Role of Three-Dimensional Ultrasound in Gynecology

Abstract

Three-dimensional ultrasound (3D USG) is a fast-evolving imaging technique that holds a great potential for use in gynecology. Its sensitivity and specificity is reported to be close to 100 % for diagnosing congenital uterine anomalies, comparable with those of magnetic resonance imaging (MRI) and laparoscopy. With 3D USG, a coronal view of the uterus can be obtained, clearly outlining the external contour of the uterus and providing accurate information about the shape of the cavity. Although 3D USG may not perform well in thin endometria, combining it with saline infusion sonography (SIS) overcomes this problem. Research shows that 3D USG is more sensitive and specific than two-dimensional ultrasound (2D USG) in defining and mapping uterine lesions, such as fibroids, adenomyosis, and intrauterine synechia. In cases of suspected malignancy, 3D USG is mainly used in the initial evaluation of patients. Measuring various indices and mapping vascular architecture with 3D power Doppler have been proposed for evaluating adnexal masses. Although some studies raised hope, no consensus is reached about its use, success, and limitations. In urogynecology, translabial 3D USG is proved to be a valuable tool, as it provides instant access to the axial plane, which clearly depicts the relationship of the vagina, urethra, rectum, and the muscular pelvic floor. Studies report no significant differences between translabial 3D USG and MRI measurements for evaluation of the pelvic floor. In conclusion, adding 3D USG to routine gynecological workup can be beneficial for clinicians, as it provides fast and accurate results in a relatively cost-effective setting.

Clinical Value of 3‐Dimensional Ultrasound in Gynecology

“…Various cost comparison analyses have been performed with other imaging modalities (eg, MRI) in other medical specialties. It appears that 3D TVUS may often be a preferred imaging modality in the specialty of obstetrics and gynecology . Therefore, the ease with which 3D TVUS can be used, with respect to the patient and provider, and what the cost analyses have shown make it imperative for gynecologic practitioners to learn its principles and apply these services to patient care.…”

Role of three dimensional ultrasound in uterine anomalies - 3D assessment of cervix in septate uteri

“…They may be found incidentally, or during work up for infertility and recurrent pregnancy loss. The estimated prevalence is 0.4% (0.1-3%) in the general population, 13.3% in infertile patients and between 3% and 38% in patients with repeated spontaneous miscarriages. 1 Congenital uterine anomalies may be initially suspected with two dimensional ultrasonography (2D US) or on hysterosalpingography (HSG) done at routine infertility workup.…”

“…This view clearly outlines the external contour of the uterus, as well as provides accurate information about the shape of the uterine cavity. 12,13 It replaces the need for invasive diagnostic hysterolaparoscopic procedures and the surgeon can plan directly a therapeutic procedure as shown by El Huseiny et al in their study. 1 Septate uterus is the most common among the Mullerian anomalies as reported by Chan et al and is also evident from our study results.…”

“…Hysteroscopy and laparoscopy may then be used only for therapeutic indications. 13 Implementation of 3D ultrasound in routine workup of infertility would improvise in optimising the appropriate surgical correction and further would improve intraoperative orientation. Ludwin et al used real-time 3D transrectal US during hysteroscopic metroplasty for assessing the length of uterine septum left behind.…”

“…It is non-invasive, fast, reproducible, readily available, relatively cost-effective tool and has now surpassed other modalities in the detection of congenital mullerian duct anomalies. 2,13,26 Though the advantage of 3D ultrasound is well documented in the past, it has not been put in routine practice for the workup of infertility and recurrent pregnancy loss. This paper apart from giving the significance of transvaginal 3D ultrasound in detecting uterine anomalies, it also highlights the 3D transvaginal assessment of cervix in double uterine cavitary abnormalities.…”