MULTIPLANAR AND THREE DIMENSIONAL ULTRASOUND
IN GYNAECOLOGY: THE UTERUS

Introduction

The use of three-dimensional ultrasound techniques in gynaecology, particularly in the evaluation of the uterus, have introduced the so-called 'third scan' or frontal plane. This scan was not available with the conventional bidimensional ultrasound and is actually obtained selecting an ideal scan (chosen by the operator) and allowing calculation by V-Mode equipment workstation: Thus a “virtual” scan is visualized on the monitor.
The information provided by this virtual scan, and moreover the possibility to compare each single voxel on the three orthogonal intersected scans, provides the operator with better diagnostic tools in the following cases:


1. The physiological uterus – to evaluate the endometrium, the position of an IUD etc.
2. Identification of

- Primitive uterine malformations: Bicornuate, unicornuate, septated and subseptated uterus;
- Benign and malignant secondary uterine malformation: Neoformations, endometriosis etc.

On this page we show the advantages of using three dimensional and multiplanar ultrasound to examine the physiological and pathological uterus.

Fig. 1. Transvaginal volume, examined by multiplanar ultrasound. Normal uterus: the so called ‘third plane’ (frontal plane).

Fig. 2a. Transvaginal volume, examined by multiplanar ultrasound. IUD normal position. In A it is possible to see one of the two arms (the left) of the T-shaped IUD.

Fig. 2b. Same case as in previous figure. 3D rendering of IUD. Surface filter. T-shaped IUD is clearly visualised.

Fig. 3a. Transvaginal volume examined by multiplanar ultrasound. Sub-mucous uterine leiomyoma. Notice in A the sub-mucous fundal location of the leiomyoma.

Fig. 3b. Transvaginal volume. 3D rendering with surface filter. Sub-mucous uterine fibroid.

Fig. 3c. Same case as before: minimum transparency filter is applied. Click here to see 3D rendering MOVIE.

Fig. 3d. Transabdominal volume, taken on 3 scans. Sub mucous uterine fibroid in virginal patient undergoing routinely examination.

Fig. 3e. Same case as in previous figure. Transabdominal volume examined by multiplanar ultrasound. Sub-mucous uterine fibroid.

Fig. 4a. Trans-abdominal volume examined by multiplanar ultrasound of a 12 years old patient affected by marked pelvic pains. Unperforated hymen.

Fig. 4b. Transabdominal volume. Hypoplastic uterus of a 22 years old patient affected by primitive amenorrhea.

Fig. 4c. Transvaginal volume examined by multiplanar ultrasound. Uterine and endometrial evaluation of menopausal woman undergoing HRT.

Fig. 5a. Trans-abdominal volume of arcuate uterus examined by MP rendering. Virginal patient. In A the frontal scan clearly states the presence of the fundal arcuate shape.

Fig. 5b. Transvaginal volume examined by MP rendering. Arcuate uterus.

Fig. 6a. Transvaginal volume examined by MP rendering. Sub-septate uterus.

Fig. 6b. Same case as the previous figure examined by MP rendering. In D can be seen the septum shown by the arrow and uterine cavity divided in two parts.

Fig. 7. Transvaginal volume. Multiplanar rendering. Septate uterus.

Fig. 8. Same case as in previous figure. Septate uterus. 3D rendering.

Fig. 9. Same case as previous figure. 3D rendering with maximum transparency filter.



Fig. 10. Same case as previous figure. 3D rendering with surface filter.

Fig. 11a. Transvaginal volume, examined by MP rendering. Unicornuate uterus.

Fig. 11b. Same case as in previous figure. Hysterosalpingoscopy which confirms previous suspect of unicornuate uterus.

Fig. 12a. Transabdominal volume examined by MP rendering. Bicornuate uterus and ovarian cysts diagnosed in a virginal patient after V-Mode routinely examination.

Fig. 12b. Transvaginal volume examined by MP rendering. Bicornuate uterus.

Fig. 13. Transabdominal volume examined by MP rendering. Endometrial benign neoplasm (polyp).



Fig. 14. Same case as previous figure. 3D rendering with surface filter.

Fig. 15. Transvaginal volume examined by MP-rendering. Endometrial polyp.



Fig. 16. Same case as previous figure. 3D-rendering.

Fig. 17. Transvaginal volume examined by MP rendering. Endometrial carcinoma.

Fig. 18. Same case as previous figure. The diameter of the endometrium is measured on the sagittal scan: size (17.4 mm)