Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital …
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sound images were obtained in 60 (98.3(N) and three-di Comparison between
hysterosalpingography and ultrasound showed that five false-positive diagnoses of
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Ultrasound
Obstet. Gynecol. 5 (1995)
233-237
Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography
D. Jurkovic, A. Geipel, K. Gruboeck, E. Jauniaux, M. Natucci and S. Campbell
Gynaecological Ultrasound Research Unit, Academic Department School of Medicine and Dentistry, University of London, London, of Obstetrics UK and Gynaecology, King’s College
Key words: THREE-DIMENSIONAL ULTRASOUND, UTERUS, CONGENITAL ANOMALIES
ABSTRACT The purpose of this study was to investigate the potential value of three-dimensional ultrasound for the assessment of normal uterine anatomy and the diagnosis of congenital uterine anomalies. A total of 61 patients with a history of recurrent miscarriage or infertility and who had previously been investigated by hysterosalpingography were recruited into the study. They first underwent a conventional twodimensional transvaginal ultrasound scan. At the end of the examination, three-dimensional ultrasound volumes were recorded and stored in the machine computer memory. The examination of planar reformatted sections was than used for the assessment of uterine morphology and the diagnosis of congenital anomalies. On three-dimensional scanning, the most useful plane was a transverse section through the whole length of the uterus from the fundus to the cervix. Hysterosalpingography showed a normal uterus in 44 (72.1(X)) patients, an arcuate uterus in nine (14.8%) and a major fusion defect in three cases (4.9%). Five patients (8.2(X) had large fibroids which were distorting the uterine cavity. Good-quality two-dimensional ultrasound images were obtained in 60 (98.3(N) and three-dimensional images in 58 (95.1’S) cases. All poor images were caused by large uterine fibroids. Comparison between hysterosalpingography and ultrasound showed that five false-positive diagnoses of arcuate uterus and three of major uterine anomalies were made on two-dimensional scans. Three-dimensional ultrasound agreed with hysterosalpingography in all cases of arcuate uterus and major congenital anomalies. The ability to visualize both the uterine cavity and the myometrium on a three-dimensional scan facilitated the diagnosis of uterine anomalies and enabled easy differentiation nua te uteri. INTRODUCTION Ultrasound has been used for the assessment of uterine morphology for more than two decades. The uterus can always be identified and the appearance of the uterine cavity and the myometrium can be analyzed in great detail. The value of ultrasound for the diagnosis of acquired uterine abnormalities, such as fibroids or endometrial cancer, is well known’. However, in patients with congenital uterine anomalies, transabdominal and transvaginal scans have been used with varying success. When used as a screening test, transvaginal sonography has provided sensitivity rates of up to 100%2. However, the distinction between the different types of anomalies is often impossible”. Ultrasound is operator-dependent and hard-copy images can be difficult for a third party to interpret. Therefore, other diagnostic methods are usually required to complete the diagnostic evaluation, particularly in those patients scheduled for corrective surgery. Hysterosalpingography is the traditional method for the diagnosis of uterine anomalies. It is an invasive test which requires the use of a contrast medium and exposure to radiation. Although hysterosalpingography provides a good outline of the uterine cavity, the distinction between different types of lateral fusion disorders is often impossible 4s. In these cases, laparoscopy or laparotomy may be necessary to achieve a final diagnosis. Although between subseptate and bicor-
Correspondence: Dr D. Jurkovic, Gynaecological Ultrasound Research Unit, Academic Department of Obstetrics and Gynaecology, King’s College School of Medicine and Dentistry, Denmark Hill, London SE5 8RX, UK
ORIGINAL PAPER
233
Received 5-l-95 Revised 3-3-95 Accepted 5-3-95
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