Three Dimentional Transvaginal ultrasound in the assessment of uterine lesions: When do we really need it?

Objective: To evaluate the use of Transvaginal 3D U/S in the assessment of uterine pathology and uterine cavity abnormalities. Materials and methods: We included 65 patients in our study, age range between 21-47. The main complaint of these patients was either vaginal bleeding, reproductive failure, recurrent abortion or infertility. Procedures Done were:-2D TVS -3D TVS for all cases -HSG -Sonohysterography using saline - Hysteroscopy -Laparoscopy done only in uterine cavity abnormalities. Results: 65 cases were examined by both Transvaginal 2D and 3D U/S. 9 cases showed normal uterine cavity and no uterine pathology. Twenty nine cases had myomas either single or multiple From the 29 cases, 8 cases had submucus myomas. There were 7 cases had endometrial polyps, 12 cases had thickened endometrium. 6 cases had uterine cavity anomalies (septate or bicornuate). Two cases had intrauterine adhesions. There were 4 cases (2 cases with Mullerian anomalies both were septate uterus and 2 cases with intrauterine adhesions) all were diagnosed by Transvaginal 3D U/S, while being missed by 2D U/S (4 false negative cases). 2 cases of endometrial polyps were missed by HSG and diagnosed by Transvaginal 3D U/S (-2 false negative cases). Transvaginal 3D U/S correlated well with HSG and hysteroscopy in the diagnosis of Mullerian anomalies however with an additional information concerning the visualization of the surrounding myometrium and the accurate differentiation between septate and Bicornuate uterus. Conclusion: TVS is an excellent tool that provides valuable information in investigating the uterine cavity abnormalities. 3D TVS allows surface and volume rendering that can produce photographic images. It is much advantageous than HSG and Hysteroscopy in the differentiation between different types of uterine anomalies. It is of great value in delineating with certain the exact position of the submucous myomas or endometrial polypi in relation to the cavity. It is believed that, in the near future, 3D U/S equipment will be less expensive, which will allow its wide spread application.