Limitations of imaging screening tests in the detection of incomplete uterine septum or arcuate uterine anomaly.

Objectives: To determine the detection rates of hysterosalpingogram (HSG), transvaginal 2D ultrasound (TV 2D US), transvaginal 3D ultrasound (TV 3D US) in diagnosing of incomplete uterine septum (IUS) and significant arcuate uterine anomaly (AUA).

Methods: This retrospective cohort study included patients with infertility or recurrent pregnancy loss (516) that were found to have IUS (317) or significant AUA (199) on diagnostic hysteroscopy (DHS). We compared the detection rate of the various radiological tests in all patients with documented IUS or AUA on DHS.

Results: The diagnosis of IUS and AUA was made in 49.7% on HSG, 54.2% on TV 2D US and 69.5% on TV 3D US. When both HSG and TV 2D US or HSG and TV3D US were used, the diagnosis was correct in 67.7% and 82.6% of patients, respectively.

Conclusion: Although HSG, TV 2D US, TV 3D US are useful in the screening for IUS/AUA, none of these imaging tests alone or in combination are accurate enough to rule out the diagnosis of such congenital uterine anomalies. In patients with a history of infertility or RPL and negative radiologic tests, DHS is the only reliable method to rule out IUS or significant AUA.