection is seen, without echogenic rim around it.

 


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  		Fig. 5. —30-year-old woman with ectopic pregnancy. Sagittal transvaginal sonogram shows case scored as 1, intradecidual sign is definitely not present. Fluid seen centrally in endometrial cavity is consistent with pseudosac.

 


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  		Fig. 6A. —37-year-old woman with ectopic pregnancy and with human chorionic gonadotropin value of 5,197 mIU/mL. Sagittal (A), transverse (B and C), and oblique (D) sonograms show endometrium. Note that fluid appears central in endometrial cavity in A but has more ringlike appearance in B–D. However, contour of fluid collection differs on two transverse sonograms. Blood in cul-de-sac (arrow, A) is present; however, reviewers were specifically instructed to ignore extrauterine findings. Surgery revealed ectopic pregnancy.

 


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  		Fig. 6B. —37-year-old woman with ectopic pregnancy and with human chorionic gonadotropin value of 5,197 mIU/mL. Sagittal (A), transverse (B and C), and oblique (D) sonograms show endometrium. Note that fluid appears central in endometrial cavity in A but has more ringlike appearance in B–D. However, contour of fluid collection differs on two transverse sonograms. Blood in cul-de-sac (arrow, A) is present; however, reviewers were specifically instructed to ignore extrauterine findings. Surgery revealed ectopic pregnancy.

 


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  		Fig. 6C. —37-year-old woman with ectopic pregnancy and with human chorionic gonadotropin value of 5,197 mIU/mL. Sagittal (A), transverse (B and C), and oblique (D) sonograms show endometrium. Note that fluid appears central in endometrial cavity in A but has more ringlike appearance in B–D. However, contour of fluid collection differs on two transverse sonograms. Blood in cul-de-sac (arrow, A) is present; however, reviewers were specifically instructed to ignore extrauterine findings. Surgery revealed ectopic pregnancy.

 


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  		Fig. 6D. —37-year-old woman with ectopic pregnancy and with human chorionic gonadotropin value of 5,197 mIU/mL. Sagittal (A), transverse (B and C), and oblique (D) sonograms show endometrium. Note that fluid appears central in endometrial cavity in A but has more ringlike appearance in B–D. However, contour of fluid collection differs on two transverse sonograms. Blood in cul-de-sac (arrow, A) is present; however, reviewers were specifically instructed to ignore extrauterine findings. Surgery revealed ectopic pregnancy.

 

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