Uterine septum structure and reproductive performance: Role of 3D TVUS and MRI

Objective

To evaluate the role 3D TVUS and MRI in diagnosing the nature of uterine septum according to the reproductive performance with histopathological examination as the reference standard.

Patients and methods

The study included 36 patients in the reproductive age presented with infertility or recurrent pregnancy loss, and diagnosed hysteroscopically with double uterine cavity. All patients were subjected to 3D TVUS. Cases in which the diagnosis of septate uterus was not confirmed by 3DUS were excluded from the study. The remaining 29 patients confirmed to have uterine septum partial or complete were included. 3D TVUS with VOCAL, was applied in order to calculate the volume of the septum, echostructure and its vascularity index (VI). The patients were then referred to MRI examination, patients were referred to operative hysteroscopy for hysteroscopic metroplasty. Sample of septal tissue was obtained and sent for histopathological examination.

Results

The Vascularity index (VI) of the muscular septum (16.63 ± 5.7%) was significantly higher than the fibrous septum (3.6 ± 1.17%). The sensitivity, specificity, PPV, and NPV in diagnosing septate uterus were 100%, 90 %, 95%, and 100% for 3D TVUS, and 95%, 80%, 90%, and 89% for MRI respectively.

Conclusion

3D TVUS is an accurate, less expensive, and a rapid examination than MRI in diagnosing uterine septa structure, it can be considered as the reference standard in diagnosing and characterizing septate uterus.