A prospective study to evaluate the efficacy of two- and three-dimensional sonohysterography in women with intrauterine lesions.

OBJECTIVE: To measure the accuracy of three-dimensional (3D) sonohysterography in detecting intrauterine lesions.
DESIGN: Prospective study.
SETTING: Teaching hospital. PATIENT(S): Two hundred nine infertile patients suspected to have an intrauterine lesion on 2D ultrasound or hysterosalpingography. INTERVENTION(S): Three-dimensional ultrasound, 2D and 3D sonohysterography (SHG). Ninety-two of the patients had a lesion distorting the endometrium on the 3D SHG, and those were referred for hysteroscopy. MAIN OUTCOME MEASURE(S): Sensitivity and specificity of 2D, 3D ultrasound, and 2D SHG compared to 3D SHG. RESULT(S): Of the 92 patients with a lesion, 48 had polyps, 35 submucous/intramural myomas, 3 both polyps and myomas, 4 müllerian anomalies, 1 thick endometrium, and 1 synechiae. Compared with the 3D SHG results, the sensitivity and specificity were 97% and 11% for the 2D transvaginal ultrasound, 87% and 45% for the 3D ultrasound, and 98% and 100% for the 2D SHG. In the group of 59 patients who had hysteroscopy, the sensitivity of the 2D SHG and 3D SHG were 98% and 100%, with a positive predictive value of 95% and 92%, respectively. CONCLUSION(S): Three-dimensional sonohysterography allows precise recognition and localization of lesions. If 2D and 3D SHG are normal, invasive diagnostic procedures such as hysteroscopy could be avoided.