INTRADECIDUAL SIGN - IS IT EFFECTIVE IN DIAGNOSIS OF AN EARLY INTRAUTERINE PREGNANCY

PURPOSE: To determine if the intradecidual sign at sonography is effec tive in the diagnosis of early intrauterine pregnancy. MATERIALS AND M ETHODS: In 102 pregnant patients, transvaginal sonography revealed an intrauterine fluid collection without a yolk sac or embryo. Four obser vers (experienced sonologist, body imaging fellow, 1st-year radiology resident, and premedical student) determined independently whether the intradecidual sign was absent, present, or indeterminate. Interpretat ions were limited to visualization of only the uterus. RESULTS: Follow -up revealed intrauterine pregnancy in 91 patients (outcome normal in 48 and abnormal in 43) and ectopic pregnancy in 11 patients. Among the four reviewers, sensitivity for diagnosis of an intrauterine pregnanc y was 34%-66%, specificity was 55%-73%, accuracy was 38%-65%, positive predictive value was 91%-93%, and negative predictive value was 12%-1 6%. Three to five ectopic pregnancies were categorized incorrectly as demonstrating the intradecidual sign, depending on the reviewer. CONCL USION: The intradecidual sign does not appear to be sensitive or speci fic in diagnosis of an early intrauterine pregnancy. When an intrauter ine fluid collection is present without an embryo or yolk sac (with po sitive pregnancy test results), a follow-up sonogram should be obtaine d unless contraindicated clinically.