Univ Paris-Sud, UMR-S0782, Clamart, France.
J Minim Invasive Gynecol. 2012 Jan-Feb;19(1):101-6. doi: 10.1016/j.jmig.2011.08.724. Epub 2011 Oct 20.
To estimate the accuracy of 3-dimensional (3-D) ultrasonography in the differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging (MRI).
Prospective cohort study (Canadian Task Force Classification II-2).
University hospital.
Thirty-one patients referred with a suspected diagnosis of septate (n = 20) or bicornuate (n = 11) uterus.
All patients underwent 3-D ultrasonography displaying the rebuilt coronal view of the uterus, office hysteroscopy, and pelvic MRI. Operative hysteroscopic assessment and treatment was performed in case of sonographically diagnosed septate uterus. Bicornuate uterus was confirmed by laparoscopy.
Concordance between suspected diagnosis with 3-D ultrasonography, hysteroscopy, and pelvic MRI and final diagnosis.
A septate uterus was diagnosed with 3-D ultrasonography in 29 patients and bicornuate uterus in 2 patients. Hysteroscopic transcervical section of the uterine septum was achieved in the 29 patients. Bicornuate uterus was laparoscopically confirmed in the 2 patients. Concordance between ultrasonography and operative hysteroscopy or laparoscopy was verified in all 31 cases. Twenty-five uterine septa and 5 bicornuate uteri were diagnosed by hysteroscopy (3 false-positive diagnoses of bicornuate uterus, 1 unfeasible hysteroscopy). Hysteroscopic diagnosis was correct in 27/30 patients. Twenty-four septate uteri and 7 bicornuate uteri were diagnosed by MRI (5 false-positive diagnoses of bicornuate uterus). Two complete septate uteri diagnosed by MRI were finally confirmed as incomplete septate uteri after 3-D ultrasonography and operative hysteroscopy. MRI diagnosis was correct in 24/31 patients.
Transvaginal 3-D ultrasonography appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies, more than office hysteroscopy and MRI. It may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus.
评估三维（3-D）超声在鉴别诊断纵隔子宫和双角子宫中的准确性，并与门诊宫腔镜和盆腔磁共振成像（MRI）进行比较。
前瞻性队列研究（加拿大任务组分类 II-2）。
大学医院。
31 例因疑似纵隔（n=20）或双角（n=11）子宫而就诊的患者。
所有患者均接受 3-D 超声检查，显示重建的子宫冠状视图，门诊宫腔镜和盆腔 MRI。如果超声诊断为纵隔子宫，则进行手术宫腔镜评估和治疗。腹腔镜证实双角子宫。
3-D 超声、宫腔镜和盆腔 MRI 的可疑诊断与最终诊断之间的一致性。
3-D 超声诊断 29 例为纵隔子宫，2 例为双角子宫。29 例患者经宫颈子宫纵隔切除术。2 例患者腹腔镜证实为双角子宫。31 例患者的超声检查与手术宫腔镜或腹腔镜检查均具有一致性。宫腔镜诊断 25 例子宫纵隔和 5 例双角子宫（3 例双角子宫假阳性诊断，1 例宫腔镜检查不可行）。27/30 例患者的宫腔镜诊断正确。MRI 诊断 24 例纵隔子宫和 7 例双角子宫（5 例双角子宫假阳性诊断）。2 例 MRI 诊断为完全纵隔子宫，经 3-D 超声和手术宫腔镜检查后最终证实为不完全纵隔子宫。31 例患者中，24 例 MRI 诊断正确。
经阴道 3-D 超声对先天性子宫畸形的诊断和分类非常准确，优于门诊宫腔镜和 MRI。它可能成为疑似纵隔或双角子宫患者子宫腔评估的唯一强制性步骤。
