Three-dimensional Transvaginal Sonography Research Articles

Preliminary application of real-time shear wave elastography to evaluate endometrial receptivity and predict pregnancy outcome.

Endometrial receptivity is crucial for the establishment of a healthy pregnancy outcome. Previous research on endometrial receptivity primarily examined endometrial thickness, endometrial echo types, and endometrial blood supply. To explore the differences in the elastic modulus of the endometrium in women with various pregnancy outcomes by real-time shear wave elastography (SWE) and to investigate its application value in evaluation of endometrial receptivity. A total of 205 pregnant women who were admitted at Wenzhou People's Hospital between January 2021 and December 2022 were selected. Three-dimensional transvaginal sonography and real-time shear wave elastography were performed in the proliferative phase and receptive phase of the endometrium, and the average elastic modulus of the endometrium in the two phases was obtained and compared. According to whether the pregnancy was successful or not, the participants were divided into the pregnancy group (n= 72) and non-pregnancy group (n= 133), and the differences in intimal thickness, 3D blood flow parameters, and average elastic modulus of intima were compared between the two groups. The average elastic modulus of the endometrium in the proliferative phase and receptive phase was (23.92 ± 2.31) kPa and (11.82 ± 2.24) kPa, respectively, and the difference was statistically significant P< 0.05. The average elastic modulus of the endometrium in the pregnancy group and non-pregnancy group was (9.97 ± 1.08) kPa and (12.82 ± 2.06) kPa, respectively, and the difference was statistically significant P< 0.05. The area under the curve of predicting pregnancy by the average elastic modulus of the endometrium in the receptive phase was 0.888 (0.841∼0.934), with corresponding P value < 0.05. The critical value was 11.15, with a corresponding sensitivity of 81.7% and specificity of 78.2%. Real-time shear wave elastography can quantitatively evaluate endometrial elasticity, indirectly reflect the endometrial phase, and provide a new diagnostic concept for evaluating endometrial receptivity and predicting pregnancy outcome in infertile patients.

3D Sonographic Diagnosis of Hydrosalpinx: Implications for the Non-Laparoscopy Confirmation of Pelvic Inflammatory Disease

Introduction: As Pelvic Inflammatory Disease (PID) has many clinical and radiographic features, the specific utility of sonographic imaging for its diagnostic confirmation may be helpful with its non-invasive approach, rather than the common reliance on the operative procedure of laparoscopy for this purpose. Since the presence of hydrosalpinx is commonly associated with PID, its associated three-dimensional transvaginal sonography (3DTVS) appearance may offer helpful diagnostic certainty. Although Timor-Tritsch introduced a sonographic technique for its display previously in 2005, the technique used in this current imaging project may be somewhat simpler to employ and possibly even more revealing. A case series was investigated for the possible diagnosis of deep invasive endometriosis (DIE), for which patients presented with pelvic pain presumed to represent DIE. A separate case series was investigated for the possible value of the O-RADS app for the diagnosis of ovarian malignancy. Since the sonographic diagnosis of hydrosalpinx was made in each dataset, and some of those patients underwent exploratory surgery, the veracity of the sonographic diagnosis could be calculated. As pelvic pain could also represent possible PID, the cases in which hydrosalpinx were found were specifically examined for it. The present investigation was performed in order to detail the value of 3D surface rendering imaging for hydrosalpinx and its ultimate diagnosis. Some patients underwent operative intervention and thus histologic confirmation, in addition to the sonographic evaluation which all patients had performed. It is the intent of this investigation to display the value of 3DTVS to diagnostically determine some cases of chronic pelvic pain as being due to PID. Methods: A series of 32 patients were sonographically evaluated with 3DTVS for complaints of pelvic pain, and when a hydrosalpinx was observed, a particular technique was employed (described below). Nine of those patients had a surgical intervention in addition to the ultrasound evaluation. The technique that was used can be described as follows. The 3D volume of the region of interest (ROI) was obtained, and it was manipulated to produce the best image of the hydrosalpinx. A large Ultrasound rendering box was created to demonstrate the external surface of the resultant 3D hydrosalpinx image. Results: A total of 32 patients underwent the described rendering imaging with 3DTVS. Of those patients, 9 (27 %) also underwent surgical exploration. 78 % of those cases revealed surgical findings consistent with the presurgical sonographic diagnosis. Conclusion: From the review of this case series, it appears that the sonographic diagnosis of chronic PID can virtually be relied upon with 3DTVS, rather than subject all patients to laparoscopy for whom this diagnosis may be considered. One can consider the described technique as a method of performing a partial “Virtual Laparoscopy”. After sonographically confirming the diagnosis of chronic PID, a gynecologist can confidently use the available medical therapeutic methods for its treatment, and if such treatment fails improvement of the patient’s symptoms, surgical extirpation can be considered (e.g. TAH-BSO). In this way, 3DTVS can be considered as an important gynecologic diagnostic tool for the described purpose. The rendered images increased the confidence in diagnosing hydrosalpinx.

Prevalence of adenomyosis features in women scheduled for assisted reproductive treatment, using the Morphological Uterus Sonographic Assessment group definitions.

Studies that use standardized ultrasonographic criteria to diagnose adenomyosis in subfertile women are needed. These would improve the understanding of the disease burden and enable further studies on its impact on fertility and assisted reproductive treatment (ART) outcome. The aim of this study was to determine the prevalence of different features of adenomyosis in women scheduled for their first ART, diagnosed at two (2D) and three-dimensional (3D) transvaginal ultrasonography (TVUS) using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions. This was a prospective, observational cross-sectional study of subfertile women aged 25 to ≤39 years, that were referred to a university hospital for their first ART between December 2018 and May 2021. Of 1224 eligible women, 1160 women fulfilled the inclusion criteria and consented to participate in the study. All women underwent a systematic 2D and 3D TVUS examination. The primary outcome was the presence of direct and indirect features of adenomyosis, as proposed by the MUSA group. Secondary outcomes were to describe the ultrasonographic characteristics of the different features, as well as any difference in the diagnostics at 2D or 3D TVUS and any association with clinical characteristics such as endometriosis. At least one direct or indirect feature of adenomyosis was observed in 272 (23.4%, 95% confidence interval [CI] 21.0-25.9) women. Direct features that are pathognomonic for the disease were observed in 111 (9.6%, 95% CI, 7.9-11.3) women. Direct features were visible only at 3D TVUS in 56 (4.8%, 95% CI 3.6-6.1) women, that is, 56/111 (50.5%) of women with at least one direct adenomyosis feature. Direct features were more common in women with endometriosis (OR 2.8, 95% CI 1.8-4.3). We found than one in 10 women scheduled for ART had direct features of adenomyosis at ultrasound examination. The present study suggests that the use of 3D TVUS is an important complement to 2D in the diagnostics of adenomyosis. Our results may further improve the counseling of women scheduled for ART and enables future studies on the impact of different features of adenomyosis on subfertility, ART results and obstetric outcomes.

The expanding role of sonography for the diagnosis of deep infiltrating endometriosis: Results of a large case series.

To investigate the value of the sonographic identification of deep infiltrating endometriosis (DIE) in women presenting with complaints suggestive of DIE. Sonography findings were correlated with subsequent surgical exploration, and histologic verification. A retrospective observational case series was investigated to document the ability of the use of sonography to accurately detect the presence of deep infiltrating endometriosis. The clinical observations were performed consistent with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations for observational studies. Recognizing the real-world office setting for this may introduce the importance of the practical clinical aspects of diagnostic procedures in general. Three-dimensional transvaginal sonography was able to accurately identify deep invasive endometriosis in 92% of the 100 women subjectively complaining of the associated symptoms of endometriosis, who underwent sonography, surgical exploration, and pathologic analysis. Additional sonographic evidence of pelvic pathology was found during the course of this investigation, perhaps complementing other means for diagnosing endometriosis. Three-dimensional transvaginal sonography is a diagnostic tool that can effectively identify deep infiltrating endometriosis, which may otherwise go undetected and untreated. These findings should encourage the use of sonography for the detection of this subtype of endometriosis.

Comparative Study Between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy In The Diagnosis Of Uterine Cavity Abnormalities In Infertile Women

Comparative Study Between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy In The Diagnosis Of Uterine Cavity Abnormalities In Infertile Women

Intraoperative Three-Dimensional Transvaginal Ultrasound for Hysteroscopic Metroplasty: a Controlled Study.

This study aims to evaluate the role of intraoperative transvaginal three-dimensional ultrasound (3DUS) during hysteroscopic metroplasty. This is a prospective cohort of consecutive patients with septate uterus undergoing hysteroscopic metroplasty with intraoperative transvaginal 3DUS guidance compared to a historical control group of patients undergoing hysteroscopic metroplasty without 3DUS. We conducted our research in a tertiary care university hospital in Rome, Italy. This study involved nineteen patients undergoing 3DUS-guided hysteroscopic metroplasty for recurrent abortion or infertility compared to 19 age-matched controls undergoing metroplasty without 3DUS guidance. During hysteroscopic metroplasty, 3DUS was performed in the study group when the operator considered the procedure to be completed, according to standards of operative hysteroscopy. If 3DUS diagnosed a residual septum, the procedure was continued until a 3DUS diagnosis of a normal fundus was obtained. The patients were followed with a 3DUS performed 3months after the procedure. The numbers of complete resections (residual septum absent), suboptimal resections (measurable residual septum of less than 10mm), and incomplete resections (residual septum > 10mm) in the intraoperative 3DUS group were compared to the numbers in the control group with no intraoperative 3DUS. At follow-up, measurable residual septa were obtained in 0% of the patients in the 3DUS-guided group versus 26% in the control group (p = 0.04). Residual septa of > 10mm were obtained in 0% of the 3DUS group versus 10.5% in the control group (p = 0.48). Intraoperative 3DUS reduces the incidence of suboptimal septal resections at hysteroscopic metroplasty.

Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology.

The uterine junctional zone is the subendometrial area in the myometrium that contributes to peristalsis and aids in spermatozoa and blastocyst transport. Alterations in the appearance of the junctional zone on transvaginal sonography (TVS) or magnetic resonance imaging (MRI) are associated with adenomyosis. The lack of standardization of description of its appearance and ill-defined boundaries on both histology and imaging hamper understanding of the junctional zone and limit its role in the diagnosis of adenomyosis. The objectives of this review were to investigate the accordance in definition of the junctional zone across different diagnostic approaches and to examine how imaging findings can be linked to histological findings in the context of diagnosis of adenomyosis. A comprehensive literature review was conducted of articles describing the appearance on imaging and the histological structure of the uterine junctional zone. Our review suggests that the junctional zone is distinguished from the middle and outer myometrium by gradual changes in smooth-muscle cell density, extracellular space, connective tissue, water content and vascular properties. However, while the signal intensity from the junctional zone to the middle myometrium changes abruptly on MRI, the histopathological changes are gradual and its border may be difficult or impossible to distinguish on two-dimensional TVS. Moreover, the thickness of the junctional zone measured on MRI is larger than that measured on TVS. Thus, these two imaging modalities reflect this zone differently. Although a thickened junctional zone is often used to diagnose adenomyosis on MRI, the presence of adenomyosis can be described more accurately as interruptions of the junctional zone by endometrial tissue, which leads to direct signs on imaging such as subendometrial lines and buds on two- and three-dimensional TVS or bright foci on MRI. The histopathological criteria for diagnosis are based on enlargement of the uterus with severe adenomyosis, and might not reflect its early stages. Clinicians should be aware that findings on MRI cannot be extrapolated readily to ultrasound. An understanding of this is necessary when investigating the uterine junctional zone as a functional unit and the association between visualization of direct features of adenomyosis in the junctional zone and clinical symptoms. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

SDMS CME Credit – Comparison of Two-Dimensional Transvaginal Ultrasound, Three-Dimensional Transvaginal Ultrasound and Hysteroscopy to Diagnose in Patients with Abnormal Uterine Bleeding: A Retrospective Observational Study

SDMS CME Credit – Comparison of Two-Dimensional Transvaginal Ultrasound, Three-Dimensional Transvaginal Ultrasound and Hysteroscopy to Diagnose in Patients with Abnormal Uterine Bleeding: A Retrospective Observational Study

Three-dimensional transvaginal ultrasonography in the evaluation of diminished ovarian reserve and premature ovarian failure.

To explore the applicability of three-dimensional transvaginal ultrasonography (3D-TVS) in the evaluation of diminished ovarian reserve (DOR) and premature ovarian failure (POF). One hundred and twenty female patients, who received 3D-TVS in our hospital from January 2020 to March 2022, were included in the study. Based on sex hormone examination, 25 cases were DOR (DOR-group), 32 cases were POF (POF-group) and 63 cases had normal ovarian function (Normal-group). The 3D-TVS quantitative examination results of the three groups of patients were analyzed and compared. There was no significant difference between the DOR-group and POF-group regarding antral follicles count (AFC), ovarian volume (OV), vascularization index (VI), vascularization flow index (VFI) and flow index (FI) of left and right ovaries (p>0.05). Compared with the Normal-group, the 3D-TVS examination indexes of the DOR-group and POF-group were significantly lower, and the 3D-TVS examination results of the POF-group were significantly lower than those of the DOR-group (p<0.05). Using sex hormone examination as the gold standard, the diagnostic specificity of 3D-TVS for DOR was 80%, and the sensitivity and accuracy were 90% and 88% respectively; The diagnostic specificity of POF was 87.5%, the sensitivity and accuracy were 95.8% and 93.8% respectively. 3D-TVS can provide scientific guidance for the clinical diagnosis and evaluation of DOR and POF.

Evaluation of the Success of Hysteroscopic Uterine Septum Resection.

The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.

Retracted: Clinical Value of Three-Dimensional Transvaginal Ultrasound in Diagnosis of Endometrial Receptivity and Ovarian Function in Patients with Infertility.

[This retracts the article DOI: 10.1155/2022/8438131.].

Comparison of Two-Dimensional Transvaginal Ultrasound, Three-Dimensional Transvaginal Ultrasound and Hysteroscopy to Diagnose in Patients With Abnormal Uterine Bleeding: A Retrospective Observational Study

Objective: The principal objective was to compare the diagnostic accuracy of two-dimensional transvaginal ultrasonography (2D TVUS), three-dimensional transvaginal ultrasonography (3D TVUS), and hysteroscopy with histopathology in patients with abnormal uterine bleeding. Materials and Methods: Fifty patients were included and underwent the three imaging methods. The negative predictive value, positive predictive value, sensitivity, and specificity of the methods were calculated. Determination of endometrial pathology and endometrial polyps by measuring the endometrial thickness, volume, and uterine area was examined. Results: The complaint of menorrhagia was reported by 72.0% of participants. Histopathologically, 70.0% of the patients had endometrial polyps and leiomyoma being monitored. An endometrial polyp was detected in 58.0% of the patients by 2D TVUS, 80.0% by 3D TVUS, and 68.0% by hysteroscopy. While 2D TVUS demonstrated 65.71% accuracy in the detection of an endometrial polyp, 3D TVUS had an 80.0% accuracy, and hysteroscopy had a 77.77% accuracy. An endometrial polyp was detected when the uterine area was ≥237 mm2. If the endometrial thickness was over 10.5 mm, it was found to be related to an endometrial polyp. According to the volume measurements by 3D TVUS, the detection of an endometrial polyp was made with 96.4% sensitivity, provided that the pathology volume was ≥0.082 cm3. Conclusion: In this cohort of patients, 3D TVUS achieved a high sensitivity to detect abnormalities and could be considered as an initial diagnostic modality, prior to the surgery, and may rival invasive procedures, such as hysteroscopy.

Uterine niche is associated with adverse in vitro fertilization and intracytoplasmic sperm injection outcomes: a retrospective cohort study

To investigate the relationship between uterine niche and reproductive outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). A retrospective cohort study in the Reproductive Medicine Center of Tongji Hospital, Wuhan, China. A total of 2449 women with cesarean section history who underwent 2874 IVF/ICSI cycles between January 2015 and December 2019. A defect deeper than 2 mm under three-dimensional (3D) transvaginal sonography (TVS) or visible under hysteroscopy was defined as uterine niche. IVF/ICSI outcomes of the first embryo transfer were obtained by telephone interview 1 year regardless of fresh embryos or frozen-thawed embryos. Generalized estimating equations (GEE), logistic regression analyses, and propensity score matching were applied to clarify the relationship between uterine niche and IVF/ICSI outcomes. Primary outcome was live birth rate. Secondary outcomes were positive human chorionic gonadotropin (hCG) test results, clinical pregnancy rate, implantation rate, miscarriage rate and ectopic pregnancy rate. After excluding 48 cycles for uterine malformation, 18 cycles for chromosome abnormality, 281cycles for no available embryo or no embryo transfer, 5 cycles for oocyte donation and 7 cycles for loss of follow-up, we finally included 2231 women with 2515 cycles in our study. Compared with women without niche, women with niche had reduced live birth rate (18.99% vs. 31.51%, adjusted OR: 0.51, 95% CI: 0.34-0.77), positive hCG test rate (34.08% vs. 46.40%, adjusted OR: 0.61, 95% CI: 0.43-0.87), clinical pregnancy rate (29.05% vs. 42.25%, adjusted OR: 0.57, 95% CI: 0.39-0.82) and implantation rate (25.87% vs. 36.95%, adjusted OR: 0.53, 95% CI: 0.38-0.76). In all the sensitivity analyses, the niche group had an 7.28%-18.22% increase in miscarriage rate even not all of them were statistically significant. Uterine niche may have a detrimental effect on subsequent fertility of women with cesarean section history undergoing IVF/ICSI treatment. Practitioners should be noted that women with uterine niches may associated with adverse IVF/ICSI outcomes.

Value of transvaginal three-dimensional ultrasound in evaluating the curative effect of Yangmo decoction in the treatment of uterine adhesion.

Intrauterine adhesions (IUA) is the damage of the basal layer of the endometrium caused by various reasons, resulting in adhesion of the uterine muscle walls to each other, which is manifested as clinical symptoms such as spanomenorrhea, amenorrhea, and infertility. Hysteroscopic adhesiolysis (HA) is the main treatment, for patients with moderate or severe adhesion or angular adhesion, the incidence of postoperative adhesion is high. Traditional Chinese medicine "Yangmo decoction" can promote endometrial growth. Three-dimensional transvaginal ultrasonography (3D-TVUS) can judge IUA and evaluate uterine receptivity through three-dimensional imaging. This study aims to investigate the value of 3D-TVUS in judging the efficacy of Yangmo decoction in the treatment of intrauterine adhesions. The clinical data of patients who underwent HA at two different centers in department of Gynecology of Third Xiangya Hospital of Central South University and Changsha Jiangwan Hospital from January 2021 to August 2021 were retrospectively collected. A total of 275 eligible patients were included. According to the postoperative management measures, the selected patients were divided into two groups. Yangmo decoction group (n=138): the use of Yangmo decoction and uterine-shaped silicon stent post HA; Hormone group (n=137): the use of estrogen, progesterone and uterine-shaped silicon stent post HA. The preoperative general data, preoperative and postoperative 3D-TVUS parameters of the two groups were analyzed. The endometrial thickness of Yangmo decoction group was thicker than that of hormone group (P<0.001), the intercornual distance was wider (P=0.016), the endometrial echo was more homogeneous (P=0.018), the percentage of bilaterally visible tubal opening was higher (P<0.001), the endometrial morphology was better (P=0.012), and endometrial blood flow, endometrial motility and uterine motion were better in Yangmo decoction group than that in the hormone group (all P<0.001). The endometrial thickness, echo, blood flow, and peristalsis, the number of visible tubal opening, uterine motion, and the intercornual distance obtained by 3D-TVUS examination are important factors to evaluate the prognosis of postoperative drug treatment for IUA. 3D-TVUS is of great significance in evaluating the efficacy of Yangmo decoction in the treatment of IUA.

Clinical Value of Three-Dimensional Transvaginal Ultrasound in Diagnosis of Endometrial Receptivity and Ovarian Function in Patients with Infertility.

Objective A case-control study was conducted to explore the clinical value of three-dimensional transvaginal ultrasound in the diagnosis of endometrial receptivity (ER) and ovarian function in patients with infertility. Methods A total of 308 infertile women treated in our hospital from March 2020 to June 2021 were enrolled as the observation group, and another 300 women of childbearing age who underwent physical examination in the same period were enrolled as the control group. The clinical value of three-dimensional transvaginal ultrasound in ER in patients with infertility was analyzed by comparing the classification of endometrial and subendometrial blood perfusion, endometrial AUC value and Pi value, and subendometrial AUC value and Pi value. According to the number of oocytes obtained, the patients were assigned into the normal response group (182 cases, ≥5 oocytes) and the low response group (126 cases, <5 oocytes). The levels of some hormones, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and FSH/LH, were measured. Transvaginal ultrasonography was performed to detect ovarian volume (OV), antral follicle count (AFC), and peak flow rate of the ovarian interstitial artery (PSV). The peak of end-diastolic flow velocity (EDV) and other indexes were analyzed. The correlation between FSH level, FSH/LH, and ultrasound indexes was analyzed, and the ROC curve was established to analyze the value of transvaginal Doppler ultrasound in evaluating ovarian reserve function and predicting ovulation. Results There were significant differences in late proliferation type I and type III, ovulatory type II and type III (P < 0.05). There exhibited no significant difference in late proliferation type II, ovulation stage type I, and implantation window stage type I, type II, and type III (P > 0.05). Regarding the endometrial AUC and Pi values, the endometrial AUC and Pi values in the observation group were lower compared to the control group during late proliferation and ovulation (P < 0.05). There exhibited no significant difference in AUC and Pi (P > 0.05). Regarding the subintimal AUC and Pi values, the subintimal AUC and Pi values in the observation group were higher compared to the control group during late proliferation and ovulation (P < 0.05). There exhibited no significant difference in AUC and Pi during the implantation window (P > 0.05). There exhibited no significant difference in menarche age, age, body mass index, and menstrual cycle between the normal response group and the low response group (P > 0.05). The levels of EDV, OV, AFC, and PSV in the normal response group were higher compared to the low response group (P < 0.01). Compared with the low response group, the levels of FSH and FSH/LH in the normal response group were lower, but the levels of LH and E2 in the normal response group were higher (P < 0.05). The results of correlation analysis of FSH, FSH/LH, and ultrasound parameters between the normal response group and the low response group indicated that FSH was negatively correlated with E2, EDV, OV, AFC, and PSV in 308 infertile women (r = −0.817, -0.846, -0.707, -0.845, -0.911, P < 0.01), but it was positively correlated with FSH/LH (r = 0.714, P < 0.01). The ultrasound parameters of ovarian reserve function in the normal response group and the low response group were compared with the indexes that predicted ovulation. The results of ROC curve analysis indicated that the cutoff values of EDV, OV, AFC, and PSV were 4.141, 3.726, 4.106, and 13.944, respectively, the specificity of each index was higher than 90.00%, and the sensitivity was higher than 80.00% except PSV. Conclusion Transvaginal ultrasound can not only accurately evaluate the ER of infertile women but also directly observe follicular development and monitor ovulation, which is of high value in evaluating ovarian reserve function and predicting ovulation.

Comparison of diagnostic accuracy of three-dimensional transvaginal ultrasound and magnetic resonance imaging in the diagnosis of scar pregnancy.

Objectives:To compare the accuracy of three-dimensional transvaginal ultrasound and magnetic resonance imaging in the diagnosis of scar pregnancy.Methods:The records of 54 patients with scar pregnancy, who underwent three-dimensional transvaginal ultrasound and magnetic resonance imaging (MRI), from June 2015 to November 2021 were reviewed. Surgery / histopathology of operative findings were analyzed as gold standard to compare the diagnosis of the two examination methods.Results:The detection rate of scar pregnancy by three-dimensional transvaginal ultrasound was 94.44%, which was not significantly different from MRI (96.30%, P>0.05). The accuracy, specificity and sensitivity of transvaginal three-dimensional ultrasonography in the diagnosis of scar pregnancy were 94.44%, 66.67% and 96.08%, respectively, and were not significantly different from MRI, 96.30%, 50.00% and 98.08% (P>0.05). The detection rates of yolk sac, embryo and heart tube pulsation by three-dimensional transvaginal ultrasound were higher than those detected by MRI (P<0.05). The detection rates of intrathecal hemorrhage, scar infiltration and uterine hematocele by MRI were significantly higher compared to three-dimensional transvaginal ultrasound (P<0.05). There was no significant difference between the two methods (P>0.05).Conclusion:Both three-dimensional transvaginal ultrasound and MRI have good diagnostic efficacy in the diagnosis of scar pregnancy. Detection rates of scar pregnancy diagnostic criteria differ between the two methods, and if necessary, the two methods can be used together, to further improve the diagnostic accuracy of scar pregnancy.

Deep Learning-Based Three-dimensional Transvaginal Ultrasound in Diagnosis of Intrauterine Adhesion

This study was aimed to enhance and detect the characteristics of three-dimensional transvaginal ultrasound images based on the partial differential algorithm and HSegNet algorithm under deep learning. Thereby, the effect of quantitative parameter values of optimized three-dimensional ultrasound image was analyzed on the diagnosis and evaluation of intrauterine adhesions. Specifically, 75 patients with suspected intrauterine adhesion in hospital who underwent the hysteroscopic diagnosis were selected as the research subjects. The three-dimensional transvaginal ultrasound image was enhanced and optimized by the partial differential equation algorithm and processed by the deep learning algorithm. Subsequently, three-dimensional transvaginal ultrasound examinations were performed on the study subjects that met the standards. The March classification method was used to classify the patients with intrauterine adhesion. Finally, the results by the three-dimensional transvaginal ultrasound were compared with the diagnosis results in hysteroscope surgery. The results showed that the HSegNet algorithm model realized the automatic labeling of intrauterine adhesion in the transvaginal ultrasound image and the final accuracy coefficient was 97.3%. It suggested that the three-dimensional transvaginal ultrasound diagnosis based on deep learning was efficient and accurate. The accuracy of the three-dimensional transvaginal ultrasound was 97.14%, the sensitivity was 96.6%, and the specificity was 72%. In conclusion, the three-dimensional transvaginal examination can effectively improve the diagnostic efficiency of intrauterine adhesion, providing theoretical support for the subsequent diagnosis and grading of intrauterine adhesion.

Impact of selected risk factors on uterine healing after cesarean section in women with single-layer uterine closure: A prospective study using two- and three-dimensional transvaginal ultrasonography.

Modern obstetrics must meet many challenges, including long-term complications resulting from the presence of a uterine niche after cesarean section. To assess the impact of selected risk factors on the uterine healing process after cesarean section. The uterus was closed with a single-layer continuous suture covering the entire thickness of the myometrium, excluding the decidua. A prospective, case-controlled study was carried out at 2nd Department of Gynecology and Obstetrics, Wroclaw Medical University, Poland. Women who delivered by cesarean section at our Department were invited to undergo an ultrasonographic assessment of the cesarean section scar from 6 to 9 weeks after the procedure. In all cases, the uterus was closed with a single-layer continuous suture. The ultrasound examination of the niche was performed according to the modified Delphi protocol. The volume of the niche was calculated and a 3D model was created. The obtained data were analyzed with clinical information from the maternal medical history and the course of the pregnancy. A total of 204 patients participated in the study. Five patients had a residual myometrial thickness (RMT) <2.2 mm and 35 had a residual myometrial thickness to adjacent myometrial thickness ratio (RMT/AMT) ≤0.5. In 45% of women, pregnancy course was complicated by gestational diabetes mellitus (GDM), gestational hypertension and hypothyroidism. The cervical canal was colonized with pathogenic flora in 22% of women. No correlation between maternal and gestational age at delivery, presence of medical complications during pregnancy, colonization of the cervical canal, and presence of niche and its parameters were found. Our study revealed that the selected risk factors, such as systemic diseases during pregnancy and in the maternal medical history, as well as the colonization of the cervical canal, have no impact on uterine scar healing in women undergoing single-layer uterine closure spanning the entire thickness of the myometrium, excluding the decidua.

Clinical application of three-dimensional transvaginal ultrasonography in the diagnosis of intrauterine adhesions.

ObjectiveThe present study aimed to evaluate the diagnostic accuracy of three-dimensional transvaginal ultrasonography (3D-TVS) for intrauterine adhesions (IUA).MethodsWe performed a retrospective cohort study. A total of 500 women aged 19 to 46 years with uterine lesions who received treatment from the Department of Obstetrics and Gynecology were enrolled. Endometrial 3D imaging was conducted to obtain the display plane and 3D-TVS parameters. Patients also underwent hysteroscopy for a definitive diagnosis.ResultsFor diagnosing IUA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of 3D-TVS were 98.8%, 90.8%, 91.4%, 98.7%, and 94.8%, respectively. For diagnosing a submucosal myoma, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 88.2%, 97.9%, 88.2%, 97.9%, and 96.4%, respectively. For diagnosing endometrial polyps, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 94.7%, 96.8%, 92.9%, 97.7%, and 96.2%, respectively.ConclusionsBefore hysteroscopy, 3D-TVS, as a method of screening, has great value for comparing differences before and after treatment, and for evaluating therapeutic effects.

Uterine niche after cesarean section: a review of diagnostic methods.

The consequence of each cesarean section is the uterine scar formation. In some patients, uterine scar after cesarean section heals incompletely and as a result, the uterine niche is formed. Most of the small niches are asymptomatic, but the large cesarean scar niches in nonpregnant women may cause a cesarean scar syndrome, which manifest itself as abnormal uterine bleeding, dysmenorrhea and secondary infertility. Among pregnant women, the presence of large niches may be associated with potentially life-threatening consequences, such as cesarean scar dehiscence and uterine rupture, placenta accreta spectrum disorders, placenta previa, cesarean scar pregnancy. Due to the possibility of dangerous consequences related to the occurrence of a uterine niche, in recent years many studies have focused on the term of cesarean scar niche, its risk factors, diagnostic methods and treatment options. Uterine niche can be examined using two- or three-dimensional transvaginal ultrasonography, as well as two- and three-dimensional sonohysterography, hysterosalpingography, hysteroscopy or magnetic resonance imaging. However, neither of the above diagnostic method is considered as the "gold standard". There are no unambiguous guidelines on some aspect concerning the diagnosis of cesarean scar niche. The aim of this study is to analyze and describe the diagnostic methods of cesarean section niche.