Reproducibility of Placental Volume and Vasculature Indices Obtained by 3‐Dimensional Power Doppler Sonography

Objective. The purpose of this study was to evaluate the reproducibility of 3‐dimensional (3D) power Doppler assessment of placental volumes and vascularization before adopting these in routine evaluation of normal and complicated pregnancies. Methods. A prospective study was performed on 30 normal singleton pregnancies from 11 to 14 weeks. To evaluate placental vascularization, 3D power Doppler sonography was applied to obtain a placental volume, and the volume acquired was analyzed using virtual organ computer‐aided analysis. Two consecutive measurements were taken from each patient by two observers blinded to each other's and the individual's previous measurement. This yielded a total of 60 data set pairs. The placental volume, vascularization index, flow index, and vascularization‐flow index (VFI) were calculated. Normal distribution of the data was confirmed with the Kolmogorov‐Smirnov test. Intraobserver and interobserver correlations were evaluated. Bland‐Altman plots and statistics were used to compare the 95% limits of agreement between measurements. Results. All 3D power Doppler placental volumes and vascular indices showed intraobserver correlations of 0.80 or higher. Similar excellent interobserver correlations were seen for all indices with the exception of the VFI, which showed a lower but acceptable correlation. The Bland‐Altman analyses indicated good reproducibility of the evaluated placental indices. Conclusions. Our findings provide validation of the technique, showing good reproducibility of the 3D power Doppler parameters when applied to studies of the placental volume and vascular tree.     

Three‐Dimensional Power Doppler Assessment of Uterine Vascularization in Women With Primary Dysmenorrhea

Objective. The aim of this study was to assess myometrial vascularization with 3‐dimensional (3D) power Doppler angiography (PDA) in women with different grades of primary dysmenorrhea at the moment of maximum menstrual pain in an effort to improve the pathophysiologic knowledge of one of the most common gynecologic conditions. Methods. This was a cross‐sectional study involving 70 voluntary women that studied or worked at the Clinica Universitaria de Navarra between January 2006 and January 2008. All women underwent transvaginal sonographic 3D PDA on the day of maximum pain after the onset of menstruation or during the first 24 to 48 hours of the new cycle if no pain was present. Three groups were defined according to a visual analog scale: no pain to mild dysmenorrhea, moderate dysmenorrhea, and severe dysmenorrhea. Vascularity assessment was done on the basis of 3D vascularity indices: the vascularization index (VI), flow index (FI), and vascularization‐flow index (VFI). Results. The mean VI and VFI for the inner 5 mm of the myometrium and the total myometrium were significantly higher in the women with severe dysmenorrhea than in those with no pain to mild dysmenorrhea (P < .05). The VI, FI, and VFI in the women with moderate dysmenorrhea did not differ significantly from those in the women with severe dysmenorrhea. Conclusions. This study evaluated the use of 3D PDA for assessing uterine and specifically myometrial vascularization. Our data indicate that women with severe dysmenorrhea have increased myometrial vascularization during the early menstrual phase compared with women without pain.     

Three‐Dimensional Power Doppler Angiography of Cyclic Ovarian Blood Flow

Objective. The purpose of this study was to assess the vascular indices generated by 3‐dimensional (3D) power Doppler angiography by evaluating the cyclic changes in the vascularity of normal ovaries, including those that were ovulating, nonovulating, and hormonally suppressed. Methods. In this prospective longitudinal observational study, a cohort of premenopausal regularly menstruating women with no known ovarian disease underwent 3D power Doppler imaging every 2 to 3 days for the duration of 1 menstrual cycle. Four indices were generated: vascularization index (VI), flow index (FI), vascularization‐flow index (VFI), and mean grayness. Comparisons of vascularity were made between ovulating, nonovulating, and hormonally suppressed ovaries. Normal ranges were established and graphed longitudinally. Results. Eighteen participants (36 ovaries) ages 28 to 45 years underwent an average of 10 examinations, yielding 368 acquired ovarian volumes for analysis. Seven participants used hormonal contraception. The VI, FI, and VFI were closely correlated (Pearson product moment correlation coefficients, 0.52–0.95). The vascular indices of ovulating ovaries were significantly higher than those of nonovulating ovaries (VI, FI, and VFI, all P < .001), with the largest discrepancies during the luteal phase. Hormonally suppressed ovaries had significantly lower vascularity throughout the cycle (VI, P < .002; FI, P < .001; VFI, P < .007). The vascular indices of all groups appeared to drop during the late follicular period and then rise again. Conclusions. The VI would suffice as the principal vascular parameter for 3D power Doppler analysis. Preovulatory scans may be more useful for distinguishing pathologic vascularization. Hormonally suppressed ovaries have significantly lower vascularity throughout the cycle. Normal‐appearing ovaries with vascular indices above the normal ranges established by these data may warrant further investigation.     

三维超声造影诊断宫腔镜分离术后合并重度宫腔粘连的价值

目的探讨三维超声造影（3D-CEUS）诊断宫腔镜下宫腔粘连分解术（TCRA）后重度宫腔粘连（SIUA）的价值。方法回顾性分析83例TCRA术后IUA患者临床资料,所有患者均行宫腔镜、经阴道二维三维超声检查、3D-CEUS检查,获得子宫内膜相关参数:子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数。以宫腔镜检查结果为准,分析3D-CEUS诊断TCRA术后SIUA的价值。结果本组TCRA术后确诊SIUA 36例,SIUA三维成像表现为宫腔形态异常、狭小、边缘不规则,内膜回声不连续等。经阴道三维超声诊断TCRA术后IUA分级准确率90.36%,与宫腔镜检查结果一致性较好（Kappa=0.795,P<0.05）。SIUA患者子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数低于中度组和轻度组（P<0.05）,二元Logistic回归分析子宫内膜厚度、容积、血管指数、血流指数、血管化血流指数与TCRA术后SIUA发生显著相关（P<0.05）。ROC结果显示,子宫内膜厚度、血管化血流指数鉴别SIUA的效能较高,曲线下面积分别为0.794、0.856,灵敏度为80.56%、74.47%,特异度为88.89%、82.98%。结论经阴道三维超声可清晰显示TCRA术后宫腔粘连程度和累及范围,为IUA分级提供可靠参考。3D-CEUS测量相关子宫内膜参数可作为SIUA诊断的定量指标。      

Carotid Stenosis Assessed With a 4‐Dimensional Semiautomated Doppler System

Objective. The purpose of this study was to compare peak systolic velocities (PSVs) and the degree of stenosis obtained with a real‐time 3‐dimensional (ie, 4‐dimensional) Doppler ultrasound scanner (Encore PV; VueSonix Sensors Inc, Wayne, PA) to conventional Doppler ultrasound imaging of the carotid arteries (common [CCA], internal [ICA], and external [ECA]). A secondary goal was to assess Encore volume flow measurements. Methods. Seventy patients referred for clinical carotid ultrasound participated in this pilot study. Peak systolic velocities of the CCA, ECA, and ICA were obtained bilaterally. The degree of stenosis in the ICA was calculated based on the ICA PSV and ICA/CCA PSV ratio. The Encore detects all 3‐dimensional blood flow velocity vectors within 10‐s longitudinal volumes of the ICA, ECA, and CCA. On the Encore, a reader determined the centerline of the vessels. The PSV and volume flow were then automatically calculated. The flow measurement error was obtained by comparing the CCA flow to the ICA and ECA flow. Data were compared using linear regression, intraclass correlation coefficients (ICCs), and Bland‐Altman analysis. Results. Due to technical difficulties, only 59 patients (323 vessel segments) were available for analysis. There was good agreement between methods for assessing the degree of stenosis based on the ICA PSV (ICC = 0.83; P < .0001) and, to a lesser degree, on the ICA/CCA PSV ratio (ICC = 0.65; P < .0001). Peak systolic velocity measurements obtained with conventional ultrasound and the Encore correlated in all vessels (r ≥ 0.32; P < .002), and Bland‐Altman analysis showed reasonable variations. The Encore mean volume flow error ± SD was ?4.1% ± 66.4% and was not biased (P = .57). Conclusions. A new semiautomated 4‐dimensional Doppler device is comparable to conventional Doppler ultrasound for assessment of carotid stenosis.     

Preexamination and postexamination assessment of parental-fetal bonding in patients undergoing 3-/4-dimensional obstetric ultrasonography.

OBJECTIVE: The purpose of this study was to determine whether there is a change in parental bonding and couples' attitudes toward their fetus after undergoing 3-/4-dimensional ultrasonography (3D/4DUS). METHODS: Sixty-five fathers and 124 mothers were asked to fill out a maternal-fetal attachment questionnaire relating to how they felt about their fetus before and after 3D/4DUS and to mark on a line indicating their feelings about the ultrasonography experience. In addition, 135 parents filled out a positive feelings questionnaire consisting of 5 sections assessing their feelings about the fetus. The 3D/4DUS examination included rendering of the fetal face, limbs, and thorax. RESULTS: One hundred forty-two patients filled out all questions and were analyzed for the total attachment score. The difference of the total score for the maternal-fetal attachment questionnaire before and after 3D/4DUS had a z value of 5.6 for all patients and was statistically significant (P < .0001). In analyzing each question, 5 were found to have a statistically significantly different score for women, but only 2 were found so for men. The scores for the line, before and after 3D/4DUS, showed a significant difference for men but not women. The women studied did not show a change using this instrument because their median response was at the maximum measurement before their sonograms. The positive feelings questionnaire showed a statistically significant change for women in all sections but for men in only 2. CONCLUSIONS: Parents have a change in attitude regarding their fetus after undergoing 3D/4DUS. Mothers showed an increase in bonding to their fetus after 3D/4DUS in more categories than fathers.     

Spatiotemporal Image Correlation Using High‐Definition Flow

Objective. The purpose of this study was to describe a new method for assessing ovarian vascularization using spatiotemporal image correlation (STIC)–high‐definition flow (HDF). Methods. Thirty healthy premenopausal fertile women were assessed in the follicular part of the menstrual cycle by transvaginal sonography. A 4‐dimensional STIC‐HDF volume was obtained from the nondominant ovary to assess 3‐dimensional (3D) vascular indices (vascularization index [VI] and flow index [FI]) during one cardiac cycle in each women. Using 1‐cm³ spherical sampling, we calculated the VI and FI from the most vascularized part of the ovarian stroma at two different moments of the cardiac cycle (systole and diastole). System settings were kept constant for all of the patients (pulse repetition frequency, 0.9 kHz; gain, 0.8; and depth, 40 mm). We calculated the VI and FI ratios between systole and diastole. Results. The mean VI during systole (11.485%; SD, 6.7%) was significantly higher than during diastole (8.653%; SD, 5.6%; P < .0001). The mean FI values during systole (47.799 [unitless]; SD, 5.8) and diastole (47.791; SD, 6.0) were nearly identical (P = .993). The VI ratio was 1.35 (95% confidence interval, 1.28–1.42), which means that the mean VI was 35% higher during systole compared to diastole, whereas the FI during systole and diastole remained constant (FI ratio, 1.00; 95% confidence interval, 0.96–1.04). There was a high correlation between VI values during systole and diastole (r² = 0.94), whereas this correlation was weaker for the FI (r² = 0.45). Conclusions. The STIC‐HDF method allows assessment of 3D vascular indices throughout the cardiac cycle. Vascularization index calculation is affected by the moment of the cardiac cycle during which the measurement is taken. However, it seems that FI calculation is not affected by the cardiac cycle in the normal nondominant ovary.     

Combinatorial therapy with three‐dimensionally cultured adipose‐derived stromal cells and self‐assembling peptides to enhance angiogenesis and preserve cardiac function in infarcted hearts

Even though stem cell therapy is a promising angiogenic strategy to treat ischaemic diseases, including myocardial infarction (MI), therapeutic efficacy is limited by low survival and retention of transplanted cells in ischaemic tissues. In addition, therapeutic angiogenesis depends on stimulating host angiogenesis with paracrine factors released by transplanted cells rather than on direct blood vessel formation by transplanted cells. In the present study, to overcome these limitations and to enhance the therapeutic efficacy of MI treatment, combinatorial therapy with three‐dimensional cell masses (3DCMs) and self‐assembling peptides (SAPs) was tested in a rat MI model. Spheroid‐type 3DCMs, which are vascular differentiation‐induced cells, were prepared by culturing human adipose‐derived stromal cells on a fibroblast growth factor‐immobilized surface. The SAPs were used as the carrier material to increase engraftment of transplanted cells. After coronary artery ligation, 3DCMs were combined with SAPs and were transplanted into ischaemic lesions. The therapeutic potential was evaluated 4 weeks after treatment. By combining 3DCMs and SAPs, survival and retention of transplanted cells increased threefold when compared with treatment with 3DCMs alone and transplanted cells established vascular networks in infarcted hearts. In addition, the size of the infarct in the 3DCM + SAP group was reduced to 6.09 ± 2.83% by the promotion of host angiogenesis and cardiac function was preserved, as demonstrated by a 54.25 ± 4.42% increase in the ejection fraction. This study indicates that combinatorial therapy with 3DCM and SAPs could be a promising strategy for therapeutic angiogenesis to treat MI. Copyright © 2016 John Wiley & Sons, Ltd.     

Three-dimensional volume sonographic study of fetal anatomy: intraobserver reproducibility and effect of examiner experience.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) sonography in assessing fetal anatomy and to determine the intraobserver reproducibility and the effect of examiner experience. METHODS: Three-dimensional volumes of the head, face, thorax, and abdomen were obtained for 40 fetuses. The volume data sets obtained were explored offline with multiplanar navigation and tomographic ultrasound imaging on a personal computer. Each case was examined twice by the same observer at least 3 months apart. The percentage for identification of fetal anatomic structures, 2-dimensional (2D) and 3D measurements, and the time spent on 2D and 3D examinations were calculated and compared. RESULTS: Ninety-two percent of fetal anatomic structures were identified with multiplanar navigation and tomographic ultrasound imaging. The genitals, the entry of the vena cava, and the ears were visualized in less than 70% of cases. Tomographic ultrasound imaging allowed viewing of 14 structures not seen in the multiplanar study. Intraobserver agreement for anatomic examinations was good (kappa = 0.78). Intraobserver agreement for fetal measurements showed differences between both examinations that approached 0 and intraclass correlation indices close to 0.9. The mean 2D scanning time +/- SD was 10.11 +/- 2.5 minutes, and the acquisition time for the 3D volumes was 1.54 +/- 0.35 minutes. The total time for the second 3D study was 7.23 +/- 1.17 minutes, significantly shorter than the 9.96 +/- 1.53 minutes spent on the first study (P < .001). CONCLUSIONS: Three-dimensional volumes are highly effective for complete fetal anatomic surveys. They show excellent intraobserver reproducibility and take less time to study as the examiner's experience increases.     

Three-dimensional ultrasonographic application for analyzing synovial hypertrophy of the knee in patients with osteoarthritis.

OBJECTIVE: The purpose of this study was to evaluate 3-dimensional (3D) ultrasonography for the visualization of intra-articular synovial hypertrophy in patients with osteoarthritis. METHODS: Knee joints of 22 patients with osteoarthritis were examined by 3D ultrasonography, and their synovial fluids were analyzed. Ultrasonographic image patterns, vascular endothelial growth factor and transforming growth factor beta concentrations in synovial fluid, and serum inflammatory markers were analyzed. RESULTS: It was possible to visualize the intra-articular structure by 3D ultrasonography. Three-dimensional ultrasonography revealed various interesting stereoscopic views of the synovial structures, and the patterns of synovial proliferation ranged from simple proliferations to complex shrubby structures. Patients with a more complex and proliferative pattern in the synovium tended to have higher C-reactive protein concentrations, but this difference was not significant (P = .09). The concentrations of vascular endothelial growth factor and transforming growth factor beta in synovial fluid were significantly higher in patients with complex hypertrophy (P < .05). CONCLUSIONS: Three-dimensional technology was useful in delineating the shape of the synovium. It may have a possible impact on future imaging in rheumatology.     

Two‐ and three‐dimensional prenatal sonographic diagnosis of prune‐belly syndrome

We report the prenatal diagnosis of 6 cases of Prune‐belly syndrome in the 2^nd trimester. The sonographic diagnosis was based on the findings of oligohydramnios, renal anomalies, and a lower abdominal cystic mass representing the abnormal dilatation of the bladder on conventional 2‐dimensional sonographic examination. We discuss the role of Doppler imaging and 3‐dimensional sonography as complementary methods to conventional sonography. Four of our 6 cases were confirmed with associated defects. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010     

Intraobserver and interobserver reproducibility of 3-dimensional power Doppler vascular indices in assessment of solid and cystic-solid adnexal masses.

OBJECTIVE: The purpose of this study was to assess the intraobserver and interobserver reproducibility of 3-dimensional (3D) power Doppler angiography-derived vascular indices in evaluation of vascularized solid and cystic-solid adnexal masses. METHODS: Stored 3D power Doppler angiographic volume data from 12 consecutive women with a diagnosis of a complex adnexal mass (6 cystic-solid and 6 solid) evaluated and treated at our institution were retrieved from our database for analysis. Two examiners performed the calculations blinded to each other. Calculations were performed offline in a computer using Virtual Organ Computer-Aided Analysis software (plane A, 9 degrees rotation step) to assess volume and vascularization (vascularization index, flow index, and vascularization-flow index) from solid areas within the tumor. In all cases, a definitive histologic diagnosis was obtained. Intraobserver and interobserver reproducibility was assessed by calculating the intraclass and interclass correlation coefficients for each index. RESULTS: All tumors proved to be malignant after surgical removal. Intraobserver reproducibility for both examiners and interobserver reproducibility were high for all indices (interclass correlation coefficient > 0.95). CONCLUSIONS: Three-dimensional power Doppler angiography is a reproducible technique for offline assessment of stored 3D volume data of vascularized adnexal masses.     

A new approach to fetal echocardiography: digital casts of the fetal cardiac chambers and great vessels for detection of congenital heart disease.

OBJECTIVE: The purpose of this study was to describe a method of 4-dimensional (4D) reconstruction of the cardiac chambers and outflow tracts using a combination of spatiotemporal image correlation, "inversion mode," and "B-flow" imaging. METHODS: Spatiotemporal image correlation and the inversion mode were used in the examination of the volume data sets of 23 fetuses with congenital heart anomalies. A subset was also examined with B-flow imaging using the gradient light algorithm. Digital reconstructions from abnormal hearts were compared with a library obtained from fetuses without abnormalities. RESULTS: Rendered images of the 4-chamber view using the inversion mode were characterized by: (1) echogenic chambers; (2) sharp delineation of chamber contours when compared with 2-dimensional (2D) images; and (3) distinct display of the myocardium, interventricular septum, interatrial septum, and mitral and tricuspid valves as anechoic structures. Ventricular septal defects, abnormal differential insertion of the atrioventricular valves, and valve atresia were well visualized with the inversion mode. The application of inversion mode or B-flow imaging to 4D rendering of the outflow tracts resulted in "digital casts" displaying the spatial relationships between the outflow tracts as well as the connections between the great arteries and ventricular chambers. The spatial relationships and communications among cardiac structures cannot be visualized with conventional 2D ultrasonography. CONCLUSIONS: The application of spatiotemporal image correlation, inversion mode, and B-flow imaging generates information about the anatomy and pathologic characteristics of the fetal heart (digital casts) that cannot be obtained with 2D fetal echocardiography. We propose that these modalities enhance the information provided by ultrasonographic interrogation of the fetal heart and will improve prenatal diagnosis.     

Stereoscopic evaluation of fetal bony structures.

OBJECTIVE: The purpose of this study was to assess the performance of stereoscopic compared with conventional viewing of 3-dimensional ultrasound (3DUS) data for evaluation of fetal bony structures. METHODS: A series of 47 human fetuses were evaluated with conventional 3DUS scanning systems. Twenty-five volumes of the fetal head, thorax, and abdomen were acquired. Volume-rendered images of the fetal cranium and spine were displayed interactively on a real-time stereoscopic graphics workstation. Visualization parameters were interactively optimized. Both conventional and stereoscopic images were evaluated for the clarity of structure visualization (0, nonvisualized; 1, nondiagnostic; 2, adequate; and 3, excellent), the ability to identify key anatomic landmarks (eg, sutures, palate, vertebrae, and ribs), artifacts, and evaluation time. RESULTS: Fetal bony structures, especially high-contrast structures, were readily identified with both conventional and stereoscopic. Overall, stereoscopic viewing provided a statistically significant improvement compared with conventional viewing (P < .01), improved conspicuity of complex bony structures, and added structural detail information that assisted in identification of complex anatomy in 14% of the fetal skull and 26% of the fetal spine cases. Overlapping structures were better identified on the volume-rendered stereoscopic display, with stereoscopic viewing improving differentiation of near and far structures. An interactive display and inclusion of a planar slice review further assisted in identification of structures. The evaluation times were comparable for the two methods. CONCLUSIONS: The stereoscopic display of rendered 3DUS data adds valuable information that assists in identification of fetal bony structures, such as cranial sutures and spinal vertebrae, particularly in complex formations. The increasing availability of stereoscopic visualization workstations will offer an additional tool for fetal diagnosis and evaluation.     

Two-dimensional and three-dimensional sonography of conjoined twins

PURPOSE: The aim of this study was to evaluate and compare the diagnostic capabilities of 2-dimensional (2D) and 3-dimensional (3D) sonography for the study of conjoined twins. METHODS: Four pregnant women with an initial 2D sonographic diagnosis of conjoined twins were examined with color Doppler sonography, 3D multiplanar sonography, and orthogonal plane imaging and 3D surface rendering. RESULTS: All 4 cases of conjoined twins were initially diagnosed with either transvaginal or transabdominal 2D sonography. 3D sonography afforded more realistic views and demonstrated more clearly the linking areas and surface anomalies, but 2D and color Doppler sonography provided more definitive and specific information about shared organs. CONCLUSIONS: Although 2D sonography is the primary modality for diagnosing and evaluating conjoined twins, color Doppler and 3D sonography can sometimes provide additional information that assists in the clinical management of these twins. 3D sonography also provides images that are easier for parents to understand, which can help them with decision making.     

Diagnosis of early intramural ectopic pregnancy

Intramural ectopic pregnancy is a very rare diagnosis. Establishing a diagnosis is difficult and is often made intraoperatively. Demonstration of a live extrauterine gestation is the only specific sign of such a pregnancy. A small number of ectopic pregnancies are interstitial or cornual pregnancies. Rupture of an intramural ectopic pregnancy is a serious clinical complication. Diagnosis of this ectopic pregnancy can sometimes be made using 2-dimensional transvaginal ultrasound (TVS), but it may also require 3-dimensional TVS. We present the case of a 25-year-old gravida 0, para 0 woman with amenorrhea lasting 6(+5) weeks. Previous surgery included a right adnexectomy for torsion of a right dermoid cyst. The patient's serum hCG was elevated. TVS provided a detailed view of the endometrial cavity. The results of 2-dimensional TVS suggested the presence of an ectopic pregnancy. The sonogram showed a gestational sac with an embryonic pole and a yolk sac, which was separated from the endometrium. Use of 3-dimensional TVS demonstrated a live embryo in a gestational sac surrounded by myometrium below the right cornu lying outside the endometrium. This finding was confirmed by laparotomy and the conceptus was excised. The patient had an uneventful postoperative course and was discharged 7 days after surgery. In our case, the previous adnexectomy was an identifiable risk factor. Nonetheless, making a diagnosis of an intramural pregnancy was challenging. Suspicion may arise when sonography has revealed an intramural gestational sac.     

Three-dimensional sonography of the endometrium and adjacent myometrium: preliminary observations.

OBJECTIVE: By evaluating a series of patients undergoing pelvic sonography with routine 2-dimensional (2D) as well as 3-dimensional (3D) reconstructed images in the coronal plane, we attempted to characterize the types of additional information that can be obtained. METHODS: Ninety randomly selected patients undergoing transvaginal pelvic sonography were imaged according to a standard 2D protocol. A 3D uterine volume was then acquired in the sagittal plane and reconstructed in the coronal plane. The endometrium and surrounding myometrium were evaluated for architecture, masses, the relationship of masses to the endometrial cavity, and the anatomic configuration of the cavity. RESULTS: Ninety-one studies were obtained. Additional findings were obtained on the coronal view in 28 studies (30.8%). No additional findings were obtained in 63 studies (69.2%). Normal endometrial and myometrial findings were obtained by conventional 2D imaging in 42 of 91 patients. Of this group, additional findings were shown in 2 (5%) patients. Forty-nine of the 91 patients had abnormal findings by 2D imaging. Additional information was obtained in 26 (53%) of these patients. Added information included uterine anomalies, better definition of the endometrium, more accurate delineation and location of endometrial polyps, location of leiomyomas, visualization of cystic areas within the myometrium, and confirmation of the location of intrauterine devices. CONCLUSIONS: The 3D reconstructed view of the endometrium and adjacent myometrium appears to be most helpful after a conventional transvaginal study, showing abnormalities within the endometrium and myometrium but being of little added benefit if the conventional findings are normal.