Role of Three-Dimensional Ultrasonography in the Evaluation of Uterine Cavity in Infertility

Introduction: The perspective of gradually increasing availability of higher-end ultrasonography machines having 3D volumetric imaging capacity in our country, it appears necessary to assess the credibility of routine use of 3D sonographic imaging for uterine cavity evaluation in infertility patients and its additional advantages in comparison to cost-effectiveness. Methodology: This study, done including total 158 patients of different age groups referred to the Department of Radio-diagnosis, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, West Bengal for radiological evaluation of infertility. All of these patients were imaged by conventional 2D and 3D volumetric ultrasound. Among these, 139 subjects further underwent Hysterosalpingography, 27 underwent Hystero-laparoscopy and 2 subjects were imaged with MRI. Results: After final possible diagnosis, 12% of the infertile patients were detected to have uterine cavity abnormalities, among which 7.59% were Mullerian Duct Anomalies and 4.43% were other kind of endometrial or sub-endometrial pathology. Again, among the Mullerian Duct anomalies, most common was Arcuate uterus (3.8% of the study population) followed by Septate / Sub-septate uterus (1.9% of the study population). 2D USG, being incapable of imaging of uterus in coronal plane, could only detect 7 abnormal uterine cavities (37% of total 19) with one misdiagnosis, whereas 3D volume Ultrasound detected 18 abnormal cavities (95% of total) with 100% sensitivity and specificity in cases of Mullerian Duct Anomalies unquestionably proving the advantages of 3D USG over 2D USG for detection of uterine cavity pathologies. Conclusion: Thus, the present work strongly supports the already proposed role of 3D USG in the diagnosis of uterine cavity abnormality, especially for congenital Mullerian duct abnormalities, and its clear benefits over the conventional 2D scan.