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 mullerian anomalies, I thick endometrium, and I 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. (C) 2003 by American Society for Reproductive Medicine.