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Contrast Imaging and 3D Ultrasound
replace 2D US, which should always precede the 3D volume acquisition; mother and help in stopping bad habits such as smoking,
36
it should be
on the contrary, it expands its capabilities. Adding 3D US technology to a borne in mind that “it is irresponsible to insonate the unborn child
conventional 2D US scan implies an additional scanning time, which in without a medical indication”.
38
gynaecology – in experienced hands – is no more than five minutes.
33
Recently, the American Institute of Ultrasound in Medicine (AIUM) held a Gynaecology
conference where a panel of experts discussed the state-of-the-art Many gynaecological applications have been explored with promising
applications of 3D US, its role in improving diagnostic effectiveness and results. This is most likely due to the fact that 3D US imaging of the
recommendations for future investigations in the field of OG.
32
In female pelvis is technically easier to obtain, given the fact that, unlike
addition, a consensus statement for the standardisation of 3D images in obstetrics, the anatomical structures are not in motion. The most-used
OG has been proposed by the International Society of Ultrasound in technique in gynaecology is multiplanar imaging. VOCAL analysis has
Obstetrics and Gynecology (ISUOG) 3D Focus Group, with the double been shown to be more repeatable and more accurate than the multiple
scope to provide the inexperienced sonographer with a guide to spatial parallel planes method utilised for volume calculations.
33
orientation and to avoid erroneous topographical interpretations.
35
3D US has been found to be useful in the diagnosis of uterine
Obstetrics anomalies: it not only allows a better evaluation of the shape of the
The widest clinical application of 3D US in obstetrics is probably the uterine fundus or of the endometrium, but also, in combination with
detection of foetal anomalies. 3D US has been found to be helpful sonohysterography, permits careful evaluation of both the external
in detecting or significantly adding to the detection of a wide range of and internal contour of the uterus, which may avoid recourse to
anomalies,
32,36
among which are anomalies of the central nervous surgery (hysteroscopy, laparoscopy or both). Figure 4 shows a coronal
system,
36,37
the foetal face including lip and palate, the foetal skeleton view of the uterus, with clear visualisation of the endometrial cavity
and extremities (including the assessment of the nasal bone for the and normal shape of the uterine fundus. Precise localisation and
pre-natal screening of Down’s syndrome) and the genito-urinary volume of uterine fibroids as well as differential diagnosis with adnexal
system.
36
The multiplanar and surface-rendered views from volume masses close to the uterus is another application of 3D US. Advantages
data of foetal structures allow optimal visualisation, which is not always of the 3D US evaluation of the endometrium include volume
possible with 2D US alone, such as for the reconstruction of a true mid- measurement for the diagnosis of endometrial cancer
40
or as a
line sagittal plane of the foetal face (see Figure 3).
36
3D volume imaging predictor of pregnancy outcome in assisted-reproduction technology
offers the great advantages of saving, storing and sending volumes and (ART).
41
HyCoSy has been shown to improve sensitivity and specificity
having them remotely reviewed by a US specialist, as well as having the of transvaginal 2D US, and can be successfully performed with a
images reviewed by a consulting specialist (paediatrician/surgeon) to shortening of the uterine distension time with 3D US (less than two
obtain more reliable counselling concerning the outcome of the minutes). It has been shown that 3D HyCoSy improves visualisation of
newborn-to-be.
36,38
polyps, fibroids, adhesions and the global uterine anatomy compared
with 2D HyCoSy and X-ray SHG.
42
3D imaging in combination with power Doppler scanning has also been
used for the visualisation of the foetal heart and vessels
39
and for Volume measurement of irregular structures such as the ovaries and the
the assessment of extracardiac vasculature, such as the insertion of the ovarian follicles as in polycystic ovarian syndrome or in the prediction
umbilical cord in the placenta and the presence of vascular of ovarian response in ART programmes has been successfully achieved
anastomoses in cases of twin-to-twin transfusions.
32
Volume by 3D US. Other applications are the location of intra-uterine devices,
measurement of different foetal organs as well as of the placenta has the diagnosis of cornual ectopic pregnancies and the assessment of the
been reported, but currently does not have a clear clinical application.
39
patency of the fallopian tubes
43
(especially in conjunction with contrast
imaging). Advantages have also been reported at the time of different
A final comment should be made on the so-called ‘bonding effect’ interventions (abscess drainage of the pelvis, retrieval of follicles at the
related to 3D US. Many parents are intrigued by being able to pay for a time of ART procedures), in differentiating benign tissue from malignant
portrait of their baby in the womb before birth.
38
However, even though adnexal mass
44
and in studying subendometrial blood flow in patients
viewing the foetus in utero may have a psychological impact on the undergoing in vitro fertilisation.
45
■
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