Clinical Value of AI-Assisted Transvaginal Color Ultrasound Combined with Serum Markers in Diagnosing Heterotopic Pregnancy after IVF-ET

Li ZHU; Heli LIU; Jian MAO; Bin ZHENG; Shuqun WANG

doi:10.12259/j.issn.2095-610X.S20251014

Volume 46 Issue 10

Oct. 2025

Turn off MathJax

Article Contents

Article Navigation > Journal of Kunming Medical University > 2025 > 46(10): 113-120

Li ZHU, Heli LIU, Jian MAO, Bin ZHENG, Shuqun WANG. Clinical Value of AI-Assisted Transvaginal Color Ultrasound Combined with Serum Markers in Diagnosing Heterotopic Pregnancy after IVF-ET[J]. Journal of Kunming Medical University, 2025, 46(10): 113-120. doi: 10.12259/j.issn.2095-610X.S20251014

Citation:

Li ZHU, Heli LIU, Jian MAO, Bin ZHENG, Shuqun WANG. Clinical Value of AI-Assisted Transvaginal Color Ultrasound Combined with Serum Markers in Diagnosing Heterotopic Pregnancy after IVF-ET[J]. Journal of Kunming Medical University, 2025, 46(10): 113-120. doi: 10.12259/j.issn.2095-610X.S20251014

Citation:

Li ZHU, Heli LIU, Jian MAO, Bin ZHENG, Shuqun WANG. Clinical Value of AI-Assisted Transvaginal Color Ultrasound Combined with Serum Markers in Diagnosing Heterotopic Pregnancy after IVF-ET[J]. Journal of Kunming Medical University, 2025, 46(10): 113-120. doi: 10.12259/j.issn.2095-610X.S20251014

PDF( 1102 KB)

Clinical Value of AI-Assisted Transvaginal Color Ultrasound Combined with Serum Markers in Diagnosing Heterotopic Pregnancy after IVF-ET

doi: 10.12259/j.issn.2095-610X.S20251014

Li ZHU¹,
Heli LIU^{2
,
,},
Jian MAO³,
Bin ZHENG³,
Shuqun WANG¹

1.
First Department of Ultrasound
2.
Second Department of Ultrasound
3.
Department of Ultrasound Imaging，Orthopedics Campus，Cangzhou Hospital of Integrated TCM～WM.Hebei，Cangzhou Hebei 061000，China

Received Date: 2025-03-03
Publish Date: 2025-10-28

Abstract

Abstract

Objective To investigate the early diagnostic value of AI-assisted transvaginal ultrasound combined with serum biomarkers for intrauterine and ectopic combined pregnancy （heterotopic pregnancy, HP） after IVF-ET. Methods This retrospective case-control study included 86 patients diagnosed with HP after IVF-ET at Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2022 and December 2024. Control groups consisted of 86 patients with normal intrauterine pregnancies and 86 patients with simple ectopic pregnancy. All patients were diagnosed through clinical diagnosis, imaging examinations, and surgical confirmation. An AI ultrasound image analysis model and serum markers （hCG, PAPP-A, APA, progesterone, PlGF） were used to jointly assess HP diagnostic efficiency. Diagnostic performance was compared by calculating sensitivity, specificity, positive predictive value, and negative predictive value. Results The AI ultrasound image analysis model's AUC was 0.835, significantly superior to traditional ultrasound （AUC=0.696）. Serum hCG and PAPP-A levels were （36, 210±9, 820） IU/L and （0.81±0.25） μg/mL, respectively. The joint diagnostic AUC was 0.909, with a sensitivity of 94.2%, specificity of 88.4%, positive predictive value of 91.6%, and negative predictive value of 92.8%. Conclusion AI-assisted ultrasound combined with serological markers significantly improves the early diagnostic accuracy of HP, outperforming single methods and providing a reliable clinical tool.
- IVF-ET,
- Heterotopic pregnancy,
- Transvaginal color doppler ultrasound,
- Artificial intelligence,
- Serum biomarkers

FullText(HTML)

References(30)

References

[1]	Han Q S, Zhou Y, Xu Y, et al. Optimal timing of GnRH antagonist initiation in IVF-ET: A retrospective cohort study on advanced maternal age women[J]. Front Endocrinol (Lausanne), 2024, 15: 1340230. doi: 10.3389/fendo.2024.1340230
[2]	Wang R, Pan W, Yu L, et al. AI-based optimal treatment strategy selection for female infertility for first and subsequent IVF-ET cycles[J]. J Med Syst, 2023, 47(1): 87. doi: 10.1007/s10916-023-01967-8
[3]	Zhu S, Fan Y, Lan L, et al. Heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: Risk factors and pregnancy outcomes[J]. Front Med (Lausanne), 2022, 9: 864560. doi: 10.3389/fmed.2022.864560
[4]	Mao Y, Peng Y, Zheng M, et al. First-trimester ultrasound diagnosis and risk factor analysis of cesarean scar pregnancy after in vitro fertilization-embryo transfer[J]. Quant Imaging Med Surg, 2024, 14(7): 5028-5039. doi: 10.21037/qims-23-1239
[5]	Li X, Cai P, Ouyang Y, et al. Heterotopic interstitial pregnancy: Early ultrasound diagnosis of 179 cases after in vitro fertilization-embryo transfer[J]. J Ultrasound Med, 2023, 42(4): 915-922. doi: 10.1002/jum.16103
[6]	邵慧娟, 郑晓凤, 李琪, 等. 胚胎移植宫内外复合妊娠合并输卵管及黄体破裂休克1例并文献复习[J]. 生殖医学杂志, 2023, 32(4): 610-612. doi: 10.3969/j.issn.1004-3845.2023.04.021
[7]	Chen X, Chen F, Zhu W, et al. Treatment effects of laparoscopy versus laparotomy on heterotopic pregnancy after in vitro fertilization and embryo transfer[J]. Int J Gynaecol Obstet, 2023, 163(2): 689-696. doi: 10.1002/ijgo.14919
[8]	尚琴琴, 刘何利. 经阴道彩色多普勒超声诊断IVF-ET术后宫内外复合妊娠效果及腹腔镜手术后妊娠结局[J]. 中国计划生育学杂志, 2024, 32(5): 1117-1120. doi: 10.3969/j.issn.1004-8189.2024.05.027
[9]	Maleki A, Khalid N, Rajesh Patel C, et al. The rising incidence of heterotopic pregnancy: Current perspectives and associations with in-vitro fertilization[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 266: 138-144. doi: 10.1016/j.ejogrb.2021.09.031
[10]	Orsi M, Motta F, Fedele F, et al. Heterotopic cervical and isthmic pregnancy[J]. Ultrasound Obstet Gynecol, 2024, 63(6): 841-842. doi: 10.1002/uog.27603
[11]	Heremans R, Valentin L, Sladkevicius P, et al. Imaging in gynecological disease (24): Clinical and ultrasound characteristics of ovarian mature cystic teratomas[J]. Ultrasound Obstet Gynecol, 2022, 60(4): 549-558. doi: 10.1002/uog.24904
[12]	Bartusevicius A, Bartuseviciene E, Maseviciene M, et al. Heterotopic tubal choriocarcinoma coexistent with a viable intrauterine pregnancy: A case report[J]. Medicina (Kaunas), 2024, 60(8): 1226.
[13]	Conover C A, Oxvig C. The pregnancy-associated plasma protein-A (PAPP-A) story[J]. Endocr Rev, 2023, 44(6): 1012-1028. doi: 10.1210/endrev/bnad017
[14]	Pasinska M, Balcerek E, Repczynska A, et al. The levels of pregnancy-associated plasma protein (PAPP-A) and chorionic gonadotropin (β-hCG) in the blood serum of women with hypothyroidism in the 1st trimester of pregnancy[J]. Int J Womens Health, 2023, 15: 167-176. doi: 10.2147/IJWH.S386414
[15]	van Dijk C E, van Gils A L, van Zijl M D, et al. Cervical pessary versus vaginal progesterone in women with a singleton pregnancy, a short cervix, and no history of spontaneous preterm birth at less than 34 weeks' gestation: Open label, multicentre, randomised, controlled trial[J]. BMJ, 2024, 384: e077033.
[16]	Gladstone R A, Ahmed S, Huszti E, et al. Midpregnancy placental growth factor screening and early preterm birth[J]. JAMA Netw Open, 2024, 7(11): e2444454. doi: 10.1001/jamanetworkopen.2024.44454
[17]	Branch D W, Lim M Y. How I diagnose and treat antiphospholipid syndrome in pregnancy[J]. Blood, 2024, 143(9): 757-768. doi: 10.1182/blood.2023020727
[18]	Zhang Y Z, Zhou L, Tian L. A mid-pregnancy risk prediction model for gestational diabetes mellitus based on the maternal status in combination with ultrasound and serological findings[J]. Exp Ther Med, 2020, 20(1): 293-300. doi: 10.3892/etm.2020.8690
[19]	张芸, 丁霞, 李刚, 等. 人工智能技术评估早孕期胎盘体积应用价值分析[J]. 中国初级卫生保健, 2024, 38(3): 56-59. doi: 10.3969/j.issn.1001-568X.2024.03.0015
[20]	陈菲, 李茂林, 蒋玉婷, 等. 深度卷积网络模型可自动识别与分割胰腺及其肿瘤: 基于3D V-Net[J]. 分子影像学杂志, 2024, 47(11): 1170-1175.
[21]	Huang Y, Yao Z, Li L, et al. Deep learning radiopathomics based on preoperative US images and biopsy whole slide images can distinguish between luminal and non-luminal tumors in early-stage breast cancers[J]. EBiomedicine, 2023, 94: 104706. doi: 10.1016/j.ebiom.2023.104706
[22]	Elsayed S, Farah N, Anglim M. Heterotopic pregnancy: Case series and review of diagnosis and management[J]. Case Rep Obstet Gynecol, 2023, 2023: 2124191.
[23]	温召迎. 经腹部超声联合经阴道超声在宫外孕诊断中的应用价值[J]. 临床医学研究与实践, 2022, 7(32): 110-113.
[24]	Vaidakis D, Papapanou M, Siristatidis C S. Autologous platelet-rich plasma for assisted reproduction[J]. Cochrane Database Syst Rev, 2024, 4(4): CD013875.
[25]	Craciunas L, Tsampras N, Raine-Fenning N, et al. Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction[J]. Cochrane Database Syst Rev, 2018, 10(10): CD011537.
[26]	Houser M, Kandalaft N, Khati N J. Ectopic pregnancy: A resident's guide to imaging findings and diagnostic pitfalls[J]. Emerg Radiol, 2022, 29(1): 161-172. doi: 10.1007/s10140-021-01974-7
[27]	宋淑花. 经阴道彩色多普勒超声在宫外孕破裂与卵巢黄体破裂鉴别诊断中的临床价值[J]. 基层医学论坛, 2024, 28(33): 76-79.
[28]	Harzif A K, Hyaswicaksono P, Kurniawan R H, et al. Heterotopic pregnancy: Diagnosis and pitfall in ultrasonography[J]. Gynecol Minim Invasive Ther, 2021, 10(1): 53-56. doi: 10.4103/GMIT.GMIT_92_19
[29]	Zhou H, Chen W, Chen C, et al. Predictive value of ultrasonic artificial intelligence in placental characteristics of early pregnancy for gestational diabetes mellitus[J]. Front Endocrinol (Lausanne), 2024, 15: 1344666. doi: 10.3389/fendo.2024.1344666
[30]	Li W B, Du Z C, Liu Y J, et al. Prediction of axillary lymph node metastasis in early breast cancer patients with ultrasonic videos based deep learning[J]. Front Oncol, 2023, 13: 1219838. doi: 10.3389/fonc.2023.1219838

Relative Articles(20)

Relative Articles

[1]	Hongyue WANG, Tingyu LI, Yu SHI, Runlin FENG, Kunqiong CAO. The Practice and Effect Analysis of SPOC + Flipped Classroom and AI Integration in Radiology Teaching. Journal of Kunming Medical University, 2025, 46(9): 166-172. doi: 10.12259/j.issn.2095-610X.S20250920
[2]	Xiaoyan WANG, Xinrui WAN, Shitao XU, Wei CHEN, Hongyan MAO, Lin WANG, Zhiqiang MA. Analysis of Serum Biomarkers in Patients with Pulmonary Tuberculosis Complicated by Invasive Pulmonary Aspergillosis. Journal of Kunming Medical University, 2025, 46(3): 132-138. doi: 10.12259/j.issn.2095-610X.S20250320
[3]	Xiaoxiao ZHANG, Lulu LIU, Feng YAN, Jinlan YANG, Zhiqiang WANG, Meili HU. Analysis of Results from AI-Assisted Cervical Cancer Screening for Rural Women in Baoding City. Journal of Kunming Medical University, 2024, 45(10): 135-139. doi: 10.12259/j.issn.2095-610X.S20241021
[4]	Yanrong HUANG, Mingying LI, Mengying GAO, Lifeng XIANG, Jiacong YAN, Yonggang LI. Application of Time-Lapse Imaging Technology and Artificial Intelligence in ART. Journal of Kunming Medical University, 2024, 45(7): 160-167. doi: 10.12259/j.issn.2095-610X.S20240724
[5]	Yiwen ZHANG, Ximing WANG, Zilong LI, Xinzhang ZHANG, Changxian CHEN, Weijun LIU, Zhenyong ZHANG. Research Progress of Artificial Intelligence in the Diagnosis and Treatment of Anorectal Diseases. Journal of Kunming Medical University, 2024, 45(2): 1-6. doi: 10.12259/j.issn.2095-610X.S20240201
[6]	Yuansen LI, Cheng CHEN, Yan TIAN, Ruo SHU, Yu XU, Yuanhua LI. Study on Serum Markers of Intestinal Barrier Damage in Heroin Addicts at Different Withdrawal Times. Journal of Kunming Medical University, 2023, 44(7): 94-99. doi: 10.12259/j.issn.2095-610X.S20230709
[7]	Hengman ZHU, Zhenfang SU, Huawei WANG, Ju TANG, Congfei ZHANG, Qingmei LIU, LIUYinghong, Jianmei GAO, Meng RAO. Construction and Application of Node Health Education Model Based on Health Information Needs of Patients Undergoing in Vitro Fertilization-embryo Transfer. Journal of Kunming Medical University, 2022, 43(1): 167-172. doi: 10.12259/j.issn.2095-610X.S20220146
[8]	Zhao Man Lin , Li Qing , Xu Wei Biao , Huang Qin , Wei Dao . . Journal of Kunming Medical University, 2020, 41(02): 110-114.
[9]	Ma Fan, Li Xiao Xia , Xiao Bo . . Journal of Kunming Medical University, 2019, 40(05): 126-128.
[10]	Hu Shun Qin , Lu Xiao Ning , Xu Jing , Tang Dan , Sun Qing , Liu Qi Yun . . Journal of Kunming Medical University, 2018, 39(12): 85-89.
[11]	Ma Yuan , Zhan Zhong Li , Sun Bao Cun , Zhao Yong He , Hu Zao Xiu . The Expression and Clinical Significance in of Protein Markers Pulmonary Large cell Carcinoma. Journal of Kunming Medical University, 2017, 38(09): 30-34.
[12]	Song Jia Mei , Chen Hui , Xu Pei Qi , Meng Yu Shi . Effect of Female Basal Testosterone Level on the Pregnancy Outcome of in Vitro Fertilization Embryo Transfer. Journal of Kunming Medical University, 2017, 38(07): 93-98.
[13]	Hou Feng Qiang . . Journal of Kunming Medical University,
[14]	Huang Yan Ling . . Journal of Kunming Medical University,
[15]	Shen Yan . . Journal of Kunming Medical University,
[16]	Zhao Dong Yan . . Journal of Kunming Medical University,
[17]	Lei Jun Hua . . Journal of Kunming Medical University,
[18]	Rui Qiao An . . Journal of Kunming Medical University,
[19]	Xu Fei . . Journal of Kunming Medical University,
[20]	Ma Yong Hong . . Journal of Kunming Medical University,