Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 3 , ISSUE 1 ( January-March, 2009 ) > List of Articles

RESEARCH ARTICLE

Three-dimensional Ultrasonography in the Diagnosis of Müllerian Duct Anomalies

Carmina Bermejo, Rocío Cantarero, Dolores Díaz, Eva Labrador, Laura Ruiz López

Keywords : congenital uterine malformations,müllerian duct anomalies,nuclear magnetic resonance,Three-dimensional ultrasonography

Citation Information : Bermejo C, Cantarero R, Díaz D, Labrador E, López LR. Three-dimensional Ultrasonography in the Diagnosis of Müllerian Duct Anomalies. Donald School J Ultrasound Obstet Gynecol 2009; 3 (1):21-30.

DOI: 10.5005/jp-journals-10009-1005

License: CC BY-NC 4.0

Published Online: 00-03-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims

We studied the effectiveness of three-dimensional (3D) ultrasonography in the diagnosis of uterine malformations.

Methods

175 patients with clinical or ultrasonographic suspicion of uterine malformation were studied between November 2004 and June 2008. In all women we measured uterine volume for processing and later reconstruction of 3D images. Cases in which no anomaly was detected with the 3D technique were excluded from study. A thorough physical genital examination with speculum was done before or after ultrasonography, except in three women with an imperforate hymen. Uterine malformations were recorded in detail, and the findings were catalogued according to the American Fertility Society (AFS) classification. In 32 women magnetic resonance (MR) imaging was also used, and agreement between the two techniques was calculated with the kappa index.

Results

The 175 müllerian anomalies we analyzed were diagnosed as agenesis (1 case), unicornuate uterus (1 genuine, 1 communicating), didelphys uterus (4), bicornuate uterus (22), septate uterus (80, 8 with two cervices) and arcuate uterus (68). For 1 unicornuate, 3 bicornuate, 25 septate (4 with two cervices) and 3 arcuate uteri we performed MR imaging. Diagnostic correlation between 3D ultrasonography and MR imaging was obtained in all cases according to the AFS classification (kappa = 100%); concordance was also seen for descriptions of associated uterine malformations except for two cases: 1 bicornuate uterus with the additional presence of a cervical septum as detected by MR imaging, which was not found on hysteroscopy for resection, and 1 septate uterus that appeared to have two cervices on 3D ultrasonography in a patient in whom physical examination was not possible, and in whom MR imaging showed a complete septum with hypointense signals (kappa = 93.45%; 95% confidence interval 80.75- 100%).

Discussion

Owing to its ability to clearly render contours of anatomical structures, 3D ultrasonography provides detailed images of uterine malformations and yields very similar results to those obtained with MR imaging. For an accurate comparison of the two techniques, ultrasonography should be accompanied by gynecologic physical exploration, since the two methods yield equivalent results for the relation between the uterine cavity and the fundus. MR imaging is especially useful to evaluate the cervix and vagina.


PDF Share
  1. Malformations of the Female Genital Tract and Embryological Bases. Curr Wom Health Rev 2007;3:248-88.
  2. Etat du haut appareil urinaire chez les porteuses de malformations uterines: etude de 133 observations. Presse Med 1967;75:1331-36.
  3. Prevalence of mullerian duct anomalies detected at ultrasound. Am J Med Genet 2000;94:9-12.
  4. Müllerian anomalies. Fertility news 24/1. Endocr Fert Forum 1990;13:1.
  5. Incidence of müllerian defects in fertile and infertile women. Hum Reprod 1997;12:1372-76.
  6. Estimated prevalence of mullerian duct anomalies. Acta Obstet Gynecol Scand 1988;67:441-45.
  7. Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol 1984;148: 140-46.
  8. Reproductive impact of congenital mullerian anomalies. Hum Reprod 1997;12:2277-81.
  9. Survey of 1120 japanese women with a history of recurrent spontaneous abortions. Eur J Obstet Gynecol Reprod Biol 1992;44:123-30.
  10. An informative protocol for the investigation of recurrent miscarriage: Preliminary experience of 500 consecutive cases. Hum Reprod 1994; 9:1328-32.
  11. Congenital anomalies of the mullerian system. Fertl Steril 1989;51:747-55.
  12. A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod 2003;18:162-66.
  13. Arcuate and bicornuate uterine anomalies and infertility. Fertil Steril 1980;34:362-64.
  14. Reproductive performance of women with congenital uterine anomalies. Hum Reprod 1993;8:122-26.
  15. Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening. Obstet Gynecol 2001;98:1099-1103.
  16. Localization of Bcl-2 in the human fetal mullerian tract. Fertil Steril 1998;70:135-40.
  17. Camptobrachydactyly: A new autosomal dominant trait with two probable homozigotes. Am J Hum Genet 1972;24:464-74.
  18. Abnormalities of the mullerian and wolffian duct systems. Birth Defects Orig Artic Ser 1978;14: 37-54.
  19. Classifications of adnexal adhesions, distal tubal obstruction, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 1988;49:944-55.
  20. Three-dimensional ultrasound for de assessment of uterine anatomy and detection of congenital anomalies: A comparison with histerosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol 1995;5:233-37.
  21. Congenital mullerian anomalies: Diagnostic accuracy of three-dimensional ultrasound. Fertil Steril 1996;65:523-28.
  22. Detection of congenital müllerian duct anomalies using three-dimensional ultrasound. J Clin Ultrasound 1997;25:487-92.
  23. Three-dimensional ultrasonography in the evaluation of the uterine cavity. Middle East Fertil Soc J 2007; 12:41-46.
  24. Reproducibility of three-dimensional ultrasound diagnosis of congenital uterine anomalies. Ultrasound Obstet Gynecol 2003; 21:578-82.
  25. Septate uterus: Detection and prediction of obstetrical complications by different forms of ultrasonography. J Ultrasound Med 1998;17:631-33.
  26. Screening for uterine abnormalities by three-dimensional ultrasound improves perinatal outcome. J Perinat Med 2002;30:9-17.
  27. Magnetic resonance evaluation of double uteri. Obstet Gynecol 1989;74:844-47.
  28. Müllerian duct anomalies: MR imaging evaluation. Radiology 1990;176:715-20.
  29. Diagnosis of uterine anomalies: Relative accuracy of MR imaging, endovaginal sonography and histerosalpingography. Radiology 1992;795-800.
  30. Magnetic resonance in the evaluation of mullerian duct anomalies. Radiol Med 1995; 89:105-11.
  31. The Role of 3-Dimensional Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of Mullerian Duct Anomalies: A Review of the Literature. J Ultrasound Med 2008;27(3):413-23.
  32. Clarifying the role of threedimensional transvaginal sonography in reproductive medicine: An evidence-based appraisal. Exp Clin Assist Reprod 2005; 2:10.
  33. Threedimensional inversion rendering: a new sonographic technique and its use in gynecology. J Ultrasound Med 2005;24:681-88.
  34. Case 94: Uterus Didelphys with Obstructing Hemivaginal Septum and Ipsilateral Renal Agenesis. Radiology 2006;239:602-06.
  35. Müllerian duct anomalies: Imaging and clinical issues. Radiology 2004;233:19-34.
  36. Septate uterus with cervical duplication: a rare malformation. Fertil Steril 1994;62:415-17.
  37. Uterus, Mullerian Duct Abnormalities. eMedicine. Article Last Updated: Oct 3, 2007.
  38. Effect of diethylstilbestrol on reproductive function. Fertile Steril 1999;72:1-7.
  39. Three-dimensional ultrasound in gynecology: current status and future perspectives. Curr Wom Health Rev 2005;1: 1-14.
  40. Clinical implications of sonographic detection of uterine anomalies for reproductive outcome. Ultrasound Obstet Gynecol 2001;18:387-400.
  41. Ultrasound and MR imaging correlation of uterine anomaly. J Wom Imag 2004;6:91-93.
  42. Small uterine septum is an important risk variable for preterm birth. Eur J Obstet Gynecol Reprod Biol 2007;135: 154-57.
  43. Cervical cerclage—its role in the pregnant anomalous uterus. Int J Fertil 1990;35:164-70.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.