Three dimensional ultrasound (3D US): high accuracy, low cost and minimal discomfort in the diagnosis of uterine anomalies

Abstract

To evaluate the role of 3D US in the diagnosis of uterine anomalies when compared with traditional imagining modalities. Prospective blinded study including all patients with uterine anomalies evaluated at a tertiary fertility center between 2004 and 2006. The uterine anomalies had been diagnosed by two dimensional ultrasound, magnetic resonance imaging, computed tomography or hysterosalplingography performed at various local institutions. All 3DUSs were performed at our center by a qualified ultrasonographer in conjunction with a Reproductive Endocrinologist. Hysteroscopy with or without laparoscopy was used as the gold standard to confirm the diagnosis. A total of 54 patients with 67 uterine anomalies were classified based on their operative reports and are shown in Table 1. Except for the diagnosis of bicornuate uterus, all other anomalies were correctly classified more frequently by 3D US than by any other imaging modalities (χ2 46.18, P<0.001). The diagnosis of adenomyosis seemed to be problematic for all diagnostic modalities employed, being misclassified as fibroids. Fundal fibroids, synechiae and polyps were commonly overlooked and uterine septum was very frequently misclassified as either bicornuate or didelphys. TablePercentage of Uterine Anomalies Correctly Diagnosed by Either 3D US or Other Imaging ModalitiesUterine Anomaly (n = 68)Correctly Diagnosed by 3D US (%)Correctly Diagnosed by Other Imaging Modalities (%)Adenomyosis (n = 3)3333Arcuate (n = 1)1000Bicornuate (n = 2)100100Didelphys (n = 2)10050Polyps (n = 17)10059Fundal Fibroids (n = 14)10043Synechiae (n = 9)10033Septum (n = 19)10032 Open table in a new tab These results show 3D US as a very promising tool which may eliminate the need for a diagnostic laparoscopy in the diagnosis of uterine anomalies. In addition, 3DUS can be used to identify patients with septate uteri who are incorrectly diagnosed as bicornuate or uterus didelphys and might benefit from hysteroscopic. Therefore, because of its relative low cost, low morbidity and superior diagnostic capability, 3DUS should be the modality of choice when evaluating a patient for a uterine anomaly.