Possibilities of threedimensional echography in the diagnosis of Mullerian duct anomalie

Objective. To determine the possibilities and advantages of various modes of three-dimensional echography and echohysterography (3DEG/3DEHG) in the diagnosis of Mullerian duct anomalies (MDAs). Materials and methods. The authors examined 450patients of reproductive age (from 15 to 45years) with various malformations of the pelvic organs. The study inclusion criteria were suspected MDAs according to previous ultrasound imaging; abnormal uterine bleeding; infertility; and recurrent miscarriage. It should be noted that in 23% of the examinees, the revealed defect was unaccompanied by any clinical manifestations and was a routine ultrasound finding during screening. 3DEG/3DEHG was done on a Canon Aplio MX device using a threedimensional transvaginal probe (6. 5 MHz). Ultrasound was performed on the day of the first patient visit to a physician and again on the 5th-7th day of the menstrual cycle. To obtain informative echograms, the authors used different available three-dimensional echography modes, such as multiplanar reconstruction, Omni-view, image inversion, Glass body vascular mode, and tomographic ultrasound imaging. 3DEHG was performed according to the authors’ standard procedure using catheter balloons, sterile saline that was delivered through an automated Hamou Endomatpump (KarlStorz, Germany). Results. The results of elastography were compared with those of MRI, hysteroscopy, laparoscopy, and laparotomy in 70, 92, 23, and 8.5% of cases, respectively. Based on the studies mentioned above, the authors identified an arcuate uterus (Class U0) in 60patients; a T-shaped uterus and accessory and cavitated uterine masses (ACUM) (Class U1) in 4 and 2 patients, respectively; incomplete and complete intrauterine septa (Class U2a/b) in 78 and 85 examinees, respectively; a bicornuate uterus (Class U3a) in 92; dimetria (Class U3b) in 91, a septate uterus (Class U3c) in 7; and a unicornuate uterus (Class U4a/b) in 31. The construction and interpretation of a three-dimensional echogram of the defect are not routine and require a specialist having sufficient qualif ications, must be performed according to the regulations and be analyzed taking into account the tasks set out below. The parameters of the uterus and parametrial area, such as the shape of the uterine corpus and its size, external myometrial contour; uterine cavity shape and volume; additional anatomical structures as two reflections from the endometrium or/and endocervix, as well as additional masses in the parametrial projection, which are connected to the corpus uteri, should be consistently assessed. The authors developed clear echographic patterns of each nosological entity, which made it possible not only to diagnose the presence of a malformation, but also to classify it, as well as to obtain additional unique defect characteristics that are relevant to determine further management tactics. Conclusion. Thus, three-dimensional echography proposes a qualitatively new method for ultrasound diagnosis of Mullerian duct anomalies, which is similar to MRI and makes it possible to get an echogram as a virtual display of real anatomy. A combination of various modes will be able to yield additional information on vascular architectonics, to predict possible pregnancy complications, to form clear indications for defect correction, and to navigate during intrauterine surgery. 3DEHG is an additional highly specif ic method used for differential diagnosis or in case of the difficult-to-interpret altered anatomy associated with other endometrial and myometrial diseases.

ACUM, three-dimensional echography, echohysterography, Mullerian duct anomalies, echographic patterns, hysteroresection of the septum, accessory and cavitated uterine masses (ACUM)