Sonohysterography: do 3D reconstructed images provide additional value?

Objective: The purpose of this study was to retrospectively determine the value of adding 3D multiplanar sonography to 2D sonohysterography.

Materials And Methods: Between September 2003 and April 2005, 80 women (mean age, 43.5 years; range, 26-78 years) underwent sonohysterography with both conventional 2D sonohysterography and 3D multiplanar imaging (volume of data acquired and reconstructed in the transverse, sagittal, and coronal planes). Three blinded readers interpreted the 2D scans alone and then the 2D and 3D images together. Visualization of endometrial abnormality (polyps, fibroids, or septations) and definition of fundal contour were scored by each reader on a three-point scale (1, visualized; 2, unsure; 3, not visualized). Wilcoxon's signed rank test was used to assess mean differences between findings. Reader agreement was determined with the kappa statistic. Pathologic correlation was performed when the findings were available.

Results: Average (mean +/- SD) reader scores for identification of endometrial abnormality were not significantly different: 1.70 +/- 0.91 for 2D alone versus 1.69 +/- 0.92 for 2D and 3D combined (p = 0.38). There also was no significant difference when polyps (2.14 +/- 0.90 vs 2.12 +/- 0.93), fibroids (2.57 +/- 0.79 vs 2.53 +/- 0.82), and septations (2.88 +/- 0.39 vs 2.87 +/- 0.42) were evaluated separately. Average scores for definition of fundal contour were significantly (p < 0.0001) different (2.93 +/- 0.34 for 2D alone versus 1.45 +/- 0.80 for 2D and 3D combined). Agreement between readers was found with average kappa values of 0.72 for 2D alone and 0.78 for 2D and 3D. For the 42 subjects for whom pathologic findings were available, readers identified 92% of the abnormalities.

Conclusion: Three-dimensional reformations improve visualization of the uterine fundus and aid in identification or exclusion of a fundal contour abnormality but do not add value in the detection of endometrial abnormalities.