Enhanced ultrasound reveals gynecological disorders

Although conventional x-ray hystero-salpingography remains the modality of choice to diagnose infertility, cumulative evidence seems to be tilting the scales in favor of 3D ultrasound.

Efficacy, invasiveness, and cost have dominated the debate over which diagnostic test best pinpoints the origins of infertility. Although 2D sonohysterography and MRI add value to the gynecologic exam, specialists have generally considered hysterosalpingography to be a faster, cheaper, and more reliable choice. But 3D ultrasound now offers a cost-effective, minimally invasive alternative in apparently infertile patients, according to a study presented at the 2005 American Institute of Ultrasound in Medicine meeting.

"Physicians can observe the fallopian tubes transvaginally with 3D ultrasound with enough detail to be able to assess the tubes' functionality in reproduction," said principal investigator Dr. Guido D. Parra, an obstetrician/gynecologist at the Human Reproductive Institute of Barranquilla in Colombia.

Parra and colleagues assessed 33 infertile patients, using 3D and standard 2D sonography prior to exploratory laparoscopy. They examined the uterine cavity and fallopian tubes using a saline infusion as a contrast agent. They found that 3D's detailed visualization allowed for a virtual fly-through of the fallopian tubes that could help plan future interventions.

While their differences were not statistically significant, 2D and 3D sonography of the distal part of the fallopian tubes demonstrated patency in 49% and 55% of patients, respectively. In addition, 3D imaging provided better visualization of the fimbrial end of the tubes and reduced the mean time for identification after contrast spill. Studies of stored information allowed additional findings with 3D that were not possible with 2D, Parra said.

Parra's findings validate other recent studies. British researchers published results for comparative studies of 3D sonohysterography and hysteroscopy for the classification of submucous fibroids. Kappa value analysis of their outcomes revealed that 3D ultrasound was as good as x-ray for the detection of fibroids, especially when the uterine cavity contains greater proportions of the fibroid (Hum Reprod 2005;20[1]:253-257).

Similar studies comparing 3D ultrasound with hysterosalpingography for the assessment of fallopian tube patency, ovarian stromal flow, and various types of intrauterine lesions concluded that 3D ultrasound added valuable information to the exam. A German study found that 3D Doppler improved the exam's accuracy when stationary, contrast-enhanced 3D sonography did not seem to provide all the answers (Ultraschall Med 2004 Sept;25[5]:367-372).