Objective To observe the ultrasonaphic changes of cesarean scar pregnancy ( CSP) after intramuscular methotrexate (MTX) injection and to investigate the value of ultrasound in the treatment . Methods ixteen patients with CSP who received intramuscular MTX treatment in Peking Union Medical College from November 2009 to October 2012 were enrolled in the study.The changes of the size and blood flow of the lesions were followed up by ultrasound , the therapeutic effect was evaluated referencing to the changes of serumβ-hCG.Results The ultrasonographic appearance showed mass-type-CSP in 10 patients and gestational sac-type-CSP in 6 patients.11 of the 16 patients were successfully treated,the mean diameter of the 11 lesions was(2.76 ±1.15)cm before treatment, and the mean level of serumβ-hCG was(2164.13 ± 2712.28)IU/L.After MTX injection, the size of the lesion and the color signals decreased gradually , 5 lesions disappeared totally after treatment .The serumβ-hCG level of all 11 patients decreased progressively (with a drop>50% weekly), and returned to normal after 54.36 ±43.58 days.While the treatment was failed in 5 patients.The mean diameter of the 5 lesions was (3.26 ±2.49) cm , and the mean level of serumβ-hCG was(11 916.34 ±5004.50)IU/L.One week after MTX injection, the ultrasound examination showed the size of lesions increased obviously , the mean diameter was 4.14 ±2.82 cm and rich color signal was detected.The serumβ-hCG leveldecreased <50% from the pre-therapy level.Afterwards, 1 patient underwent transvaginal ultrasound-guided embryo aspiration, 1 underwent uterine artery embolization (UAE) combined with laparoscopic curettage , 1 underwent surgical treatment after UAE and 1 underwent surgical treatment directly.All patients were cured.Conclusion Ultrasonography could be helpful in monitoring the changes of size and blood flow of CSP masses during the intramuscular MTX treatment , and it has an important role in evaluating the therapeutic effect and guiding the treatment .% 目的观察瘢痕妊娠（CSP）肌内注射氨甲蝶呤（MTX）治疗后超声声像图变化，探讨超声检查在CSP治疗中的作用和意义。方法应用超声动态随访2009年11月至2012年10月北京协和医院收治的16例肌内注射MTX治疗CSP患者病灶大小及血流变化情况，并参考血β－hCG变化情况评估治疗效果。结果16例CSP患者超声表现为瘢痕处包块型10例，孕囊型6例。16例患者中11例肌内注射MTX治疗成功；此11例患者治疗前病灶直径平均（2．76±1．15） cm，患者血β－hCG水平（2164．13±2712．28）IU／L；治疗后超声随访病灶缓慢缩小，血流信号减少或消失，其中5例超声随访病灶完全消失，该11例患者血β－hCG水平进行性下降（治疗后1周内下降幅度＞50％），（54．36±43．58）d后恢复至正常范围。16例患者中5例单纯肌内注射MTX治疗失败；此5例患者治疗前病灶直径平均（3．26±2．49）cm，患者血β－hCG水平（11916．34±5004．50）IU／L；治疗1周后超声复查病灶不缩小反而明显增大，病灶直径平均（4．14±2．82）cm，血流信号丰富，该5例患者血β－hCG水平治疗后1周内下降幅度均＜50％。1例患者行超声引导下清宫术，1例行子宫动脉栓塞（UAE）后腹腔镜下清宫术，1例行UAE后开腹病灶切除术，2例行开腹病灶切除术。5例患者均获得成功治愈。结论超声检查能有效监测CSP患者病灶大小及血流变化情况，帮助临床评估治疗效果及指导进一步治疗。
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