Diagnostic value of three-dimensional saline infusion sonohysterography in the evaluation of the uterus and uterine cavity lesions

Abstract

PurposeThe purpose of this review is to illustrate and discuss the seldom used technique of three-dimensional (3D) saline infusion sonohysterography (SIS) based on instillation of sterile saline through a catheter into the uterus under real-time vaginal transducer observation for assessment of the endometrial cavity.Material and methodsThe cases for this pictorial review were selected from the imaging material collected at the Ultrasound Unit, Clinical Imaging Department, Women’s Hospital of Hamad Medical Corporation during a seven-year period from 2011 to 2017. This was a retrospective collection of 216 consecutive cases that underwent two-dimensional (2D) and 3D SIS for evaluation of the uterine cavity, followed by verification of results with histopathology. An open-sided speculum is inserted into the vagina. An intrauterine catheter is then threaded into the endometrial cavity. After that, the speculum is removed carefully, and a vaginal transducer is inserted. Using a 60-ml syringe attached to the catheter, saline solution is instilled under direct real-time observation (2D SIS). Subsequently, reconstruction of the three-dimensional anatomy of the intrauterine cavity is performed.Pictorial reviewThe review presents the most common indication for SIS, like abnormal bleeding in pre- and postmenopausal patients. SIS allows us to distinguish between focal lesions and global endometrial thickening. SIS should be supported as a second-line diagnostic procedure for abnormal uterine bleeding, when findings from transvaginal ultrasound are inconclusive.ConclusionsThe addition of 3D techniques to SIS procedure helps in the distinction between endometrial and myometrial lesions, also it facilitates delineation of uterine anatomy, resulting in more precise and accurate diagnosis.

Gynecologic Teleultrasound and COVID‐19

“…29 Three‐dimensional ultrasonography has huge potential for evaluating infertile patients, performing difficult procedures under guidance, and studying patients with abnormal uterine bleeding, hydrosalpinges, and cancer. 30 Also, pelvic US should be a real‐time exam to reap the benefit of scanning the patients with the vaginal probe using 2D and potentially also 3D Doppler evaluation to be added when needed. 31 , 32 , 33 While capturing and recording and electronically transmitting 3D volumes for remote evaluation by manipulating their content is possible, it seems less ideal demanding technologic know‐how.…”

“…The coronal plane of the uterus is only visible when reconstructed from a volume and is key to imaging the uterus for indications such as uterine anomalies, IUD positioning, locations of fibroids and polyps 29 . Three‐dimensional ultrasonography has huge potential for evaluating infertile patients, performing difficult procedures under guidance, and studying patients with abnormal uterine bleeding, hydrosalpinges, and cancer 30 . Also, pelvic US should be a real‐time exam to reap the benefit of scanning the patients with the vaginal probe using 2D and potentially also 3D Doppler evaluation to be added when needed 31–33 .…”

Features of uterine cavity in women with extragenital disorders and abnormal uterine bleedings

“…To clarify the nature of small intrauterine pathology (small polyps of the endometrium, submucous myomatous nodes), ultrasound is used with the infusion of saline into the uterine cavity. Usually this image is only two-dimensional, but now there is a technical possibility of a three-dimensional image for a more accurate determination of the type of abnormality [11][12][13][14][15]. This method is also used to determine the need for such invasive diagnostic method as hysteroscopy [16].…”

“…In doubtful cases, a targeted biopsy can be performed using hysteroscopy to exclude false negative results from a blind biopsy [20]. Today, hysteroscopy has become a simpler, safer outpatient procedure that is well tolerated by most patients [15,[21][22][23].…”

Accuracy of Three-Dimensional Saline Infusion Sono-Hysterography Versus Diagnostic Hysteroscopy in Diagnosis of Uterine Cavity Lesions

“…SIS allows radiologist to differentiate between focal and disperse endometrial pathologic conditions. It is less costly, less complex, & takes less time to identify & measure intra cavitary abnormalities than hysteroscopy [5] .…”