Molar Pregnancy / Gestational Trophoblastic Disease Imaging

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Ultrasound morphology + beta-hCG
   Ultrasound morphology + beta-hCG? (GTD is abnormal trophoblastic proliferation. Complete mole ultrasound snowstorm/cluster-of-grapes (multiple small cystic hyperechoic areas in the cavity, no fetus) + uterus large for dates + markedly raised beta-hCG (often >100,000) + bilateral theca lutein cysts; partial mole is triploid, may show a fetus/amniotic fluid, easily misdiagnosed as missed miscarriage.)
   • Typical complete mole (snowstorm + very high hCG + theca lutein cysts) → Complete mole · evacuation + follow-up
   • Partial/atypical (fetus/amniotic fluid visible, moderate hCG) → Partial mole · confirm by pathology
   • Myometrial invasion/hypervascular/hCG plateau or rise after evacuation (invasive GTN) → Invasive GTN → chemotherapy
2. [End] Complete mole · evacuation + follow-up
   Complete mole: suction evacuation + serial beta-hCG to negative; benign itself but about 15–20% progress to persistent/invasive GTN, choriocarcinoma 2–3%; MRI shows disrupted zonal anatomy/multicystic/hypervascular. Serial monitoring follow-up is key.
3. [End] Partial mole · confirm by pathology
   Partial mole (triploid, fetus/amniotic fluid visible, lower hCG): easily misdiagnosed as missed/incomplete miscarriage; evacuation + pathology (p57) to confirm + serial beta-hCG; progression to GTN about 0.5–5%.
4. [End] Invasive GTN → chemotherapy
   Invasive GTN (hCG plateau/rise after evacuation, myometrial invasion hypervascular, metastasis): GTN chemotherapy by FIGO/WHO score (single/multi-agent), imaging to assess myometrial invasion and metastasis (lung/pelvis); choriocarcinoma is hypervascular and bleeds easily.

Source guidelines & references

• Complete hydatidiform mole imaging (Radiopaedia; Pathology Outlines)
• Gestational trophoblastic disease FIGO/WHO scoring and management

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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