title: Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies.
abstract: BACKGROUND
  Uterine anomalies may lead to infertility recurrent miscarriage, preterm labour intrauterine growth restriction and post-partum haemorrhage. Infertility and recurrent miscarriage are relatively common problems in the female population. Diagnostic algorithms in such cases include the evaluation of uterine anatomy Magnetic resonance imaging (MRI) is the most accurate technique for visualizing the female genitourinary tract anatomy but as it is expensive and not readily available, it is not useful in everyday practice. Hysterosalpingography (HSG) is a frequently performed procedure that plays an important role in evaluating the uterus and fallopian tubes. The most typical indication for HSG is infertility and recurrent miscarriage, which are common problems in the female population. However this procedure is invasive, exposes the patient to ionizing radiation, carries a risk of complications and does not show the external contour of the uterus, which is essential for differentiating uterine anomalies. Three dimensional transvaginal ultrasound (3D TV USG) is a noninvasive and quick, imaging method that may be used in diagnosing uterine anomalies. This method allows evaluate the external contours of the uterus, making it comparable to MRI.
  
  
  OBJECTIVE
  In this study we discuss the advantages and disadvantages of HSG and 3D TV USG in diagnosing uterine anomalies. Additionally we present the results of HSG and 3D TV USG of 155 patients referred to our Department because of infertility and/or suspected uterine anomalies.
  
  
  RESULTS
  After performing HSG, in the studied group 118 patients were diagnosed with a normal uterus, 4 with unicornuate (including 1 patient with an unicornuate uterus, with rudimentary horn), and 6 with didelphys uterus. In 22 cases, due to the lack of evaluation of external contour of the uterus, we could not differentiate arcuate, septate and bicornuate uterus. After performing 3D TV USG we confirmed the HSG diagnosis and precise differentiated 22 disputable cases. 8 with arcuate, 11 with septate (2 complete and 9 partial) and 3 with complete bicornuate uterus. In 5 patients, severe pain and lack of cooperation during HSG made the acquisition of diagnostic X-ray images impossible. In these cases 3D TV USG allowed the anatomic assessment of the uterus, a normal uterus was found in all of them. All uterine anomalies were then confirmed by hysteroscopy and/or laparoscopy
  
  
  CONCLUSIONS
  Basing on a review of the literature and our results, we conclude that HSG is not the optimal method for diagnosing uterine anomalies, while 3D TV USG can accurately show the uterus anomalies and may become an alternative method to MRI.
authors.forename: Piotr
authors.initials: P
authors.lastname: Szkodziak
authors.forename: Sławomir
authors.initials: S
authors.lastname: Woźniak
authors.forename: Piotr
authors.initials: P
authors.lastname: Czuczwar
authors.forename: Tomasz
authors.initials: T
authors.lastname: Paszkowski
authors.forename: Paweł
authors.initials: P
authors.lastname: Milart
authors.forename: Ewa
authors.initials: E
authors.lastname: Wozniakowska
authors.forename: Wojciech
authors.initials: W
authors.lastname: Szlichtyng
mesh_terms: D000328:Adult; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007247:Infertility, Female / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014564:Urogenital Abnormalities / Q000000981:diagnostic imaging*; D014599:Uterus / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media