Comparing the effectiveness of ultrasound and mri in assessing cesarean uterine scar defects
- Authors: Sukhareva T.A.1, Martynov S.A.1, Adamyan L.V.1, Kulabukhova E.A.1, Uchevatkina P.V.1, Letunovskaya A.B.1, Boykova Y.V.1
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Affiliations:
- Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
- Issue: No 4 (2023)
- Pages: 78-86
- Section: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/274836
- DOI: https://doi.org/10.18565/aig.2022.264
- ID: 274836
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Abstract
Objective: To improve the effectiveness of uterine cesarean scar defect assessment using ultrasonography and magnetic resonance imaging (MRI).
Materials and methods: This comparative study included 61 patients with uterine scar dehiscence after cesarean section (CS), who were interested in having another pregnancy. All patients underwent expert pelvic ultrasonography (eUS) and MRI at V.I. Kulakov NMRC for OG&P; 30 patients underwent echo-hysterosalpingography (eHSG). Each examination (eUS and MRI) was performed by two independent specialists. Scar parameters were measured using the standardized Delphi technique, irrespective of the examination method used. Measurements of uterine scar parameters obtained using eUS, MRI, and eHSG in the same patients were compared, and the consistency of measurements between specialists was assessed.
Results: A comparative analysis showed a statistically significant difference in the minimum scar thickness (mST) between eUS [2.19(0.77) mm] and MRI [1.93 (0.7) mm] (p<0.05). A comparative analysis of MRI and eHSG data also revealed statistically significant differences in niche depth measurements of 3.29 (1.48) and 7.01 (2.97) mm, respectively (p<0.05); mST was significantly lower when measured by eHSG than MRI, 1.5 (0.4) mm and 1.81 (0.6) mm, respectively (p=0.03). There was no statistically significant difference between the eUS and MRI measurements taken by two independent specialists. However, according to the Bland–Altman analysis, MRI and eHSG showed less variability than eUS, indicating higher reproducibility.
Conclusion: If a uterine scar is detected on ultrasound, MRI or eHSG is recommended to confirm the diagnosis and decide whether surgical treatment is necessary, as these methods are highly reproducible and reduce the risk of diagnostic errors. eHSG should be considered as the "gold standard" for diagnosing uterine scar defects after CS, due to its advantages of filling the uterine cavity with contrast and the possibility of detecting perforating scar defects.
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About the authors
Tatyana A. Sukhareva
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Author for correspondence.
Email: t_sidorova@oparina4.ru
ORCID iD: 0000-0002-5508-3611
PhD Student at the Gynecological Department
Russian Federation, MoscowSergey A. Martynov
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: s_martynov@oparina4.ru
ORCID iD: 0000-0002-6795-1033
Dr. Med. Sci., Leading Researcher at Gynecological Department
Russian Federation, MoscowLeyla V. Adamyan
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: l_adamyan@oparina4.ru
Dr. Med. Sci., Professor, Academician of RAS, Deputy Director for Science, Head of Gynecological Department
Russian Federation, MoscowElena A. Kulabukhova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: e_kulabukhova@oparina4.ru
PhD, Radiologist at the Department of Radiation Diagnostics
Russian Federation, MoscowPolina V. Uchevatkina
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: p_uchevatkina@oparina4.ru
Radiologist at the Department of Radiation Diagnostics
Russian Federation, MoscowAnna B. Letunovskaya
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: annletynovskaya@yandex.ru
PhD, Obstetrician-Gynecologist, Obstetric Diagnostic Sonographer
Russian Federation, MoscowYulia V. Boykova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: j_boikova@oparina4.ru
PhD, Obstetrician-Gynecologist, Obstetric Diagnostic Sonographer
Russian Federation, MoscowReferences
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