Abstract
Objectives: To demonstrate the value of 3-dimensional (3-D) ultrasound (US) in the diagnosis of congenital uterine anomalies. Methods: Fifty one infertile patients referred to our US unit during 12 years period, with suspected diagnosis of congenital uterine anomalies by previous HSG or 2D US examinations, were evaluated by transvaginal 3-D US. The 3-D US diagnoses were compared to the initial HSG diagnosis, and to hysteroscopic evaluation when performed. Results: 3-D scan confirmed the initial HSG diagnosis in 27 out of 51 (52.9%) women. The concordancy rates between the initial diagnosis by HSG and 3-D US results were 30.4% for bicornuate uterus; 75% for arcuate uterus; 83% for septate uterus; and 80% for unicornuate uterus. Of the 13 cases with normal HSG and suspicious 2-D US, 30.8% were found to be normal by 3D sonography. In cases where hysteroscopy was done, the results were 100% in concordance with the 3-D US evaluations. Conclusions: 3-D US is an accurate test for the assessment of uterine congenital anomalies. Its ability to concomitantly visualized, the external uterine contour with the uterine cavity on the same coronal plan, makes this noninvasive, easy to perform test the procedure of choice for the diagnosis of uterine anomalies.
Highlights
Congenital Mullerian duct anomaly is a common cause of infertility, first trimester abortion, preterm labor, and fetal malpresentations [1]
Several techniques are available for the evaluation of Mullerian duct anomaly, among which the traditional hysterosalpingography (HSG) is the most world-widely used, with its inherent limitation resulting from its inability to detect the external fundal contour of the uterus
Among the 23 cases that were initially diagnosed by HSG as bicornuate uterus, the 3-D sonography confirmed the diagnosis in 7 (30.4% concordance), while in the remaining 16 patients, 7 were diagnosed as having arcuate and 9 with septate uterus
Summary
Congenital Mullerian duct anomaly is a common cause of infertility, first trimester abortion, preterm labor, and fetal malpresentations [1]. Its estimated prevalence varies between 0.1% - 3% [2,3,4] in the general population and between 3% to 38% in patients with repeated spontaneous miscarriages or with infertility [5,6,7,8,9,10] This discrepancy results from the heterogeneous population samples, the clinical diversity of Mullerian anomalies and the different diagnostic techniques used. An invasive method which combines hysteroscopy and laparoscopy has been suggested as the gold standard for achieving a final diagnosis Noninvasive tools such as three-dimensional (3-D) ultrasound and magnetic resonance imaging (MRI) have been added to our armamentarium, with their ability to demonstrate uterine contours, and to improve the detection and differentiation between septate and bicornuate uteri
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