3D Transvaginal Sonography Research Articles

Comparison of Three Dimensional Ultrasound Features of Uterine Junctional Zone in Patients with Ovarian or Deep Infiltrating Endometriosis

To assess by three-dimensional (3D) transvaginal sonography (TVS) the detectable alterations of the uterine junctional zone (JZ) in patients with endometriomas only (OMAs) or with isolated deep endometriosis (DIE) and to compare these findings to those without pelvic endometriosis.

Number of Antral Follicles, Ovarian Volume, and Vascular Indices in Asymptomatic Women 20 to 39 Years Old as Assessed by 3-Dimensional Sonography

Our aim was to elicit data representative of normal findings on 3-dimensional (3D) transvaginal gray-scale and power Doppler sonography of ovaries in women of fertile age. A total of 303 gynecologically asymptomatic white women 20 to 39 years old with spontaneous regular menstrual cycles were examined with transvaginal 3D gray-scale and power Doppler sonography on cycle days 4 to 8. We used a 6- to 12-MHz transducer. The ovarian volume, number and volume of antral follicles of 2 mm or larger, vascularization index, flow index, and vascularization-flow index were calculated using dedicated software. Results are presented separately for women with follicles of 2.0 to 10.0 mm and for those with at least 1 follicle larger than 10.0 mm for 3 age groups: 20 to 29, 30 to 34, and 35 to 39 years. There were 214 women (71%) with follicles of 2.0 to 10.0 mm and 89 (29%) with follicles larger than 10.0 mm. In women with follicles of 2.0 to 10.0 mm, the right ovary was on average 0.8 cm3 larger and contained on average 1.2 more follicles than the left one. The ovarian volume, number of follicles, and total follicular volume decreased significantly with age in both ovaries (P = .000-.029): for the right ovary ovarian volume, the median (range) decreased from 8.4 (3.7-17.3) cm3 at 20 to 29 years to 6.5 (2.4-12.7) cm(3) at 35 to 39 years, the number of follicles from 14 (1-32) at 20 to 29 years to 8 (1-21) at 35 to 39 years, and the total follicular volume from 1.08 (0.01-3.10) cm3 at 20 to 29 years to 0.84 (0.03-2.00) cm3 at 35 to 39 years. The size of the largest follicle and the vascular indices manifested no clear changes with age in any ovary. In women with follicles larger than 10 mm, the number of follicles decreased with age in both ovaries. We have elicited data representative of normal findings on 3D trans-vaginal sonography of ovaries in gynecologically asymptomatic white women of fertile age. Our gray-scale sonographic results may be used as reference values for general gynecology in populations similar to ours. Vascular indices must be interpreted with caution because of difficulties with standardization.

OP25.07: Ultrasound evaluation of the cesarean scar: comparison between one and two layer uterotomy closure

Objectives: To compare the residual myometrial thickness and the size of the cesarean scar defect after oneand two layer uterotomy closure. Methods: From July 2010 a continuous two-layer uterotomy closure technique replaced a continuous one-layer technique after cesarean delivery at the Department of Obstetrics and Gynecology at Aarhus University Hospital. A total of 149 consecutively invited women (68 women with one-layer and 81 women with two-layer closure) had their cesarean scar examined with 2D transvaginal sonography (TVS) 6–16 months post partum. Inclusion criteria were non-pregnant women with one previous elective cesarean, no post-partum uterine infection or uterine re-operation, and no type 1 diabetes. Scar defect width, depth, and residual myometrial thickness were measured on the sagittal plane, and scar defect length was measured on the transverse plane. Results: The median residual myometrial thickness was 4.6 mm (interquartile range (iqr) ± 3.1) after one-layer closure and 5.8 mm (iqr ± 3.7) after two-layer closure (P = 0.04). A scar defect was visible in 66/68 women (97%) with one-layer closure, and 78/81 women (96%) with two-layer closure, respectively. Median defect width was 6.8 mm (iqr ± 4.1) after one-layer compared to 5.6 mm (iqr ± 2.9) after two-layer closure (P = 0.01). No significant differences were found in defect height and length between women with oneand two-layer closure. Conclusions: Two-layer closure of the uterotomy significantly increases residual myometrial thickness and decreases defect width. Results do not prove but imply increased scar strength after two-layer closure.

A Study of the Cost, Accuracy, and Benefits of 3-Dimensional Sonography Compared With Hysterosalpingography in Women With Uterine Abnormalities

We conducted a prospective blinded study to evaluate the costs, accuracy, risks, and benefits of 3-dimensional (3D) transvaginal sonography compared to hysterosalpingography. A total of 101 women aged 26 to 44 years with evidence of uterine anomalies were enrolled. All participants had routine hysterosalpingography as part of their infertility evaluation as well as 3D transvaginal sonography as part of the study. Surgical findings were used as the standard for final diagnosis. A total of 6 normal uteri and 119 uterine anomalies were classified: 30 congenital uterine anomalies (3 arcuate, 1 unicornuate, 4 bicornuate, 2 didelphys, and 20 septate uteri) and 89 acquired anomalies (38 polyps, 30 fibroids, 17 synechiae, and 4 adenomyosis). Congenital anomalies were correctly identified in 30 of 30 cases by 3D sonography but from 10 to 30 of 30 cases by hysterosalpingography. The detection rates for acquired uterine anomalies were lower for both techniques: 44 to 89 of 89 cases for 3D sonography and 22 to 74 of 89 cases for hysterosalpingography. Only 7 of the 20 septi would have been surgically corrected if patients only had hysterosalpingography. On the contrary, 30 of 30 patients with congenital uterine anomalies, 2 of 4 patients with adenomyosis, and all 6 patients with normal uteri were spared from surgery with diagnoses by 3D sonography. No adverse effects were reported after sonography, and only 6 minor ones were reported after hysterosalpingography. Three-dimensional transvaginal sonography provides visualization and evaluation of the uterine cavity with similar or better accuracy than standard hysterosalpingography in the office setting, with lower cost and morbidity.

Does Three-Dimensional Sonography Improve the Diagnostic Accuracy of Ovarian Tumors with Previous Inconclusive Imaging?

Does Three-Dimensional Sonography Improve the Diagnostic Accuracy of Ovarian Tumors with Previous Inconclusive Imaging?

Uterine Junctional Zone in Infertile and Fertile Patients with and without Pelvic Endometriosis: A Three-Dimensional Ultrasound Study

The aim of this study is to assess the efficacy of 3D transvaginal sonography (TVS) to detect morphological alterations of the JZ in infertile patients affected by pelvic endometriosis and to correlate the findings to the laparoscopic stage of endometriosis.

P30.03: Localization of essure microinserts with 3d transabdominal ultrasound after hysteroscopic sterilization

To evaluate three-dimensional (3D) transabdominal ultrasound (US) as a minimally invasive confirmation test to localize Essure® microinserts 3 months after ambulatory hysteroscopic sterilization. This single-center prospective cohort study included all 66 patients who underwent hysteroscopic Essure® sterilization in a tertiary care hospital. 3D transvaginal and 3D transabdominal US were used to determine the position of the Essure® microinserts across the utero-tubal junction 3 months after the procedure. The microinserts were visualized without problems by 3D transabdominal ultrasound for 55 of the 66 patients (83%) and by 3D transvaginal US, for 62 (94%). The women whose implants were not visualized by the abdominal approach had either a retroverted uterus or a BMI > 30. Laparoscopic tubal sterilization was finally recommended to 5 women: 2 (3%) whose microinserts were not visualized and 3 (4.5%) whose microinserts were not correctly positioned according to both ultrasound approaches. Transabdominal 3D ultrasound is an interesting alternative for confirming correct placement of the Essure® microinserts. Despite visualization problems in cases of a retroverted uterus and BMI > 30, it provides better imaging of the uterine fundus. This technique is easy and reproducible and could replace the 3D transvaginal ultrasound in most cases. It is less invasive than 3D transvaginal US, pelvic X-Ray, or hysterosalpingography. Further studies are needed to confirm our results and validate transabdominal 3D US as a confirmation test after Essure® hysteroscopic tubal sterilization.

Intra‐ and interobserver variability of 2D and 3D transvaginal sonography in the diagnosis of benign versus malignant adnexal masses

The purpose of this study was to investigate the intraobserver and interobserver agreements in the diagnosis of malignant versus benign adnexal masses using two-dimensional ultrasonography (2D US) and three-dimensional ultrasonography (3D US). Two experienced sonographers performed a retrospective review of digitally stored 2D images and 3D data from a sample of 41 consecutive patients with a diagnosis of adnexal mass. Each observer independently, and blinded to each other, evaluated the 2D static images of each adnexal mass and then the 3D volumes 1 week later. The observers were required to classify the adnexal lesion as benign or malignant according to pattern recognition analysis. Intraobserver and interobserver agreement were assessed by calculating the kappa index (κ). Intraobserver agreement between 2D US and 3D US for the observer A was 1.00 and for the observer B was 0.69. Interobserver agreement was 0.69 for 2D US and 1.00 for 3D US (p > 0.05) Although 3D US in the diagnosis of adnexal masses appeared more reproducible than 2D US, the difference was not statistically significant.

Fetal Neuroimaging by Transvaginal 3D Ultrasound and MRI

ABSTRACT Three-dimensional (3D) ultrasound is one of the most attractive modality in the field of fetal ultrasound imaging. In multiplanar imaging of the brain structure, it is possible to demonstrate not only the sagittal and coronal sections but also the axial section of the brain, which cannot be demonstrated from parietal direction by a conventional 2D transvaginal sonography. Parallel slicing provides a tomographic visualization of internal morphology similar to MR imaging. Fetal neuroimaging with advanced 3D ultrasound technology is easy, noninvasive and reproducible methods. It produces not only comprehensible images but also objective imaging data. It has been controversial whether ultrasound or MRI is more practical and effective in prenatal assessment of fetal CNS abnormalities. In the assessment of enlarged ventricles, no significant difference between dedicated neurosonography and MRI in detection of intracranial structure. However, MRI is superior to ultrasound in evaluation of the brainstem, posterior fossa and cortical development especially in the late pregnancy. Meanwhile, transvaginal high-frequent 3D ultrasound has superiority to MRI in detection of intracranial calcification, vascular anatomy, intratumoral vascularity, bony structure. For CNS anomaly screening scan, ultrasound is no doubt the first modality, and once CNS abnormality is suspicious, after considering each advantage and disadvantage of transvaginal 3D ultrasound and MRI, it is suggested to use those different technologies according to what to be detected and evaluated in each abnormal CNS case. Of course, those two technologies should be utilized as alternatives and complementaries as well. In terms of fetal neurological function analysis, four-dimensional ultrasound research on fetal behavior have been launched in multicenters, and it will be greatly expected to elucidate relations between antenatal behavior and postnatal neurological prognosis.

Determinants of fertility and reproductive success after hysteroscopic septoplasty for women with unexplained primary infertility: a prospective analysis of 88 cases

Objective To evaluate prospectively the effect of hysteroscopic septoplasty as therapy for unexplained primary infertility in women with uterine septum as a sole cause for reproductive failure and to define the factors influencing reproductive success. Study design In a prospective comparative study, we enrolled 103 infertile women with uterine septum as a sole cause for reproductive failure. They had had unexplained primary infertility >2 years and a follow-up >12 months. Uterine anomalies were diagnosed by means of hysterosalpingography (HSG) and 2D-transvaginal sonography (TVS) with intrauterine saline infusion. Hysteroscopic septoplasty was performed in the early follicular phase. Pregnancy rates (PR) according to patient and septum characteristics (septum size) were the main outcome measures. Results Follow-up was complete for 88 patients. The mean (±SD) age of the patients was 36.1 ± 2.1 years. Forty-two patients became pregnant (40.7%). The mean (±SD) delay in conception was 7.5 ± 2.6 months. Nearly 80% of the pregnant women conceived spontaneously. Of 44 pregnancies in 42 women, 36 live newborns were delivered. The PR was significantly higher in women <35 years of age or with <3 years of unexplained primary infertility. Moreover, in women with a septum size larger than one-half of their uterine length the PR was significantly higher than those with septum size <1/2 of their uterus ( P = .12). Conclusion Fertility and pregnancy after hysteroscopic septoplasty in women with unexplained primary infertility and uterine septum as a sole cause for reproductive failure seems to depend on patient age, duration of infertility before septoplasty, and septum size. Women with a septum size larger than one-half of their uterine length have a higher chance of successful pregnancy after hysteroscopic septoplasty.

P26.10: The role of 2D and 3D transvaginal sonography on the diagnosis of enterovaginal fistula

P26.10: The role of 2D and 3D transvaginal sonography on the diagnosis of enterovaginal fistula

Three dimensional sonographic evaluation of adenomyosis: the junctional zone features in infertile patients

OBJECTIVE: The uterine junctional zone (JZ) seems to play a central role in the implantation process. JZ is accurately evaluated on the coronal section of the uterus obtained by three dimensional (3D) transvaginal sonography (TVS). 3D ultrasound criteria for alteration of the JZ show a high accuracy for adenomyosis diagnosis. The aim of this study is to evaluate detectable morphological alterations of the JZ by 3D TVS in infertile patients.

Three-Dimensional Vascular Indices Calculated Using Conventional Power Doppler and High-Definition Flow Imaging

The purpose of this study was to determine whether there are differences in 3-dimensional (3D) vascular indices when calculated using high-definition flow imaging (HDF) and power Doppler imaging (PD). Twenty-five consecutive asymptomatic premenopausal women (mean age, 31 years; range, 28-33 years) without a history of gynecologic disease who attended routine gynecologic checkups were included in the study. All women had regular menstrual cycles, and none had uterine or myometrial disease detected on basal transvaginal sonography. All women underwent 3D transvaginal sonography. In each patient, a first volume using conventional PD was obtained, immediately followed by a second volume using HDF. Volumes were stored and subsequently analyzed for calculating 3D vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) from the endometrium. The median VI, FI, and VFI were significantly higher when calculated using HDF compared with conventional PD (P < .05). Three-dimensional vascular indices calculated using HDF are higher than those calculated using conventional PD.

Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography

To evaluate the diagnostic accuracy of introital three-dimensional (3D) transvaginal sonography for preoperative detection of rectovaginal septal endometriosis. Ultrasonographic results were compared with surgical and histologic findings. University Department of Obstetrics and Gynecology. This prospective study included 39 women with suspected rectovaginal endometriosis. All patients underwent 3D transvaginal sonography for the evaluation of the rectovaginal septum, before undergoing laparoscopic radical resection of endometriosis. Rectovaginal endometriosis was defined as hypoechoic areas, nodules, or anatomic distortion of this specific location. Sensitivity, specificity, and likelihood ratios (positive or negative) were calculated with 95% confidence intervals (CIs). Surgery associated with histopathologic evaluation revealed deep endometriosis in the rectovaginal septum in 19 patients. The specificity, sensitivity, positive likelihood ratio, and negative likelihood ratio were 94.7% (95% CI, 78.6%-99.7%), 89.5% (95% CI, 73.3%-94.5%), 17.2 (95% CI, 2.51-115), and 0.11 (95% CI, 0.03-0.41), respectively. Introital 3D ultrasonography seems to be an effective method for the diagnosis of endometriosis of the rectovaginal septum and should be included in the preoperative evaluation of patients with clinical suspicion of deep endometriosis.

Hematocolpos Secondary to Acquired Vaginal Scarring After Radiation Therapy for Colorectal Carcinoma

Hematocolpos in a postmenopausal woman is uncommon because most cases are due to a congenital anomaly and present during the neonatal or perimenarchal period. In older women, hematocolpos results from near or complete vaginal occlusion secondary to radiation therapy for cervical carcinoma or from scarring after surgical procedures such as cone biopsy Rarely, vaginal obstruction may be due to postmenopausal atrophy, endometriosis, or vaginitis, leading to scarring or adhesions. 1―6 Hematocolpos after radiation therapy for colorectal carcinoma is a rare clinical entity. We report an unusual case of hematocolpos secondary to acquired vaginal scarring after radiation therapy for colorectal carcinoma in a postmenopausal woman who had dyspareunia and pelvic and lower back pain. Characteristics on 3-dimensional (3D) transvaginal sonography (TVS) and magnetic resonance imaging (MRI), as well as intraoperative sonographic guidance, are described, together with current management and a review of the literature. The diagnosis of vaginal scarring and associated hematocolpos was suggested by TVS and confirmed by intraoperative sonography.

Optimal Use of 3D and 4D Transvaginal Sonography in Localizing the Essure® Contraceptive Device

Current protocol in the United States does not include sonographic imaging for assessing proper placement of the Essure ® microinsert coils. An alternative to the current requirement of hysterosalpingography for imaging the metallic coils is described using 3D and 4D multiplanar imaging. Studies showing the advantages of using optimal sonographic techniques over other imaging modalities are shown to be less invasive, simpler, and with fewer risks. A review of 3D and 4D sonography reveals advantages in imaging the Essure microdevices.This article explores optimum techniques for localizing the Essure microdevices with 3D and 4D transvaginal sonography.

Can 3-dimensional Ultrasound Change Gynecological Ultrasonographic Examination?

Abstract Objective To verify whether 3D transvaginal ultrasonography is as accurate as 2D conventional ultrasonography and whether it provides additional advantages in gynecologic diagnosis. Material and methods We performed a prospective study in 46 women who underwent 2D and 3D transvaginal scans successively. Three 3D volumes (uterus and each ovary) were acquired and evaluated 4 months later on a personal computer. We compared 2D and 3D scans in relation to sonographic diagnosis and biometry and the time spent. Results There was complete agreement between 2D and 3D techniques for sonographic diagnosis (31 normal exams, 16 adnexal cysts and seven myomas), except for the visualization and measurement of the uterine cervix. The mean time for 2D scans was 3.29 ± 1.32 minutes and was 2.96 ± 0.58 minutes for 3D examination (P = 0.076). The time required to acquire 3D volumes was only 1 hour, freeing 1 hour and 32 minutes for the performance of new scans. Conclusions Transvaginal 3D ultrasonography can be more efficient than conventional 2D ultrasonography in gynecologic diagnosis.

Ectopic Pregnancy Complicated by an Arteriovenous Malformation of the Fallopian Tube

Ectopic pregnancy is still correlated with a high incidence of morbidity and mortality. 1 Increasing occurrences of sexually transmitted diseases (gonorrhea and chlamydia), pelvic inflammatory diseases, previous abortions, bitubal ligations, intrauterine devices, assisted reproductive techniques, late primiparity, and previous surgery are associated with chronic salpingitis, which is the most common finding associated with and responsible for ectopic pregnancy. 2 Improvements in the resolution of high-frequency transvaginal sonography have contributed greatly to the diagnosis of ectopic pregnancy, which has already been correlated with the β-human chorionic gonadotropin (β-hCG) level. 3,4 The introduction of 2-dimensional (2D) transvaginal scanning, color Doppler imaging, and nowadays, 3-dimensional (3D) transvaginal sonography can provide information about the location and size of the ectopic mass and impairment of the tube. Evaluation of these factors is important for selecting the best treatment for the patient and choosing among the different therapeutic possibilities (laparoscopy, methotrexate administration, and expectant management). Arteriovenous malformations (AVMs) in the female genital tract are relatively uncommon lesions in which there is direct communication between arterioles and venules. They can be either congenital or acquired. The association between ectopic pregnancy and AVMs is extremely rare; indeed, in the literature we found just 2 cases of ectopic pregnancy associated with an AVM. 5,6 We report a case of an ectopic pregnancy complicated by an AVM in which 2D transvaginal sonography, color Doppler imaging, pulsed wave Doppler imaging, and new 3D modes, including tomographic ultrasound imaging, the glass body mode, and 3D bidirectional power Doppler (HD-Flow) imaging, indicated the diagnosis and the best surgical plan.

¿Puede la ecografía tridimensional cambiar la exploración ecográfica ginecológica en nuestro medio?

ObjectiveTo verify whether 3D transvaginal ultrasonography is as accurate as 2D conventional ultrasonography and whether it provides additional advantages in gynecologic diagnosis. Material and methodsWe performed a prospective study in 46 women who underwent 2D and 3D transvaginal scans successively. Three 3D volumes (uterus and each ovary) were acquired and evaluated 4 months later on a personal computer. We compared 2D and 3D scans in relation to sonographic diagnosis and biometry and the time spent. ResultsThere was complete agreement between 2D and 3D techniques for sonographic diagnosis (31 normal exams, 16 adnexal cysts and seven myomas), except for the visualization and measurement of the uterine cervix. The mean time for 2D scans was 3.29±1.32 minutes and was 2.96±0.58 minutes for 3D examination (P=.076). The time required to acquire 3D volumes was only 1 hour, freeing 1 hour and 32 minutes for the performance of new scans. ConclusionsTransvaginal 3D ultrasonography can be more efficient than conventional 2D ultrasonography in gynecologic diagnosis.

224: 2D and 3D Transvaginal Ultrasound (TV-US) and Sonohysterography (SHG) for the Detection of Intrauterine Lesions Prior to Hysteroscopy

224: 2D and 3D Transvaginal Ultrasound (TV-US) and Sonohysterography (SHG) for the Detection of Intrauterine Lesions Prior to Hysteroscopy