Contrast-enhanced ultrasound enhancement-pattern classification for procedure selection and perioperative outcomes in cesarean scar pregnancy

By
Yang, Jinfeng
Xu, Zhongya
Liu, Xueke
Feng, Jin
Niu, Ying
April 13, 2026
0 min

Frontiers In Surgery

Overview

This study establishes a classification system for contrast-enhanced ultrasound (CEUS) patterns in cesarean scar pregnancy (CSP) and evaluates its impact on procedure selection and perioperative outcomes. The findings indicate strong associations between CEUS patterns and conventional ultrasound severity markers, with high concordance in procedural recommendations.

Background

Cesarean scar pregnancy (CSP) is a growing concern linked to significant complications such as hemorrhage and uterine rupture. Accurate imaging and classification are crucial for effective management and surgical planning. The introduction of CEUS offers enhanced visualization of vascularity and lesion characteristics, potentially improving patient outcomes.

Data Highlights

Parameter	Value
Concordance of CEUS recommendations with definitive management	90.1% (κ = 0.82)
Interobserver agreement for CEUS classification	κ = 0.800
Interobserver agreement for TVS classification	κ = 0.775

Key Findings

CEUS patterns were strongly associated with TVS severity markers, including residual myometrial thickness.
CEUS-based recommendations showed 90.1% concordance with definitive management decisions.
The CCSPB CEUS pattern improved prediction for cases requiring scar repair compared to TVS alone.
Perioperative outcomes varied significantly based on the selected procedure.
Incremental value of CEUS was demonstrated in predicting lesion resection plus scar repair.

Clinical Implications

The CEUS enhancement-pattern classification can guide clinicians in selecting appropriate procedures for CSP, potentially improving patient outcomes. Understanding the relationship between CEUS patterns and surgical needs may enhance preoperative planning and reduce complications.

Conclusion

The CEUS classification system aligns with established ultrasound indicators and supports informed decision-making in CSP management. Further validation through prospective multicenter studies is recommended.