Contrast‐Enhanced Ultrasound for Target Localization Before Ultrasound‐Guided Local Injection in Cesarean Scar Pregnancy

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Objectives To evaluate the role of contrast‐enhanced ultrasound (CEUS) in preprocedural target localization for cesarean scar pregnancy (CSP) and to assess the outcomes of ultrasound‐guided local injection. Methods This retrospective study included 31 patients with CSP who underwent CEUS prior to ultrasound‐guided local injection. CEUS was used to identify the hypervascular implantation site. Methotrexate (MTX) (50 mg) was administered locally into the gestational sac, followed by targeted injection toward the implantation site. Serum β‐human chorionic gonadotropin (β‐hCG) levels and ultrasound findings were monitored during follow‐up. Initial treatment success was defined as a satisfactory decline in β‐hCG levels after a single injection without additional MTX. Results CEUS demonstrated earlier enhancement and higher peak intensity at the implantation site than in the surrounding tissues (all p < .001). The hypervascular implantation region delineated by CEUS was significantly larger than that detected by color Doppler imaging ( p < .001). Initial treatment success was achieved in 26 of 31 patients (83.87%). The mean time to β‐hCG resolution after tissue removal was 21.78 ± 6.96 days. A major complication occurred in 1 patient (3.23%), who required surgical intervention due to severe bleeding. Conclusions CEUS improves visualization of the hypervascular implantation site and may facilitate target localization before ultrasound‐guided local injection. This approach appears feasible and relatively safe for the management of selected CSP patients.