Gabinete Médico Velazquez, Madrid, Spain.
Ultrasound Obstet Gynecol. 2010 May;35(5):593-601. doi: 10.1002/uog.7551.
To demonstrate the value of three-dimensional (3D) ultrasound in the diagnosis of uterine malformations and its concordance with magnetic resonance imaging (MRI).
This study included 286 women diagnosed with uterine malformation by 3D ultrasound, having been referred to our clinics on suspicion of uterine malformation following clinical and/or conventional two-dimensional ultrasound examination. With the exception of three with intact hymen, patients underwent both bimanual examination and speculoscopy before and/or after sonography. MRI was performed in 65 cases. We analyzed the diagnostic concordance between the techniques in the study of uterine malformations.
Using 3D ultrasound we diagnosed: one case with uterine agenesis; 10 with unicornuate uterus, four of which also underwent MRI; six with didelphic uterus, one of which had MRI; 45 with bicornuate uterus, 12 of which had MRI; 125 with septate uterus (18 with two cervices), 42 of which had MRI (six with two cervices); 96 with arcuate uterus, three of which had MRI; and three with diethylstilbestrol (DES) iatrogenic uterine malformations, all of which had MRI. Among the 65 which underwent MRI, the diagnosis was: four cases with unicornuate uterus, 10 with bicornuate uterus (two with two cervices), 45 with septate uterus (five with two cervices), three with arcuate uterus and three with DES-related uterine malformations. The concordance between 3D ultrasound and MRI was very good (kappa index, 0.880 (95% CI, 0.769-0.993)). Discrepancies in diagnosis between the two techniques occurred in four cases. There was very good concordance in the diagnosis of associated findings (kappa index, 0.878 (95% CI, 0.775-0.980)), this analysis identifying differences in two cases.
There is a high degree of concordance between 3D ultrasound and MRI in the diagnosis of uterine malformations, the relationship between cavity and fundus being visualized equally well with both techniques. 3D ultrasound should be complemented by careful gynecological exploration in order to identify any alterations in the cervix.
展示三维（3D）超声在子宫畸形诊断中的价值及其与磁共振成像（MRI）的一致性。
本研究纳入了 286 名经 3D 超声诊断为子宫畸形的女性患者，这些患者在临床和/或二维超声检查后因怀疑子宫畸形而就诊于我院。除了 3 名处女膜完整的患者外，所有患者在超声检查前和/后均进行了双合诊和窥器检查。65 例行 MRI 检查。我们分析了两种技术在子宫畸形研究中的诊断一致性。
使用 3D 超声诊断为：1 例子宫发育不全；10 例单角子宫，其中 4 例也进行了 MRI 检查；6 例双子宫，其中 1 例进行了 MRI 检查；45 例双角子宫，其中 12 例进行了 MRI 检查；125 例纵隔子宫（18 例有两个宫颈），其中 42 例进行了 MRI 检查（6 例有两个宫颈）；96 例弓形子宫，其中 3 例进行了 MRI 检查；3 例因己烯雌酚（DES）致医源性子宫畸形，均进行了 MRI 检查。在进行 MRI 检查的 65 例患者中，诊断为：4 例单角子宫，10 例双角子宫（2 例有两个宫颈），45 例纵隔子宫（5 例有两个宫颈），3 例弓形子宫和 3 例 DES 相关子宫畸形。3D 超声和 MRI 的诊断一致性非常好（kappa 指数，0.880（95%置信区间，0.769-0.993））。两种技术的诊断差异出现在 4 例。两种技术在伴发发现的诊断上具有非常好的一致性（kappa 指数，0.878（95%置信区间，0.775-0.980）），该分析确定了 2 例存在差异。
3D 超声和 MRI 在子宫畸形的诊断中有很高的一致性，两种技术均能很好地显示宫腔和宫底的关系。3D 超声应辅以仔细的妇科检查，以识别宫颈的任何变化。
