Ultrasound screening for congenital uterine anomalies.

The aim of this study was to investigate the prevalence of congenital uterine anomalies in 1046 women attending gynaecological ultrasound clinics for a variety of indications. Using three-dimensional ultrasound, anomalies were found in 55 women (5.4%), including 32 (3.1%) with an arcuate uterus and 23 (2.3%) with major anomalies. The prevalence of uterine anomalies was similar to the findings in women undergoing elective sterilisation, but lower than in studies of women with recurrent miscarriage.

The diagnostic value of endometrial thickness and volume measurements by three-dimensional ultrasound in patients with postmenopausal bleeding.

We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology. A total of 103 patients with a history of postmenopausal bleeding were recruited into the study. Patients who were taking hormone replacements therapy or other hormonal preparations with a known effect on the endometrium were excluded. Each patient underwent three-dimensional ultrasonography for the measurement of endometrial thickness and volume. In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage. Endometrial cancer was diagnosed in 11 patients. The mean endometrial thickness was 29.5 mm (SD 12.59) and the mean volume was 39.0 ml (SD 34.16). In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps. The endometrial thickness and volume in patients with benign pathology was 15.64 mm (SD 5.26) and 5.47 ml (SD 6.32), respectively. In 71 patients with atrophic or normal endometrium the mean thickness and volume was 5.29 mm (SD 3.97) and 0.91 ml (SD 1.71), respectively. Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer. The optimal cut-off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 83.3% and positive predictive value of 54.5%. With the cut-off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 91.7%. Both the thickness and volume were higher in patients with advanced and less differentiated cancers. The measurements of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women.

Selection and identification of standard cardiac views from three-dimensional volume scans of the fetal thorax.

The feasibility of fetal echocardiographic examination using three-dimensional ultrasonography was investigated in 54 healthy pregnant women with uncomplicated pregnancies between 17 and 37 weeks of gestation. In 46 cases (85.2%), good quality three-dimensional volumes of the fetal heart were obtained from both apical and lateral four-chamber views. By reslicing apical volumes, the reformatted sections of the long axis view of the left ventricle and the aortic crest were seen in 40 (87%) and 38 (83%) of 46 cases, respectively. The short axis was seen in 26 (57%) and ductal arch in 30 (65%) cases. The examination of lateral volumes was much less successful. The short axis was seen in 11 (24%) cases, and the aortic crest in 22 (48%), whereas the analysis of the longitudinal views was not possible. The best results were obtained at a gestational age between 22 and 27 weeks. Three-dimensional fetal echocardiography allowed the examination of the four chambers of the heart and left outflow tract during the late second trimester. The technique may become useful for the screening and diagnosis of congenital cardiac defects in the future.

Ultrasound features of normal early pregnancy development.

Recent advances in ultrasound imaging have improved the assessment of early pregnancy development. The gestational sac can be detected within the uterine cavity as early as 4 weeks and 3 days after the last menstrual period. High resolution images of early embryos have enabled ultrasound studies of normal brain, abdominal wall or limb development. The definition of standard developmental morphological features may open the possibility of screening for structural defects early in the first trimester of pregnancy.

Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography.

The purpose of this study was to investigate the potential value of three-dimensional ultrasound for the assessment of normal uterine anatomy and the diagnosis of congenital uterine anomalies. A total of 61 patients with a history of recurrent miscarriage or infertility and who had previously been investigated by hysterosalpingography were recruited into the study. They first underwent a conventional two-dimensional transvaginal ultrasound scan. At the end of the examination, three-dimensional ultrasound volumes were recorded and stored in the machine computer memory. The examination of planar reformatted sections was than used for the assessment of uterine morphology and the diagnosis of congenital anomalies. On three-dimensional scanning, the most useful plane was a transverse section through the whole length of the uterus from the fundus to the cervix. Hysterosalpingography showed a normal uterus in 44 (72.1%) patients, an arcuate uterus in nine (14.8%) and a major fusion defect in three cases (4.9%). Five patients (8.2%) had large fibroids which were distorting the uterine cavity. Good-quality two-dimensional ultrasound images were obtained in 60 (98.3%) and three-dimensional images in 58 (95.1%) cases. All poor images were caused by large uterine fibroids. Comparison between hysterosalpingography and ultrasound showed that five false-positive diagnoses of arcuate uterus and three of major uterine anomalies were made on two-dimensional scans. Three-dimensional ultrasound agreed with hysterosalpingography in all cases of arcuate uterus and major congenital anomalies. The ability to visualize both the uterine cavity and the myometrium on a three-dimensional scan facilitated the diagnosis of uterine anomalies and enabled easy differentiation between subseptate and bicornuate uteri.