The Measurable and Unmeasurable Visual Benefits of 3D Saline Infusion Sonohysterography

Abstract

Objectives: To test the accuracy of 2D and 3D saline infusion sonohysterography in the diagnosis of endometrial polyps, submucous fibroids, intrauterine adhesions and depth of septae in comparison to hysteroscopic findings. Materials and methods: 197 women with abnormal uterine bleeding, infertility or recurrent miscarriages were included in the study. A provisional diagnosis was made after 2D saline infusion sonohysterography. This was followed be 3D volume acquisition and manipulation of the 3D images to make a final diagnosis. All patients had hysteroscopy during the early follicular phase. Findings during 2D and 3D saline infusion were compared to each other and to those obtained during hysteroscopy. Results: There was no difference regarding the primary diagnosis between the two SIS techniques in relation to the presence or absence of polyps, fibroids, intrauterine adhesions or septae. However, 3D SIS gave better visual impression and clearer documentation of the extent of the intrauterine pathology. This was especially so for the number and distribution of endometrial polyps as well as the extent and distribution of intrauterine adhesions and the depth of septae. These were useful preoperative findings for planning and facilitation of surgery. However, there were no differences between the two ultrasound techniques regarding the number or location of submucous fibroids. Conclusion: 3D saline infusion sonohysterography when available, could add useful information especially for mapping and documenting the extent of intrauterine pathology. This information could be of great help in counselling patients and facilitating hysteroscopic surgery. However, both SIS techniques failed in diagnosing endometrial micropolyps which were seen only during hysteroscopy.