Assisted Reproductive Technology Unit, Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong.
Hum Reprod Update. 2017 Mar 1;23(2):188-210. doi: 10.1093/humupd/dmw040.
A detailed assessment of the uterus forms a pivotal part of the ART treatment process. The emergence of three-dimensional ultrasound (3D US) has provided clinicians with a highly powerful tool in this respect. Assessments with 3D US range from the reconstruction of anatomical planes elusive to conventional US, to the objective measurement of anatomical volumes and vascularization parameters. However, despite the ever increasing number of publications emerging in the literature, the question of which aspects of 3D US are of most clinical value remains a topic of debate.
The objective of this review is to dissect which aspects of the 3D US assessment of the uterus are supported by a strong level of evidence to date, and should therefore be incorporated into current routine clinical practice.
We conducted a systematic search of the PubMed database up to May 2016, using a combination of text words and Medical Subject Headings (MeSH) pertaining to the 3D US assessment of the uterus. All articles published in the English language were screened to ascertain relevance to women of reproductive age; further citations were retrieved through manual reference list searching.
A multitude of predominantly observational studies were identified, which concerned a vast variety of 3D US uterine assessments. All articles unequivocally praised the non-invasive, cost-effective, highly acceptable and objective nature of 3D US. Studies regarding the value of assessing the endometrial volume and vascularization prior to embryo transfer appeared conflicting and inconsistent. Studies regarding the imaging of uterine pathology and identification of intratubal and intrauterine devices consistently reported high rates of diagnostic accuracy. A recent RCT did not show an improvement in clinical outcomes when comparing 3D versus 2D US during embryo transfer. However, preliminary studies suggested that 3D US is superior in determining the site of implantation, particularly in ambiguous cases such as interstitial and angular pregnancies. Finally, pilot studies have suggested that the further integration of 3D and possibly 4D US with surgical interventions of the uterus may be a promising prospect.
3D US may prove to be an invaluable tool in the assessment of the uterus within the context of ART. Currently, the aim should be to highlight the aspects of 3D US that are most evidence-based and valuable for patients, and to incorporate these into routine clinical practice.
对子宫进行详细评估是辅助生殖技术（ART）治疗过程的关键部分。三维超声（3D US）的出现为临床医生提供了一个非常强大的工具。3D US 的评估范围从对传统 US 难以捉摸的解剖平面的重建，到对解剖体积和血管化参数的客观测量。然而，尽管文献中不断涌现出越来越多的出版物，但 3D US 的哪些方面最具临床价值的问题仍然存在争议。
本综述的目的是剖析迄今为止哪些方面的 3D US 子宫评估具有强有力的证据支持，并因此应纳入当前的常规临床实践。
我们对 PubMed 数据库进行了系统搜索，截至 2016 年 5 月，使用与 3D US 子宫评估相关的文本词和医学主题词（MeSH）进行组合搜索。筛选出所有发表在英语中的与育龄妇女相关的文章，以确定其相关性；通过手动检索参考文献进一步获取引文。
确定了大量主要为观察性研究，涉及到各种 3D US 子宫评估。所有文章都毫不含糊地赞扬了 3D US 的非侵入性、成本效益高、高度可接受和客观的性质。关于在胚胎移植前评估子宫内膜体积和血管化的价值的研究结果似乎相互矛盾且不一致。关于子宫病理学成像和识别输卵管内和子宫内装置的研究一致报告了高诊断准确性率。一项最近的 RCT 并未显示在胚胎移植期间比较 3D 与 2D US 时临床结局的改善。然而，初步研究表明，在确定植入部位方面，3D US 具有优势，特别是在间质和角部妊娠等模棱两可的情况下。最后，初步研究表明，将 3D 甚至 4D US 与子宫的手术干预进一步结合可能是一个很有前途的前景。
3D US 可能在 ART 背景下的子宫评估中成为一种非常有价值的工具。目前，目标应该是突出 3D US 最具循证依据和对患者最有价值的方面，并将其纳入常规临床实践。
