Three-dimensional ultrasonography in the evaluation of the uterine cavity

Objective: To evaluate the use of three-dimensional transvaginal ultrasound (3D TVS) in the assessment of uterine cavity pathology and uterine congenital anomalies.
Materials and methods: One hundred and twenty three patients were studied. All cases were subjected to 2D TVS, 3D TVS and hysterosalpingography (HSG). Hysteroscopy / Laparoscopy were done for all patients to whom ultrasound and radiology results were compared.
Results: Out of 123 cases studied, 102 were found to have: a. uterine cavity anomalies (n=38, Group I), b. uterine myomas, and c. polyps (n=52, Group II) and intrauterine adhesions (n=12, Group III). In Group I, sensitivity, specificity and predictive values were higher for 3D TVS compared to 2D TVS or HSG but comparable to both techniques combined. Also, the positive and negative likelihood ratios were strong and comparable for 3D TVS and 2D TVS + HSG. In Group II, 3D TVS showed highest sensitivity, specificity and predictive values which were similar to 2D TVS + HSG but higher than each technique alone. In Group III, all tests showed low sensitivity and positive predictive value. The negative likelihood ratio was poor for all methods.
Conclusions: The use of 3D TVS is a valuable non-invasive method for assessment of uterine cavity pathology and is more useful than HSG and 2D TVS combined in cases of uterine anomalies, submucous myomas and polyps. However, its value in the assessment of intrauterine adhesions is limited.

Keywords
Uterus, uterine cavity, evaluation, ultrasound, three-dimensional, 3D, sonography