Valsky Dan Vadim, Cohen Sarah M, Hochner-Celnikier Drorith, Lev-Sagie Achinoam, Yagel Simcha
Department of Obstetrics and Gynecology, Hadassah University Hospital-Mount Scopus, PO Box 24035, Jerusalem IL-91240, Israel.
J Ultrasound Med. 2006 May;25(5):613-6. doi: 10.7863/jum.2006.25.5.613.
An intrauterine device (IUD) is a highly effective and prevalent form of birth control with a low failure rate. It is not without complications, including irregular bleeding and pelvic pain, perforation, expulsion, and pregnancy. Investigation of the symptomatic patient and routine follow-up of asymptomatic women with IUDs include transvaginal ultrasonography to rule out IUD malposition and other complications. Three-dimensional ultrasonography (3DUS) has been shown to have added value in imaging the pelvic organs, including the uterus. However, even with 3DUS, the operator may encounter difficulty in imaging the IUD in its entirety, because of variability in both echogenicity and exact location.
More than 30 women undergoing IUD placement evaluation, including routine examinations and cases of suspected pregnancy, irregular bleeding, infection, and pelvic pain, were evaluated with 3DUS and volume contrast imaging in the C plane (VCI-C), which visualized acoustic shadows of the IUDs, facilitating identification of the intrauterine position and type of the device.
Four examples are presented from women undergoing evaluation of IUD placement in whom 2-dimensional ultrasonography failed to visualize the device satisfactorily. Volume contrast imaging in the C plane allowed visualization of the acoustic shadows of the IUDs, thereby providing more exact imaging of the type of device as well as aiding in locating the IUD. In a woman with irregular bleeding, a bicornuate uterus with pregnancy in 1 horn and a bowed T-type IUD in the contralateral horn were diagnosed with VCI-C.
We conclude from these shadow images that VCI-C is a useful modality in cases of difficult visualization of the IUD; VCI-C visualization of the acoustic shadow of the IUD may provide an adjunctive approach.
宫内节育器（IUD）是一种高效且普遍使用的避孕方式，失败率较低。但它并非没有并发症，包括不规则出血、盆腔疼痛、穿孔、排出及妊娠。对有症状的患者进行检查以及对无症状带器妇女进行常规随访时，包括经阴道超声检查以排除IUD位置异常及其他并发症。三维超声检查（3DUS）已被证明在盆腔器官（包括子宫）成像方面具有附加价值。然而，即便使用3DUS，由于回声性和确切位置的变异性，操作者可能在完整成像IUD时遇到困难。
对30多名接受IUD放置评估的女性进行了评估，包括常规检查以及疑似妊娠、不规则出血、感染和盆腔疼痛的病例，采用3DUS及C平面容积对比成像（VCI-C），该成像可显示IUD的声影，有助于确定宫内节育器的位置及类型。
展示了4例接受IUD放置评估女性的病例，其中二维超声检查未能令人满意地显示节育器。C平面容积对比成像可显示IUD的声影，从而更准确地成像节育器类型并辅助定位IUD。在一名不规则出血的女性中，通过VCI-C诊断出双角子宫，一侧角部妊娠，对侧角部有一个弯曲的T型IUD。
从这些声影图像中我们得出结论，VCI-C在难以显示IUD的情况下是一种有用的方法；VCI-C对IUD声影的显示可能提供一种辅助手段。
