PURPOSE: To evaluate the relationship of the endometrial canal and dec
idua vera to the interstitial gestational sac and to determine if this
relationship can be used to increase the predictive value of ultrasou
nd (US) in the diagnosis of interstitial ectopic pregnancy. MATERIALS
AND METHODS: The US findings in 12 patients with interstitial ectopic
pregnancy were reviewed. Radiologists also reviewed the cases of 40 pa
tients with various diagnoses to assess the accuracy of the interstiti
al line sign. RESULTS: US showed a definite gestational sac in four of
the 12 patients (33%); the rest had a heterogeneous mass in the cornu
al region. Thinning of the myometrial mantle was seen in these four pa
tients. The gestational sac appeared eccentric in three of these but i
n only three of 12 (25%) overall. The endometrial canal or interstitia
l portion of the tube was identified in 11 of 12 patients (92%). The i
nterstitial line had better sensitivity (80%) and specificity (98%) th
an eccentric gestational sac location (sensitivity, 40%; specificity,
88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for
the diagnosis of interstitial ectopic pregnancy. CONCLUSION: The inter
stitial line sign is a useful diagnostic sign of interstitial ectopic
pregnancy.