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Maternal–Foetal Medicine
Figure 3: Surface-rendered image of Foetal Face 2 shows the presence at the same time of one submucous fibroid and
Obtained by 3D Ultrasound
one uterine polyp.
Fallopian tubal patency is another evaluation that may benefit from the
use of contrast media. The sensitivity and specificity of the positive
predictive value (PPV) and negative predictive value (NPV) of
hysteroslpingo-contrast sonography with the use of 2D or 3D
with/without power Doppler were higher compared with hysteroscopy
and laparoscopy with dye intubation in the assessment of tubal patency
in infertile patient.
28
Furthermore, a combination of hysteroslpingo
contrast sonography with Echovist combined with 3D power Doppler
imaging appeared to have advantages over the conventional
hysteroslpingo contrast sonography, especially in terms of visualisation
of spill of contrast from the distal end of the tube, which was reached
twice as often with the 3D technique.
29
Another promising area of
research is in gynaecological oncology. Neoangiogenesis is the typical
process related to all malignant tumours, and attempts to investigate
Figure 4: Coronal View of the Uterus Obtained by the abnormal vascularisation of ovarian cancer have been performed
3D Ultrasound
using colour and power Doppler. The addition of contrast media
(Levovist, Shering) could definitely provide more information on the
presence and quality of these small vessels in helping to discriminate
benign and malignant ovarian masses.
30
Onset, degree and duration of
Doppler enhancement in the ovarian arteries were significantly
different, with faster onset, higher intensity and longer duration in
malignant tumours. Sonographic screening for ovarian cancer with the
use of US contrast media may allow an early diagnosis of vascular
changes associated with the presence of tumour. The most recent use
for US contrast media has been in the evaluation of microinsert location
and tubal status in a post-Essure
®
setting,
31
a new form of permanent
tubal sterilisation. Contrast-infusion sonography with Definity US
contrast agent (Bristol Myers-Squibb Medical Imaging, North Billericay,
MA) was found to be a safe, accurate and convenient US-based
alternative to hysterosalpingography as a confirmation test three
months after Essure placement. However, its future routine use will
need more confirmatory accuracy and reproducibility research.
3D Ultrasound
There is clear visualisation of a normally shaped endometrial cavity and normal
3D US technology has evolved rapidly and even though the indications
uterine fundus.
still need to be clearly defined, there is great potential for its routine
This technique is particularly useful when locating focal endometrial clinical application in certain fields of OG. Briefly, with 3D US, a volume
abnormalities or confirming that a focal abnormality diagnosed by US rather than a slice (as with 2D US) is acquired and stored: this allows the
is present and, consequently, better defining the nature of the display of information not just in the acquisition plane but in any plane
abnormality.
20
The sensitivity and specificity of saline infusion for and in any orientation. With the simultaneous visualisation of all three
detection of polyps were significantly higher than for transvaginal US mutually perpendicular section planes on the equipment screen, the
alone (93 and 94% versus 75 and 76% for transvaginal US) and were sectional planes can be rotated so that the object of interest can be
comparable to those seen with hysteroscopy.
21–23
Figure 1 shows two viewed in the correct anatomical position. Compared with conventional
uterine polyps in the uterine cavity very well identified by 2D US, 3D carries some advantages. At the moment, probably the most
sonohysterography. A prospective series of 214 consecutive pre- and significant is that US volume data can be rescued and analysed/
post-menopausal women with abnormal uterine bleeding and manipulated long after the patient has left the office.
32,33
Furthermore,
suspected uterine abnormality on transvaginal US found an initial digitally saved volumes can be transmitted electronically to be reviewed
approach of sonohysterography followed by hysteroscopy, if needed or fully interpreted by other consultants, thus allowing a wider utilisation
for diagnosis or therapy, was preferable to routinely proceeding to of this technology at remote locations where experts in the field are not
diagnostic hysteroscopy because the latter could be avoided in 84% present.
34
In addition, accurate volume measurements can be obtained
of patients.
24
Saline contrast sonohysterography is an accurate even in structures that are irregular in shape, such as the endometrium
method for the detection of structural abnormalities of the uterine and some foetal structures.
cavity, but it is less successful in assessing the extent of submucosal
fibroid protrusion into the uterine cavity.
25,26
Additional information on Multiplanar imaging, surface and volume rendering and semi-automated
the quantification of the percentage of a submucous fibroid volume calculation through Virtual Organ Computer-Aided anaLysis
protruding into the uterine cavity may be obtained by the (VOCAL) are the tools available for qualitative and quantitative
combination of saline-contrast sonohysterography and 3D US.
27
Figure assessment of 3D data. It should be kept in mind that 3D US does not
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