3-dimensional Ultrasonography Research Articles

Acrania-Exencephaly-Anencephaly Sequence on Antenatal Scans

Acrania-Exencephaly-Anencephaly sequence is the progression from an absent cranial vault (acrania) showing relatively normal appearing exposed brain (exencephaly) to no recognisable brain parenchymal tissue (anencephaly). The study presents different cases of acrania, exencephaly and anencephaly along with their imaging features on Two Dimensional (2D) Ultrasonography (US) and additional benefits of using Three Dimensional (3D)/Four Dimensional (4D) ultrasonography to aid in the diagnosis. Over a span of one year, seven patients with abnormal foetuses were scanned during the first trimester or at 18-20 weeks of gestation using both 2D and 3D/4D volumetric probes. The International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) practice guidelines were adopted for appropriateness. Specific imaging features seen on 2D US helps early diagnosis and high detection rate of this rare type of Neural Tube Defect (NTD) malformation. A 3D/4D US can also detect foetal acrania, exencephaly and anencephaly as early as 2D scan and in addition can illustrate findings with different modes of reconstruction, which 2D US cannot. Hence, 3D/4D US may contribute to early detection of foetal acrania-exencephaly-anencephaly sequence.

Can Three-Dimensional Transvaginal Sonography Replace Office Hysteroscopy in Detecting Uterine Abnormalities in Infertility Patients?

Background:Evaluation of uterine cavity is an important step during investigation of infertile women. The presence of uterine pathology causes impaired receptivity, failed implantation and poor pregnancy outcomes. Various investigative modalities though available; have their limitations. Hysteroscopy considered the gold standard diagnostic modality is invasive; thus, an investigation which could overcome its limitations was required. 3-Dimensional transvaginal sonography (3D TVS), which non-invasively visualizes uterine morphology, registers all three imaging planes simultaneously could be an alternative to hysteroscopy.Aim:To compare 3-D TVS with the gold standard office hysteroscopy for evaluating uterine cavity in sub fertile women.Setting and Design:It was a comparative study carried out at the Reproductive Medicine Centre of a tertiary care hospital.Materials and Methods:Over 12 months , 154 women with infertility underwent both hysteroscopy and 3D TVS. The primary outcome was to compare the sensitivity and specificity of 3D TVS in diagnosing endouterine abnormalities and assess if 3-DTVS could replace hysteroscopy for evaluation of uterine cavity.Statistical Analysis:The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of the 3-D TVS was calculated.Results:The 3-D TVS had a sensitivity of 88.46% ; specificity of 99.21% for detection of uterine abnormalities with hysteroscopy as gold standard. The Positive Predictive Value was 95.83%; Negative Predictive Value 97.69% and diagnostic accuracy was 97.4%. It was seen that of 24 lesions diagnosed by 3D TVS, hysteroscopy was in agreement with 21 lesions.Conclusion:3D TVS with advantages of giving better spatial orientation, non-invasive, pain free, can replace hysteroscopy for screening endouterine lesions. With no statistically significant superiority of hysteroscopy over 3D TVS as seen in this study it may be deemed unnecessary in 50% patients having normal uterine cavity.

Size and Volume Charts for Fetal Adrenal Gland: A Prospective Study in Indian Population

AbstractThe fetal adrenal gland plays a pivotal role in perinatal survival. Because imaging the fetal adrenal gland is not part of routine antenatal ultrasonography (US), there is a paucity of available data about imaging techniques. The purpose of this study was to construct gestational age-wise data for fetal adrenal gland size and volume (2D US measurements) for 20, 21, 22 and 32 weeks of gestation and define a technique to measure the gland ultrasonographically. One year prospective study, at a single centre. 87 consecutive pregnant women with uncomplicated singleton pregnancy were included. Exclusion criteria were multiple pregnancy, maternal complications, congenital anomalies or fetal growth abnormality and a previous child suffering with Congenital Adrenal Hyperplasia (CAH). All measurements were made in 2 dimensional ultrasonography. In coronal sections of the fetal abdomen, fetal adrenal glands were identified just above the upper pole of the kidney to measure length and breadth. With the fetal spine in an anterior position, fetal adrenals were identified on either side of the spine and the width was measured. The gestational age included was 20, 21, 22 and 32 weeks. Both fetal adrenal glands could be visualised and identified in all cases (100%). Length, breadth, width and volume of both the glands for the above gestational ages with 95% confidence limit have been calculated. Antenatal imaging of the fetal adrenal gland can be done by 2D US if indicated.

Adding Insult to Injury: Levator Ani Avulsion in Women With Obstetric Anal Sphincter Injuries.

In women with obstetric anal sphincter injuries, we compared the rate of major levator ani avulsion after forceps-assisted delivery versus spontaneous vaginal delivery. Prospective cohort of primiparous women with obstetric anal sphincter injuries. The primary outcome was the rate of major levator ani avulsion as measured by 3-dimensional transvaginal ultrasonography performed between 1 and 2 weeks postpartum. Secondary outcomes included ultrasonographic anteroposterior hiatal diameter, levator hiatal area, and levator-urethra gap, and differences in validated pelvic disorder questionnaires scores at 1 to 2 and 13 weeks postpartum. Sixty-two women (30 spontaneous deliveries, 32 forceps deliveries) were included in the final analysis. After controlling for delivery variables, women who underwent forceps-assisted delivery were more likely to experience a major avulsion as compared with those who underwent spontaneous delivery (21/32, [65.6%] vs 8/30 [26.7%]; odds ratio, 5.9; 95% confidence interval, 1.5-24.5; P = 0.014). They were also more likely to have larger levator-urethra gaps bilaterally (P = 0.012, 0.016). After controlling for potential confounders, levator ani avulsion was independently associated with persistent anal incontinence symptoms at 13 weeks postpartum (P = 0.02). In women with obstetric anal sphincter injuries, the risk of levator ani avulsion is almost 6 times higher after forceps-assisted vaginal delivery as compared with spontaneous vaginal delivery. In those with avulsion, recovery of anal continence is compromised, suggesting that adding insult (avulsion) to injury (obstetric anal sphincter injury) may have negative functional consequences.

Absent Cavum Septi Pellucidi

Absent Cavum Septi Pellucidi

Dandy-Walker Malformation

Dandy-Walker Malformation

Hidden Spaces: Treatment of an Occult Utero-Vaginal Septum

Study Objective To describe the unique presentation and surgical management of a complete utero-vaginal septum. Design Video case report. Setting Tertiary care academic medical center. Patients or Participants We present a 25-year-old G2P0020 who is referred for evaluation after imaging and clinical examination revealed conflicting information. She was initially seen by her local provider for menorrhagia. Locally, an ultrasound revealed a septate uterus and examination under anesthesia with hysteroscopy noted a single vagina and cervix with a unicornuate uterus. Due to incongruous findings, she was referred for evaluation. Interventions Magnetic resonance imaging (MRI), examination under anesthesia, vaginal surgery and operative hysteroscopy. Measurements and Main Results MRI identified a complete utero-vaginal septum with a single septate cervix. Vaginal gel was used to define vaginal anatomy and gel was noted to fill the right hemivagina, while none noted on the left. Examination under anesthesia revealed an imperforate hymen with a small opening on the left as the cause for confusion in the clinical presentation. A hymenectomy was performed followed by guided surgical management of a complete utero-vaginal septum, unicollis. Conclusion Presentation of mullerian anomalies are often complex and anatomic variations in commonly described anomalies make misdiagnoses common. Advanced imaging with use of MRI with vaginal gel or 3-dimensional ultrasonography and detailed examination are often helpful. Differentiating between unicollis and bicollis presentations in complete utero-vaginal septum cases is an important distinction during surgical management.

Craniosynostosis: Clinical Presentation, Genetics, and Prenatal Diagnosis.

Craniosynostosis is a fetal condition caused by premature closure of the cranial sutures. Through provider awareness, we can raise suspicion in high-risk individuals, increase prenatal detection, optimize genetic testing, perform appropriate antenatal surveillance and delivery planning, and allow for a comprehensive, multidisciplinary approach to treatment. The aim of this study was to review what is currently known regarding the genetics, pathophysiology, diagnosis, and treatment of craniosynostosis for the obstetric care provider. A comprehensive literature review was performed using the PubMed database with the search term "craniosynostosis." The search was limited to the English language. A total of 220 articles were identified, and a total of 53 were used in completion of this article. The results highlight the multiple factors involved with abnormal suture formation, including various genetic factors. Although rare at this time, prenatal detection can allow families to prepare and practitioners to provide appropriate clinical treatment. Both 3-dimensional sonography and magnetic resonance imaging have been identified as modalities to aid in detection for high-risk individuals. Early referral allows for less-invasive surgical outcomes with lower complication rates. Familiarity with craniosynostosis among obstetric providers can improve patient counseling, prenatal detection rates, and appropriate antepartum, intrapartum, and postpartum counseling.

A Gel Pad Designed to Measure Muscle Volume Using Freehand 3-Dimensional Ultrasonography.

We developed an innovative gel pad that covers the entire lower leg to remove artifacts due to the pressure of the transducer in freehand 3-dimensional ultrasonography. In comparison to the reference method in water, this study showed that this new method was valid (bias, 3.4 mL; limit of agreement, 7.7 mL for a volume of ≈220 mL) and reliable (coefficient of variation, <1.1%) for the measurement of gastrocnemius medialis muscle volume. Considering that it is easier to use than the water tank technique, it has much promise for volumetric measurement of many muscles.

Feasibility of three dimensional power Doppler ultrasonography methods to assess placental perfusion

ObjectivesGiven the crucial role of the placenta in establishing a healthy pregnancy, reliable non-invasive methods to measure placental perfusion are desirable. The aim of this study is to determine the reproducibility and potential bias in different three-dimensional power Doppler (3DPD) methods assessing placenta perfusion. MethodsTen singleton pregnancies around 16 weeks of gestation, with an anteriorly located placenta and centrally inserted umbilical cord were included in this study. Eight different combinations of a specific placental sweep and sonobiopsy method were used to evaluate placental perfusion. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were determined offline using the 4D-view program. Reproducibility and repeatability of the methods, expressed as correlation coefficients and Bland-Altman mean differences, were calculated. Differences between sampling methods were analyzed using t-test or Mann-Whitney U test. ResultsIntra- and inter-class correlation coefficient (CC) was highest when using a spherical centrally placed sonobiopsy of 2 cm3 in a whole placenta sweep (method 1; IntraCC VI 0.985, FI 0.769, VFI 0.993, InterCC VI 0.986, FI 0.784, VFI 0.987). Overall, intraCCs were higher compared to interCCs. Lowest mean differences in VI and FI were found comparing spherical to manual sonobiopsies, whereas the mean differences in VFI were lowest when comparing central versus peripheral located sonobiopsies. Comparing the three vascular indices, best median intra- and interCC and lowest mean differences were found for VFI. ConclusionsThree dimensional placental vascularization analysis showed best reproducibility using whole placental sweep volume and centrally located, spherical sonobiopsy of 2 cm3.

Sonographic renal length and volume of normal Thai children versus their Chinese and Western counterparts.

Background Renal size is an important indicator in the diagnosis of renal diseases and urinary tract infections in children.Purpose The purpose of this study is twofold. First, it aimed to measure the renal length and calculate the renal volume of normal Thai children using 2-dimensional ultrasonography (2D-US) and study their correlations with somatic parameters. Second, it aimed to compare the age-specific renal size of normal Thai children with the published data of their Western and Chinese counterparts.Methods A total of 321 children (150 boys, 171 girls; age, 6–15 years) with a normal renal profile were prospectively recruited. All subjects underwent 2D-US by an experienced pediatric radiologist and the renal length, width, and depth were measured. Renal volume was calculated using the ellipsoid formula as recommended. The data were compared between the left and right kidneys, the sexes, and various somatic parameters. The age-specific renal lengths were compared using a nomogram derived from a Western cohort that is currently referred by many Thailand hospitals, while the renal volumes were compared with the published data of a Chinese cohort.Results No statistically significant difference (P<0.05) was found between sexes or the right and left kidneys. The renal sizes had strong correlations with height, weight, body surface area, and age but not with body mass index. The renal length of the Thai children was moderately correlated (r=0.59) with that of the Western cohort, while the age-specific renal volume was significantly smaller (P<0.05) than that of the Chinese children.Conclusion Therefore, we concluded that the age-specific renal length and volume obtained by 2D-US would vary between children in different regions and may not be suitably used as an international standard for diagnosis, although further studies may be needed to confirm our findings.

Three Dimensional Ultrasound of Pelvic Floor to Evaluate the Anatomical and Functional Changes of Primipara After Delivery

Objective: During pregnancy and childbirth, a series of remodeling processes may lead to the occurrence of pelvic floor dysfunction. Our aim was to explore the influence of different delivery methods on pelvic floor in primipara after delivery through three-dimensional (3D) ultrasound examination. Method: A total of 48 primiparas were selected as the study object. Among which, 21 primiparas underwent cesarean section were selected as observation group, 27 primiparas in vaginal delivery were selected as the control group. The 3D ultrasound examination of pelvic floor was carried out 6–8 weeks postnatally to observe and compare the prolapse of anterior, middle and posterior pelvic organs of parturient women in Valsalva movement. The posterior ureterovesical angel (PUA), urethral tilt angel (UTA), cervical mouth position (CMP), and bladder neck position (BNP) were measured. The changes of hiatus of levator ani muscle in patients with anal constriction, rest and Valsalva were observed and measured. Result: Compared with the data in control group, the number of cases of anterior, middle and posterior pelvic organ exfoliation in observation group was lesser, the UTA and BNP were higher, the CMP was lower, and the area of hiatus of levator ani muscle was smaller both at the time of calm, contraction and Valsalva movements. Conclusion: The damage of pelvic floor in primipara during transvaginal delivery is great. The 3D ultrasound is an objective and simple imaging method to screen the diseases of pelvic floor dysfunction.

Imaging of the Fetal Zygomatic Bone: A Key Role in Prenatal Diagnosis of First Branchial Arch Syndrome.

First arch syndromes are congenital defects caused by failure of neural crest cells to migrate into the first branchial arch. First arch syndrome is classified into 2 main clinical manifestations: Treacher Collins syndrome, characterized by bilateral underdevelopment of the zygomatic bones; and Pierre Robin sequence. The aim of this study was to describe the feasibility of visualization of the fetal zygomatic bone and assess its application in cases referred for features suggestive of first arch syndrome. A prospective cohort study was conducted. The feasibility of visualization of the zygomatic bone was performed in 50 sequential fetuses with a normal anatomic scan between 12 and 24 weeks' gestation using 3-dimensional sonography. Following this, cases referred for targeted scans for suspected first branchial arch syndrome were assessed for the presence or absence of the zygomatic bones. Visualization of the fetal zygomatic bone was feasible in all low-risk cases. Cases referred for targeted scans included 11 isolated cases of micrognathia or retrognathia, 3 cases of microtia, and 3 cases of auricular or facial vestiges. Within this group, the zygomatic bones were visualized in all but 2 cases. No associated extrafacial malformations were detected; therefore, this phenotype was consistent with Treacher Collins syndrome. Prenatal imaging of the zygomatic bones offers a clinically based sonographic approach to cases referred for features suggestive of first arch syndrome and enables differentiation between the 2 main clinical manifestations: Treacher Collins syndrome and Pierre Robin sequence.

Immediate Effect of Abdominal and Pelvic Floor Muscle Exercises on Interrecti Distance in Women With Diastasis Recti Abdominis Who Were Parous.

There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous. In this cross-sectional study, 38 women who were parous, with a mean age of 36.2years (SD=5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported. Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10mm (95% CI=7 to 13.2), whereas during twisted curl-up it was 9.4mm (95% CI=6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1mm (95% CI=3.2 to 8.9) and 3.5mm (95% CI=0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference=-2.8mm [95% CI=-5.2 to 0.5], -4.7mm [95% CI=-7.2 to -2.1], and-5.0mm [95% CI=-7.9 to -2.1], respectively). Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD. To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.

Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders.

PurposeThe aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders.MethodsEligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms.ResultsThere were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography. Agreement of the 2 diagnostic tests was confirmed using Cohen’s kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement.ConclusionThis study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.

Role of Measurement of Placental Thickness and Diameter at the Third Trimester Using Two Dimensional Ultrasound in Determination of Low Birth Weight

Background: Birth weight is the first weight of the fetus or newborn obtained after birth preferably measured within the first hour of life before significant postnatal weight loss has occurred. Aim of the work: This study was conducted in order to assess the role of measurement of placental thickness and diameter at the third trimester using two dimensional ultrasound in determination of low birth weight. Patients and methods: This study was carried out at Sayed Galal University Hospital and Damanhour Teaching Hospital on 400 uncomplicated pregnant women who was attend the outpatient clinic at Sayed Galal University Hospital and Damanhour Teaching Hospital, two dimensional ultrasound measurement of placental thickness and diameter was done to assess its role in determination of low birth weight. Results: The results of this study show that there were significant positive correlations between neonatal weight and GA, Placental diameter, Placental thickness, Biparietal diameter, Femur length & Abdominal circumference (P 0.05). Also our results shows that there was no statistical significant difference according to parity regarding fetal and placental measures. The results show that there was no statistical significant difference according to fetal sex regarding placental measures (P > 0.05). Conclusion: The result of this study shows a strong positive correlation between neonatal weight and placental thickness, so placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in the assessment of fetal weight.

Prevalence of Congenital Anomalies of Uterus in Sohag Government: A Descriptive Study by Trans-Vaginal Three Dimensional Ultrasound

AbstractBackground: A large number of uterine anomalies are detected routinely in reproductive medicine. The prevalence of these congenital uterine anomalies in women with repro-ductive failure remains unclear especially in Upper Egypt.The Aim of Study: Was to estimate the prevalence of congenital uterine anomalies in women with infertility in Sohag by Transvaginal Three Dimensional Ultrasound (TV3DUS).Methods: This study was a descriptive cross-sectional study carried out for 977 infertile women in 2018 based on reviewing of radiological images at Sohag governorate. After taking informed and written consent, a detailed history, general and systemic examination was done. All the cases underwent TV3DUS performed during the postmenstrual phase. Exami-nations had been performed using flips iu220 machine by a single operator and was commented as either normal or abnormal uterine cavity.Results: A total of 977 women were included in the study. 808 (82.7%) had a normal uterus and 169 (17.3%) had a congenital uterine anomalies. The most common anomalies were arcuate [n=84 (49.7%)] and septate [n=62 (36.8%)] uterus, followed by unicornate [n=9 (5.3%)] and then T-shaped and hypoplastic uterus [n=4 each (2.3% each)], lastly didelphys and bicornate [n=3 each (1.8% each)].Conclusions: TV3D ultrasound is an accurate and simple method to detect and classify congenital uterine anomalies and should become the first diagnostic step in the assessment of the uterine cavity. Prevalence of uterine congenital anomalies in Sohag was 17.3%. The most common type of uterine congenital anomalies was arcuate uterus.

Micrognathia

Micrognathia

Parameters of 2-Dimensional Perineal Ultrasonography Before and After Male Sling Procedure for Urinary Incontinence After Radical Prostatectomy

To compare ultrasonographic patterns of 2-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomic changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature. Thirty-one patients from 2 centers were selected for examination and surgery. They were allocated into mild and/or moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3-6 months postoperatively after the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest. Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (P = .024). The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure.

EP28.05: Uncomplicated pregnancy‐derived uterine arteriovenous malformations should be conservatively managed by ultrasound‐based triage and GnRHa administration

To report conservative management of post-miscarriage uterine arteriovenous malformations (AVM) diagnosed by 2- and 3-dimensional transvaginal sonography with colour or power Doppler assessment (2D-3D-TVS) and conservatively managed by gonadotropin-releasing hormone agonist (GnRHa) administration. Consecutive fertile patients with a recent history of first trimester miscarriage or abortion were considered. 2D-3D-TVS was performed by the GE Voluson E8 unit, using a wide-band 3-9 MHz transducer. Criteria for the sonographic diagnosis were presence of an irregular lobulated myometrial lesion with mixed echogenicity by 2D TVS imaging, on sagittal and/or transverse section of the uterus, adjacent to the uterine cavity with or without clearly visible products of conception, with abundant intralesional vascularisation (colour score 4), and high velocity blood flow within the vascular “web” with a peak systolic velocity (PSV) of > 20 cm/sec by colour or power Doppler imaging. In the absence of significant bleeding, a proper counseling and informed consent, a 3.75mg GnRH agonist was selectively administered. A sonographic follow-up was given within two months. Eight patients were enrolled. Median age was 33 years (IR 29-35). Median lesion diameter and volume were 25mm (IR 23-31) and 8cm3 (IR 6-14). Median PSV was 32 cm/sec (IR 29-38). In all patients the myometrial lesion spontaneously and uneventfully disappeared within the two months' follow-up period. Ultrasound based triage by 2D-3D-TVS with colour or power Doppler assessment should be considered the gold standard for diagnosis of AVM, being the simplest and most cost-effective diagnostic imaging modality. Conservative management of uncomplicated patients should be based on GnRHa and sonographic follow-up. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.