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Abstract
Introduction:Abnormal uterine bleeding is a common but complicated symptom with lots of causes. One of the important advantages of 3D ultrasound is obtaining the coronal (frontal) view of the uterus. Introducing the multislice display, three-dimensional ultrasound has joined the much desired image display possibilities of MRI and CT.
Material and methods: One hundered cases recruited from the outpatient gynaecological clinic, Kasr El-Ainy Hospitals, were included in the study. All cases presented with abnormal uterine bleeding. 2D ultrasound was done for all patients. 3D volumes were then acquired and the coronal plane was reconstructed. 3DXI was then applied in all 3 planes. The endometrium and surrounding myometrium were evaluated. The patients were then subjected to abdominal or vaginal hysterectomy. Surgical specimens were evaluated grossly and microscopically. Results: Sensitivity, PPV and NPV and accuracy of 3D and 3DXI were higher than 2D U/S in cases of polyps and endometrial carcinoma and lower in cases of fibroids. Specificity of 3D, 3DXI was higher than 2D U/S in cases of polyps.All values of 2D, 3D, DXI were equal in cases of adenomyosis, endometrial hyperplasia and ovarian cysts.The overall accuracy of 3D and 3DXI was 95.57 % while that of 2D was 94.73%. Conclusions: A large sized uterus was a limitation for 3D and 3DXI ultrasound assessment(16-20 weeks). 3D and 3DXI were more accurate than 2D in describing the exact site and grade of submucous fibroids. Both were accurate in determining the exact site in relation to the uterine cavity. In cases of endometrial carcinoma with positive myometrial invasion, 2D U/S diagnosed invasion by disruption of the endometrial-myometrial junction at the fundus, anterior and posterior walls. 3D and 3DXI in their various views showed the relation between the endometrium and myometrium not only at the these sites, but also at the cornual angles and lateral walls,. 3DXI was even more accurate in diagnosing or negating the presence of invasion, as it allowed the study of the volume with precision in the 3 orthogonal planes with cuts up to 4mm apart.
Recommendations: 3D U/S is recommended for accurate assessment of the site and grade of submucous fibroids. 3D U/S is recommended for accurate assessment of endometrial polyps. 3D and 3DXI are more accurate than 2D in diagnosing and negating the presence of myometrial invasion in endometrial carcinoma. 3DXI may be compared with MRI in future studies in cases of endometrial carcinoma.