The role of 3-dimensional ultrasound for the diagnosis of congenital uterine anomalies

Efraim Zohav, Yaakov Melcer, Ilan Tur-Kaspa, Jacob Rabinson, Eyal Y. Anteby, Raoul Orvieto

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DOI: 10.4236/ojog.2011.14047                

Abstract

Objectives: To demonstrate the value of 3-dimensional (3-D) ultrasound (US) in the diagnosis of congenital uterine anomalies. Methods: Fifty one infertile patients referred to our US unit during 12 years period, with suspected diagnosis of congenital uterine anomalies by previous HSG or 2D US examinations, were evaluated by transvaginal 3-D US. The 3-D US diagnoses were compared to the initial HSG diagnosis, and to hysteroscopic evaluation when performed. Results: 3-D scan confirmed the initial HSG diagnosis in 27 out of 51 (52.9%) women. The concordancy rates between the initial diagnosis by HSG and 3-D US results were 30.4% for bicornuate uterus; 75% for arcuate uterus; 83% for septate uterus; and 80% for unicornuate uterus. Of the 13 cases with normal HSG and suspicious 2-D US, 30.8% were found to be normal by 3D sonography. In cases where hysteroscopy was done, the results were 100% in concordance with the 3-D US evaluations. Conclusions: 3-D US is an accurate test for the assessment of uterine congenital anomalies. Its ability to concomitantly visualized, the external uterine contour with the uterine cavity on the same coronal plan, makes this noninvasive, easy to perform test the procedure of choice for the diagnosis of uterine anomalies.

Keywords

Mullerian Anomalies; 3-Dimensional (3-D) Ultrasonography; Hysterosalpingography; Hysteroscopy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Buttram, V.C. and Gibbons, W.E. (1979) Mullerian abnormalities: A proposed classification and analysis of 144 cases. Fertility and Sterility, 32, 40-46.
[2]	Byrne, J., Nussbaum-Blask, A., Taylor, W.S., Rubin, A., Hill, M., O’Donnell, R. and Shulman, S. (2000) Prevalence of Mullerian duct anomalies detected at ultrasound. American Journal of Medical Genetics, 94, 9-12. doi:10.1002/1096-8628(20000904)94:1<9::AID-AJMG3>3.0.CO;2-H
[3]	Ashton, D., Amin, H.K., Richart, R.M. and Neuwirth, R.S. (1988) The incidence of asymptomatic uterine anomalies in women undergoing transcervical tubal sterilization. Obstetrics Gynecology, 72, 28-30.
[4]	Acien, P. (1997) Incidence of Mullerian defects in fertile and infertile women. Human Reproduction, 12, 1372-1376.
[5]	Stampe Sorensen, S. (1988) Estimated prevalence of Mullerian duct anomalies. Acta Obstetricia et Gynecologica Scandinavica, 67, 441-445. doi:10.3109/00016348809004257
[6]	Stray-Pedersen, B. and Stray-Pedersen, S. (1984) Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. American Journal of Obstetrics and Gynecology, 148, 140-146.
[7]	Raga, F., Bauset, C., Remoh’I, J., Bonilla-Musoles, F., Simon, C. and Pellicer, A. (1997) Reproductive impact of congenital Mullerian anomalies. Human Reproduction, 12, 2277-2281. doi:10.1093/humrep/12.10.2277
[8]	Makino, T., Hara, T., Oka, C., Toyoshima, K., Sugi, T., Iwasaki, K., Umeuchi, M. and Iizuka, R. (1992) Survey of 1120 Japanese women with a history of recurrent spontaneous abortions. European Journal of Obstetrics and Gynecology and Reproductive Biology, 44, 123-130. doi:10.1016/0028-2243(92)90057-6
[9]	Clifford, K., Rai, R., Watson, H. and Reagan, L. (1994) An informative protocol for the investigation of recurrent miscarriage: Preliminary experience of 500 consecutive cases. Human Reproduction, 9, 1328-1332.
[10]	Tur-Kaspa, I., Gal, M., Hartman, M., Hartman, J. and Hartman, A. (2006) A prospective evaluation of uterine abnormalities by saline infusion sonography (SIS) in 1009 women with infertility or abnormal uterine bleeding. Fertility and Sterility, 86, 1731-1735. doi:10.1016/j.fertnstert.2006.05.044
[11]	Reute, K.L., Daly, D.C. and Cohen, S.M. (1989) Septate versus bicornuate uteri: Errors in imaging diagnosis. Radiology, 172, 749-752.
[12]	Steiner, H., Staudach, A., Spitzer, D. and Schaffer, H. (1994) Three-dimensional ultrasound in obstetrics and gynecology: Technique, possibilities and limitations. Human Reproduction, 9, 1773-1778.
[13]	Jurkovic, D., Giepel, A., Gruboeck, K., Jauniaux, E., Natucci, M. and Campbell, S. (1995) Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: A comparison with hysterosalphingography and two dimensional sonography. Ultrasound Obstetrics Gynecology, 5, 233-237. doi:10.1046/j.1469-0705.1995.05040233.x
[14]	Raga, F., Bonilla-Musoles, F., Blanes, J. and Osborne, N.G. (1996) Congenital mullerian anomalies: Diagnostic accuracy of three-dimensional ultrasound. Fertility and Sterility, 65, 523-528.
[15]	Nicolini, U., Bellotti, M., Bonazzi, B., Zamberletti, D. and Candiani, G.B. (1987) Can ultrasound be used to screen uterine malformations? Fertility and Sterility, 47, 89-93.
[16]	Caliskan, E., Ozkan, S., Cakiroglu, Y., Sarisoy, H.T., Corakci, A. and Ozeren, S. (2010) Diagnostic accuracy of real-time 3D sonography in the diagnosis of congenital Mullerian anomalies in high-risk patients with respect to the phase of the menstrual cycle. Journal of Clinical Ultrasound, 38, 123-127.
[17]	Pellerito, M.S., McCarthy, S.M., Doyle, M.B., Glickman, M.G. and DeCherney, A.H. (1992) Diagnosis of uterine anomalies: Relative accuracy of MR imaging, endovaginal sonography and hysterosalpingography. Radiology, 183, 795-800.
[18]	Fedelee, L., Dorta, M., Brioschi, D., Massari, C. and Candiani, G.B. (1989) Magnetic resonance evaluation of double uteri. Obstetrics Gynecology, 74, 844-847.
[19]	Wu, M.H., Hsu, C.C. and Huang, K.E. (1997) Detection of congenital mullerian duct anomalies using three-dimensional ultrasound. Journal of Clinical Ultrasound, 25, 487-492. doi:10.1002/(SICI)1097-0096(199711/12)25:9<487::AID-JCU4>3.0.CO;2-J
[20]	Mohamed, M., Momtaz, M.D., Alaa, N., Ebrashy, M.D., Ayman, A. and Marzouk, M.D. (2007) Three-dimensional ultrasonography in the evaluation of the uterine cavity. MEFS Journal, 12, 41-46.
[21]	Ghi, T., Casadio, P., Kuleva, M., Perrone, A.M., Savelli, L., Gianchi, S., Pelusi, C. and Pelusi, G. (2009) Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertility and Sterility, 92, 808-813. doi:10.1016/j.fertnstert.2008.05.086
[22]	Alc’azar, J.L. (2005) Three-dimensional ultrasound in gynecology: Current status and future perspectives. Current Women’s Health Review, 1, 1-14. doi:10.2174/1573404052950221
[23]	Whitehouse, G.H. and Wright, C.H. (1992) Imaging in gynaecology. In Grainger, R. G., and Allison, D. J., Eds., Diagnostic Radiology, 1825-1853.
[24]	Sorensen, S.S. (1987) Hysteroscopic evaluation and endocrinological aspects of women with mullerian anomalies and oligomenorrhea. International Journal of Fertility, 32, 445-452.
[25]	Bermejo, C., Martínez Ten, P., Cantarero, R., Diaz, D., Pérez Pedregosa, J., Barrón, E., Labrador, E. and Ruiz López, L. (2010) Three-dimensional ultrasound in the diagnosis of Mullerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstetrics Gynecology, 35, 593-601. doi:10.1002/uog.7551