Comparative Study between 3D Ultrasound & Power Doppler versus Hysteroscopy in Diagnosis of Cavitary Uterine Lesions

Abstract

Background: Structural pathologies in the uterine cavity such as Müllerian duct anomalies (MDAs) and intrauterine lesions (fibroids, polyps, synechiae) may have important roles in subinfertility, implantation failure and adverse pregnancy outcomes. Various modalities such as hysterosalpingography (HSG), sonography, laparoscopy and hysteroscopy are used in the evaluation of MDAs and intrauterine lesions. Three-dimensional ultrasound (3DUS) has been introduced as a non-invasive technique that permits the obtaining of anatomic images of endometrium and myometrium, accurate depiction of the septate uterus, and even the measurement of septal height and thickness. Aim of the work: The aim of the study is to assess diagnostic accuracy of 3D ultrasound with power Doppler compared with hysteroscopy in detecting uterine cavity abnormalities in infertile women considering that hysteroscopy is the gold standard. Patients and Methods: This prospective study was conducted at Ain shams university maternity hospital. A total of 379 infertile women suspected with uterine cavity lesions by 2D/US included in the study. Patients were included in the study according to the following inclusion criteria: Female with suspected Mullerine lesions in 2D US and exclusion criteria: contraindication for hystreoscopy (pelvic infection-endomertial cancer-excessive bleeding –sever vaginitis). Results: There was significant high agreement between 3D US and Hysteroscopy regarding overall diagnosis of intracavitary lesions with (sensitivity 92.2%, specificity 100%, PPV 100%, NPV 89.5%, DA 95.6%). Regarding the power Doppler flow mapping characteristics, Single vessel was significantly most frequent in polyp. Rim-like vessel was significantly most frequent in fibroid. No significant difference according to Hysteroscopy diagnoses regarding multiple vessels. Conclusion: As evident from the current study, as regard correlation between 3D ultrasound with power Doppler compared with hysteroscopy, 3D US with power Doppler flow mapping are a valuable tool for diagnosing focal endometrial pathology and is useful in distinguishing between focal endometrial lesions such as submucosal fibroids and endometrial polyps with results comparable to hysteroscopy.