The purpose of this study was to investigate the potential value of three-dimensional ultrasound for the assessment of normal uterine anatomy and the diagnosis of congenital uterine anomalies. A total of 61 patients with a history of recurrent miscarriage or infertility and who had previously been investigated by hysterosalpingography were recruited into the study. They first underwent a conventional two-dimensional transvaginal ultrasound scan. At the end of the examination, three-dimensional ultrasound volumes were recorded and stored in the machine computer memory. The examination of planar reformatted sections was than used for the assessment of uterine morphology and the diagnosis of congenital anomalies. On three-dimensional scanning, the most useful plane was a transverse section through the whole length of the uterus from the fundus to the cervix. Hysterosalpingography showed a normal uterus in 44 (72.1%) patients, an arcuate uterus in nine (14.8%) and a major fusion defect in three cases (4.9%). Five patients (8.2%) had large fibroids which were distorting the uterine cavity. Good-quality two-dimensional ultrasound images were obtained in 60 (98.3%) and three-dimensional images in 58 (95.1%) cases. All poor images were caused by large uterine fibroids. Comparison between hysterosalpingography and ultrasound showed that five false-positive diagnoses of arcuate uterus and three of major uterine anomalies were made on two-dimensional scans. Three-dimensional ultrasound agreed with hysterosalpingography in all cases of arcuate uterus and major congenital anomalies. The ability to visualize both the uterine cavity and the myometrium on a three-dimensional scan facilitated the diagnosis of uterine anomalies and enabled easy differentiation between subseptate and bicornuate uteri.
We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology. A total of 103 patients with a history of postmenopausal bleeding were recruited into the study. Patients who were taking hormone replacements therapy or other hormonal preparations with a known effect on the endometrium were excluded. Each patient underwent three-dimensional ultrasonography for the measurement of endometrial thickness and volume. In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage. Endometrial cancer was diagnosed in 11 patients. The mean endometrial thickness was 29.5 mm (SD 12.59) and the mean volume was 39.0 ml (SD 34.16). In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps. The endometrial thickness and volume in patients with benign pathology was 15.64 mm (SD 5.26) and 5.47 ml (SD 6.32), respectively. In 71 patients with atrophic or normal endometrium the mean thickness and volume was 5.29 mm (SD 3.97) and 0.91 ml (SD 1.71), respectively. Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer. The optimal cut-off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 83.3% and positive predictive value of 54.5%. With the cut-off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 91.7%. Both the thickness and volume were higher in patients with advanced and less differentiated cancers. The measurements of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women.
The aim of this study was to investigate the prevalence of congenital uterine anomalies in 1046 women attending gynaecological ultrasound clinics for a variety of indications. Using three-dimensional ultrasound, anomalies were found in 55 women (5.4%), including 32 (3.1%) with an arcuate uterus and 23 (2.3%) with major anomalies. The prevalence of uterine anomalies was similar to the findings in women undergoing elective sterilisation, but lower than in studies of women with recurrent miscamage.The true prevalence of congenital uterine anomalies in the general population is not known; previous studies reporting on uterine anomalies examined women with a history of infertility or recurrent miscarriage. One of the reasons for this pre-selection of study populations was the invasive nature of the tests for the examination of the uterus including hysterosalpingography, hysteroscopy and laparoscopy. Three-dimensional ultrasound, that has recently been introduced into clinical practice, enables noninvasive and accurate diagnosis of congenital uterine anomalies'. We used this new technique to determine the prevalence of congenital anomalies in women attending gynaecological ultrasound unit for a variety of indications. MethodsThis was a prospective observational study involving pelvic ultrasound examination in 1046 women attending our gynaecological ultrasound unit. The women were either self-referred for ovarian cancer screening or they were referred for a scan by their consultant gynaecologists or general practitioners because of suspected pelvic abnormalities (Table 1). Exclusion criteria were pregnancy, previous hysterectomy or myomectomy, and referral for investigation of infertility or recurrent miscarriages.Each woman first underwent a conventional B-mode transvaginal ultrasound examination using a 7.5 MHz mechanical probe (Combison 530 3D Voluson, Kretztechnik, Zipf, Austria). The longitudinal axis of the uterus, from the isthmus to the fundus, was first defined and then a series of transverse sections were obtained. When there was any duplication or splitting of the endometrial echo, fusion anomalies were suspected and in these women a three-dimensional ultrasound scan was used to determine the diagnosis. In the three-dimensional ultrasound examination the uterus was visualised in a longitudinal plane and a three-dimensional volume was generated by the automatic rotation of the mechanical transducer through 360". The volumes, in the shape of truncated cones with a depth of 4.3-8.6 cm and a vertical angle of 90", were analysed on-line using the technique of computer-generated planar reformatted sections. Although the images were similar to those of conventional two-dimensional sonography, with this technique it is possible to obtain an unlimited number of sections through the uterus which cannot be seen on routine scans. The acquisition of three-dimensional volumes is about 10 s, but complete analysis is achieved in 3 to 10 minutes.Congenital uterine anomalies were classified according to the criteria of the Am...
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