Sabry Ahmed S A, Fadl Shimaa A, Szmigielski Wojciech, Alobaidely Amal, Ahmed Sanaa S H, Sherif Hanan, R H Yousef Reda, Mahfouz Ahmed
Clinical Imaging Department, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
Department of Radiology, University of Washington Medical Center, Seattle, Washington, USA.
Pol J Radiol. 2018 Nov 30;83:e482-e490. doi: 10.5114/pjr.2018.80132. eCollection 2018.
The purpose of this review is to illustrate and discuss the seldom used technique of three-dimensional (3D) saline infusion sonohysterography (SIS) based on instillation of sterile saline through a catheter into the uterus under real-time vaginal transducer observation for assessment of the endometrial cavity.
The cases for this pictorial review were selected from the imaging material collected at the Ultrasound Unit, Clinical Imaging Department, Women's Hospital of Hamad Medical Corporation during a seven-year period from 2011 to 2017. This was a retrospective collection of 216 consecutive cases that underwent two-dimensional (2D) and 3D SIS for evaluation of the uterine cavity, followed by verification of results with histopathology. An open-sided speculum is inserted into the vagina. An intrauterine catheter is then threaded into the endometrial cavity. After that, the speculum is removed carefully, and a vaginal transducer is inserted. Using a 60-ml syringe attached to the catheter, saline solution is instilled under direct real-time observation (2D SIS). Subsequently, reconstruction of the three-dimensional anatomy of the intrauterine cavity is performed.
The review presents the most common indication for SIS, like abnormal bleeding in pre- and postmenopausal patients. SIS allows us to distinguish between focal lesions and global endometrial thickening. SIS should be supported as a second-line diagnostic procedure for abnormal uterine bleeding, when findings from transvaginal ultrasound are inconclusive.
The addition of 3D techniques to SIS procedure helps in the distinction between endometrial and myometrial lesions, also it facilitates delineation of uterine anatomy, resulting in more precise and accurate diagnosis.
本综述的目的是阐述和讨论一种较少使用的三维（3D）生理盐水灌注子宫超声造影（SIS）技术，该技术是在实时阴道探头观察下，通过导管向子宫内注入无菌生理盐水，以评估子宫内膜腔。
本图像综述的病例选自2011年至2017年七年间哈马德医疗公司妇女医院临床影像科超声科收集的影像资料。这是一项对216例连续病例的回顾性收集，这些病例接受了二维（2D）和3D SIS以评估子宫腔，随后通过组织病理学验证结果。将开放式窥器插入阴道。然后将子宫内导管插入子宫内膜腔。之后，小心地取出窥器，插入阴道探头。使用连接到导管的60毫升注射器，在实时直接观察下注入生理盐水（2D SIS）。随后，对子宫腔内的三维解剖结构进行重建。
该综述介绍了SIS最常见的适应证，如绝经前和绝经后患者的异常出血。SIS使我们能够区分局灶性病变和整体子宫内膜增厚。当经阴道超声检查结果不明确时，SIS应作为异常子宫出血的二线诊断方法。
在SIS程序中增加3D技术有助于区分子宫内膜病变和肌层病变，也有助于描绘子宫解剖结构，从而实现更精确准确的诊断。
